Federal pressure on private parties to squelch challenges to Biden administration narratives, tacitly tolerated by the Supreme Court in a decision last month making it harder for social media users to sue public officials, goes beyond COVID-19, elections and Hunter Biden's laptop. 

It also includes how to treat children with so-called "gender confusion," as revealed by legal discovery in a lawsuit challenging Alabama's ban on puberty blockers and cross-sex hormones for those under 19 – what supporters call gender-affirming care, which also includes surgical removal of healthy breasts and genitals.

A YouGov poll last month found most Americans agree with presumptive Republican presidential nominee Donald Trump's position on the issue – banning "hormonal or surgical treatment for transgender minors" – while fewer than one-third back President Biden's opposition.

Unlike the murky role played by then-National Institutes of Allergy and Infectious Diseases Director Dr. Anthony Fauci in virus researchers suddenly changing their minds about SARS-CoV-2's origin, Assistant Secretary for Health Rachel Levine's demands heavily influenced a transgender health group's last-minute decision to lower its standards for minors.

Also influential was the American Academy of Pediatrics' threat to the World Professional Association for Transgender Health to oppose the eighth version of WPATH's Standards of Care, which are widely relied upon globally by gender clinics, healthcare providers and insurers, if the final version of SOC 8 kept the age minimums in the draft.

The two organizations closely collaborate, according to emails between their leadership obtained by The Daily Caller News Foundation through a public records request to West Virginia University, which employs a WPATH U.S. affiliate board member and AAP Committee on State Government Affairs member.

While scientists on the Feb. 1, 2020 conference call with Fauci had a potential personal interest in discrediting the COVID lab-leak theory – Fauci's discretion over NIAID research grants – communications between staff for Levine and WPATH don't suggest the latter feared financial retribution from Levine.

Rather, the most senior transgender official in the U.S. government was bearing down on WPATH to finish SOC 8 and ditch the draft's age minimums of 14-17 for various hormonal and surgical procedures including castration and mastectomy.

This is despite WPATH members swapping stories on its internal discussion forum about young patients or colleagues developing life-threatening medical conditions or even dying after years of treatment – more serious than the sexual dysfunction and developmental problems already reflected in research and even federal guidance on gender-affirming care.

While WPATH President Marci Bowers, also transgender, told The New York Times that the "political climate" prevented WPATH from approving age minimums when SOC 8 came out nearly two years ago, Levine's role was not previously known.

"The failure of WPATH to be ready with SOC 8 is proving a barrier to optimal policy progress" and Levine is "eager to learn when SOC 8 might be published," a WPATH staffer told colleagues in redacted communications cited by Canadian sexologist James Cantor in his newly unsealed "expert report" for the defendants in Boe v. Marshall, the lawsuit challenging Alabama's ban.

"[T]his should be taken as a charge from the United States government to do what is required to complete the project immediately," wrote the staffer, whose name was redacted.

Levine's chief of staff, Sarah Boateng, also conveyed to WPATH, according to the latter's staff, that the "biggest concern" for the Department of Health and Human Services leader was "specific minimum ages" in the draft adolescent chapter of SOC 8, which Levine is "confident  ... will result in devastating legislation for trans care." 

Levine asked whether WPATH could create "an adjunct document ... that is published or distributed in a way that is less visible than the SOC8," the staffer says Boateng conveyed, apparently referring to age guidance.

The official was "mainly" worried how surgery age minimums "will affect access to health care for trans youth and maybe adults too," according to a WPATH staffer who appears to be outside the U.S. "Apparently the situation in the USA is terrible," Levine and the administration worry minimums "will make matters worse" and Levine "asked us to remove them."

The WPATH executive committee "explained to her [Levine] that we could not just remove them at this stage," one internal communication says, but the next one in Cantor's expert report – phrased as WPATH's response to Levine's office – says "we have made changes as to how the minimal ages are presented in the documents" while being unable to remove them entirely.

The changes bewildered SOC 8 committee members, Cantor's report shows. 

"I don’t see how we can simply remove something that important from the document … at this final stage of the game," one said, without completing the requisite "Delphi process" in which 75% of guidelines committee members must agree with recommendation statements.

Another described "the most strange experience" of seeing minimums removed at the "last minute," because "nobody wanted to make" those changes.

The unsealed documents were flagged June 25 by independent science journalist Jesse Singal, who said they give a "potential explanation" for why "until late in the game the document [SOC 8] did have age minimums until, suddenly, it did not."

A day earlier, Manhattan Institute fellow in gender medicine Leor Sapir posted snippets from Cantor's report pertaining to WPATH committee members' view of AAP, which had threatened to oppose SOC 8 with age minimums, and its role in the document's development.

They mocked AAP's understanding of gender identity and grasp of scientific research, saying AAP's own guidelines "have a very weak methodology, written by [a] few friends who think the same," its comments on SOC 8 are "thin on scientific evidence" and its representatives are "very junior clinicians."

The disclosure of Levine's influence spooked the Biden administration such that the White House told The New York Times on Friday it opposes such surgery for minors despite HHS's Office of Population Affairs approving it "case-by-case in adolescence." Becker's Hospital Review said this is the first time the administration frowned on a gender-affirming procedure.

HHS told the Times that Levine objected to surgery age minimums based on "her view" they were "not supported by science or research," but Levine's staff didn't mention science or research in the communications cited in Cantor's expert report.

Lawyers for the families challenging the Alabama ban, which resembles European restrictions on the procedures, already shot themselves in the foot through perceived "judge-shopping" to avoid a President Trump appointee who favored them.

AL.com reported the lawyers dismissed two lawsuits after they were consolidated and randomly assigned to U.S. District Judge Liles Burke, then refiled one that was again assigned by Burke, who blocked the law before the 11th U.S. Circuit Court of Appeals overruled him.

"Of course, the irony here is that counsel ultimately succeeded before Judge Burke," a three-judge panel convened to investigate Burke's allegations wrote in a report last fall, determining that several lawyers "intentionally attempted to direct their cases to a judge they considered favorable and, in particular, to avoid Judge Burke."

Lawyers Melody Eagan and Jeffrey Doss apologized to Burke at a hearing Friday on the alleged misconduct, claiming they weren't familiar with routine transfer procedures among judges, AL.com reported. "Our sensitivities were heightened with the nature" of the case, Eagan said.

The judge, who has yet to rule on possible sanctions, didn't buy lawyer Kathleen Hartnett's explanation for dropping the consolidated case on a Friday night, right after Burke scheduled a status conference for the following Monday: no one could make it.

There were 21 lawyers representing the plaintiffs, the judge said, according to Alabama Reflector: "This is something someone two days out of law school could have attended."