Sen. Rand Paul, R-Ky., compared gender-affirming surgery to “genital mutilation” during confirmation hearings Thursday for Dr. Rachel Levine, President Joe Biden’s nominee for assistant secretary of health.
If approved, Levine will become the first openly transgender federal official to be confirmed by the U.S. Senate.
Paul, a former ophthalmologist, was questioning Levine about transition-related care for transgender youth when he said that “genital mutilation is considered particularly egregious because ... it is nearly always carried out on minors and is a violation of the rights of children.”
Erroneously claiming that Levine supports “surgical destruction of a minor’s genitalia,” Paul asked Levine if she believed minors are capable of making “such a life-changing decision as changing one’s sex?”
Levine, a pediatrician, responded that transgender medicine is “a very complex and nuanced field with robust research and standards of care that have been developed,” and promised to discuss specifics if she is confirmed.
Paul continued his line of questioning, asking if she supports permitting the government to override a parent’s consent to give a child puberty blockers, cross-sex hormones and “amputation surgery of breasts and genitalia.” Levine provided a similar response, leading Paul to accuse her of evading the question.
He further questioned criticism of prescribing hydroxychloroquine to treat Covid-19 by the same people who support hormones for transgender teenagers.
Dr. Colt Wasserman, a fellow with Physicians for Reproductive Health, who provides gender-affirming care to trans minors, told NBC News that Paul’s questions and concerns are “not based in medical fact whatsoever.”
Wasserman said gender-affirming care is understood and supported by major medical associations and physicians “to be a life-affirming practice that, through an informed consent process, patients, parents and their providers come together to support gender-diverse youth in the medical environment in a wide range of ways, which typically doesn't involve any kind of procedural intervention.”
“There's a lot of concern about surgery or irreversible decisions,” when it comes to the health care that transgender youth receive, Wasserman added, but surgery is not a component of that care.
The World Professional Association for Transgender Health states in its Standards of Care regarding transgender adolescents that surgery “should not be carried out until (i) patients reach the legal age of majority in a given country, and (ii) patients have lived continuously for at least 12 months in the gender role that is congruent with their gender identity.” The standards add, “The age threshold should be seen as a minimum criterion and not an indication in and of itself for active intervention.” The legal age of majority is at least 18 across the U.S.
Duke Health’s Center for Gender Care for Children and Adolescents, for example, will offer children under 16 therapies to delay puberty and provide hormone replacement therapy for those 16 and older.
“During this time, your child must meet with their local therapist weekly to manage the emotional changes that happen during hormone therapy,” according to the clinic’s website.
Access to gender-affirming care has also been found to have a positive impact on the mental health of trans young people. A study published in January 2020 found that transgender people who used puberty blockers had lower rates of suicidal thoughts as adults when compared to trans people who couldn’t access them.
Rodrigo Heng-Lehtinen, deputy executive director of the National Center for Transgender Equality, said Paul’s language was hurtful to Levine and all the trans people watching her hearing.
“There is a lot of misinformation out there about health care for transgender young people, in particular, but what's really important to know is that all of the leading medical institutions have researched this and really recognize that it's primary care,” Heng-Lehtinen said. “It's different for every trans young person, just because any kind of medical care is different for any kind of individual patient, so it's personalized, but this is legitimate health care.”
Heng-Lehtinen cited the American Medical Association, the American Psychological Association and the American Academy of Pediatrics as medical organizations that support the rights of transgender adolescents to receive appropriate care with the support of providers and parents.
LGBTQ rights advocates swiftly condemned Paul’s comments and praised Levine’s testimony.
“While Rand Paul is a doctor, his own history makes it clear that he has no respect for science or medicine,” Pennsylvania state Rep. Brian Sims, a Democrat and longtime Levine ally, told NBC News.
Sims, who is gay and recently announced his bid for lieutenant governor, called Levine “a world-class public-health expert.”
“While I remain excited about what Dr. Levine's selection by President Biden means for her and the LGBTQ+ communities, I'm even more excited about what it means for the country."
Later in Thursday’s hearings, Sen. Patty Murray, D-Wash., chair of the Senate health committee, called Paul’s remarks “ideological and harmful misrepresentations.”
But the American Principles Project, a conservative lobbying group that opposes gay marriage, transgender rights and abortion, defended Paul’s “immense courage” in challenging Levine.
“It is important that the American people are aware of just how extreme Joe Biden’s nominees are and what they are likely to support as members of his administration,” the group’s executive director, Terry Schilling, said in a statement. “Dr. Levine’s radical ideology ought to be a disqualifier for any position at HHS, never mind one as important as assistant secretary for health, and we urge the Senate to reject this confirmation when it comes up for a vote.”
Levine was most recently Pennsylvania's secretary of health, and helped steer the commonwealth's coronavirus response. She received high marks for remaining what The Pittsburgh Post-Gazette called “the calm in the eye of the Covid-19 storm.” She was, however, criticized for her policy of returning nursing home residents who had been treated for Covid-19 in hospitals back to their facilities.
She is also no stranger to transphobic attacks from conservatives. For example, in a Jan. 19 article about her nomination, the far-right media outlet Breitbart misgendered and deadnamed Levine repeatedly. (Deadnaming refers to using a transgender person’s former name.)
Shortly after the nomination, Pennsylvania state Rep. Jeff Pyle posted a picture on Facebook mocking Levine’s appearance. After widespread criticism, Pyle, a Republican, deactivated his Facebook page and claimed that he had “no idea” the post “would be ... received as poorly as it was,” The Associated Press reported.
Levine is the first trans person to be nominated for a Senate-confirmed position, and “whenever you're the first trans person, a target gets put on your back,” Heng-Lehtinen said.
“My heart really goes out to her for having to endure those attacks, and I'm grateful that she is so skilled at navigating it as she is, but she shouldn't have to do that,” he said. “For Senator Paul to kind of blurt out these myths and misconceptions about trans people and try to use that against her, I think really shows how much transphobia is still out there. So as historic as it is for a trans person to be able to be up in front of the Senate, and that's an important first step, it also reveals just how far we have to go.”
Paul’s questions come at the end of a long week for LGBTQ advocates. The House debated and passed the Equality Act on Thursday, and multiple states, including South Carolina and Utah, held hearings on bills that would ban transgender athletes from competing in school sports.
Nat Mulkey, a transgender medical student at Boston University who uses gender-neutral pronouns, said they had the privilege of being able to step away from the news “when it feels personally attacking and harmful,” but that not every trans person does. Mulkey said Paul’s language would negatively affect trans young people.
“It's not a hyperbole, or an overstatement to say that it is deadly,” Mulkey said of the senator’s language. They said allowing young trans people an “authentic and private experience with their doctor to discuss these issues and not have the invalidation at such a national level is so important to fostering their health and their lives in general.”
The Senate Committee on Health, Education, Labor and Pensions must vote on whether to recommend Levine’s nomination to the full Senate. It is not yet known when that vote will happen.