The federal government engaged in a stunning deception by secretly shaping a medical association’s transgender policy for political aims — then arguing in court that red states were not allowed to diverge from that policy, because it would be putting politics over scientific expertise.

The findings could deal a crippling blow to the Biden administration’s efforts to stop Republican-led states from banning the genital mutilation of children, and prove embarrassing for the judges — including an appointee of Donald Trump — who appeared to accept the argument that medical associations are above politics and should be deferred to by red-state politicians.

The Biden administration sued states including Tennessee, Alabama, and Kentucky, with transgender guidance from the World Professional Association for Transgender Health (WPATH) as its key piece of evidence. But the documents obtained via discovery in an Alabama lawsuit show that, in fact, the WPATH guidance was crafted in close collaboration with the Biden administration specifically with an eye to influence such lawsuits and block legislation.

Rachel Levine, a transgender Biden political appointee in the Department of Health and Human Services, pressured WPATH not to recommend that gender surgeries be limited to a specific age, fearing that spelling out the age — which would be low — would make it easy for citizens to object to them as radical and lead to a backlash.

“She liked the SOC-8 very much but she was very concerned that having ages (mainly for surgery) will affect access to health care for trans youth and maybe adults too. Apparently the situation In the USA is terrible and she and the Biden administration worried that having ages in the document will make matters worse. She asked us to remove them,” a WPATH email said.

WPATH complied, with officials noting that they were still suggesting surgeries for minors, just making it more difficult to get a “headline” out of it by obscuring it.

Some in WPATH chafed at letting politics govern a medical document, with one noting that it was a “global document” that should not be contorted for one country’s politics and saying, “I am a little surprised that we would be asked to do this after all the care and endless discussion by experts to reach this consensus on ages for surgeries.”

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“I’m concerned about the headline: SOC 8 changes at last minute at request of USA official,” one wrote. Another said: “It is frustrating to have to have politics in our brains as we make these decisions. But it is what it is!”

After Tennessee state lawmakers voted to ban the gender conversion of minors, private individuals sued the state in federal court, and the Biden administration intervened, taking their side. The administration argued that “Standards of care for treating transgender youth diagnosed with gender dysphoria have been published by several well-established medical organizations, including the World Professional Association for Transgender Health” and, “The standards of care published by these organizations provide a framework that is based on the best available science and clinical experience.” Of 60 footnotes, eight cite directly to WPATH.

Judge Eli Richardson, a Trump appointee hearing the case in the Middle District of Tennessee, relied on WPATH’s SOC to block enforcement of the law, saying that the state only has a compelling interest in banning something if it is harmful, and WPATH says transgender procedures are safe.

“WPATH is the leading association of medical and mental health professionals in the treatment of transgender individuals. … The guidelines are based on scientific research and clinical experience,” he wrote. “The Court thus evaluates Defendants’ evidence in light of the prevailing standards of care and conclusions contained in the WPATH and Endocrine Society guidelines.”

Tennessee argued that children may regret not being able to procreate as a result of their gender surgeries, but Richardson relied on WPATH, writing, “Indeed, the WPATH guidelines explain that ‘there is evidence that fertility is still possible for individuals taking estrogen and testosterone…’ The Court is therefore not convinced that possible negative impacts on fertility warrant an outright ban on procedures used to treat gender dysphoria in minors.”

He noted that he is not the only judge who has made law based on the SOC, saying, “The Court finds further support for its reliance on information contained in the guidelines in the fact that several courts in cases similar to this have relied on these guidelines.”

Tennessee lawmakers similarly explained, as an example of harms averted by a ban, that people undergoing gender surgery are often unable to have sexual function, but Richardson said that the WPATH guidelines say that “gender affirming care can help [transgender individuals] improve their sexual function and increase their sexual pleasure and satisfaction.” (Richardson might have been embarrassed to know that in leaked documents, WPATH President Marci Bowers said she had never seen a single boy whose puberty was blocked achieve orgasm as a transgender woman.)

Richardson’s ruling was ultimately overturned by an appeals court. But the Supreme Court has agreed to take up the Tennessee case, a move that the DOJ is attempting to use to stall a similar ban in Alabama, where a lawsuit resulted in the unearthing of the WPATH documents.

Stanley Goldfarb, a longtime professor of medicine and chairman of Do No Harm, a group that opposes injecting leftist politics into medicine, told The Daily Wire, “It is shameful and wrong that Levine and allies manufactured the outcome they needed to corner politicians into endorsing dangerous and experimental medical treatments for children” and “used the power of the federal government to bully WPATH into disguising bad politics as independent, evidence-based science.”

Attorneys general in the conservative states argued that WPATH standards were based on flimsy science. The emails obtained in discovery in the Alabama case showed that WPATH members themselves agreed.

One reason some members were willing to give into Levine’s demands to remove recommended ages for surgery was because, they acknowledged, there was little medical evidence supporting WPATH’s recommendations in the first place. “I’m concerned about the headline: SOC 8 changes at last minute at request of USA official. The one reason I might be ok changing is we don’t have exact data/studies in recommending the ages,” one WPATH member said. “I do wonder how they will be defended in court cases, but it should be done.”

Jon Arcelus Alonso, the co-chair of the SOC initiative, chided WPATH President Marci Bowers for internally acknowledging that the group’s recommendations were often based on scant scientific evidence. Instead, Bowers said they were based on the “consensus” of members. “In the last few days I have heard from Marci that the ages don’t have any scientific backup. Our guidelines are not only evidence based but they are primarily consensus based. There are many recommendations in the SOC that don’t have direct evidence,” he wrote.

He urged WPATH to confidently profess to be the embodiment of medical science regardless. “We need to believe that we are the experts and we know what we are saying and no being shaken by others,” he added.

Another WPATH member dismissed the need for scientific precision, writing, “My hope with these SoC is that they land in such a way as to have serious effect in the law and policy settings that have affected us so much recently; even if the wording isn’t quite correct for people who have the background you and I have.”

Meanwhile, Loren Schechter, an expert witness in some of the lawsuits who was involved in WPATH, advocated for removing language in which the group characterized how strong the scientific evidence was for each of its statements.

“I am concerned about language such as ‘insufficient evidence,’ ‘limited data,’ etc… I say this from the perspective of current legal challenges in the US. Groups in the US are trying to claim that gender-affirming interventions are experimental and should only be performed under research protocols (this is based on two recent federal cases in which I am an expert witness). In addition, these groups already assert that research in this field is low quality (ie small series, retrospective, no controls, etc…). My specific concern is that this type of language (insufficient evidence, limited data, etc…) will empower these groups,” she wrote.