Newly uncovered communications reveal that the Biden administration and Rachel Levine of Health and Human Services had an even greater role in removing age restrictions from guidance on the performance of sex change operations than previously known, with the Biden official personally meeting with the organization in charge of drafting the document, leading to concerns about political interference.

A recent report found that the staff of Levine, a man who identifies as a woman, was in contact with members of the World Professional Association for Transgender Health (WPATH), urging them to remove age restrictions from guidance on sex change operations. These new documents show that Levine was more involved than previously understood and personally met with WPATH leadership as he lobbied the organization.

“I just got off a very productive call with Rachel Levine,” Joshua Safer, the Executive Director of the Mount Sinai Center for Transgender Medicine and Surgery in New York, wrote in an August 12, 2021, email to WPATH staffers, including its Marci Bowers, who is currently the group’s president. “The failure of WPATH to be ready with SOC 8 is proving a barrier to optimal policy progress and she was eager to learn when SOC 8 might be published.”

“My view is that this should be taken as a charge from the United States government to do what is required to complete the project immediately,” Safer went on to say.

An August 19, 2021, email in which both the sender and recipient were redacted said, “I really want to push this agenda forward VERY STRONGLY. At the end of the day the SOC8 will significantly improve the lives of millions of trans people and their families globally. I am meeting with Rachel Levine and her team next week, as the US Department of Health is very keen to bring the trans health agenda forward. I want to make absolutely sure that the commitments we make on behalf of WPATH are real and achievable.”

On July 2, reacting to “Some feedback from a member of Adm Levine’s staff,” WPATH’s Walter Bouman found it “disturbing” to encounter political interference in what he viewed as a medical process. “Just read the email trail, which I found disturbing for a number of reasons…. It is not appropriate to take any feedback from a nonmedical professional seriously… if Washington does not want to launch the SOC8 we’ll do it in Brussels at the European Union.”

But six weeks later, Bouman seemed to make peace with it. On August 21, he wrote, “What was agreed in the past, may be obsolete in the present. We will discuss this in the Board and get back to you; and i will check what Rachel Levine’s point of view is on these issues.” Meanwhile, one WPATH Executive Committee Agenda includes the note, “Dr. Rachel Levine Meeting Update.”

Other emails show Levine’s staff pressuring WPATH to remove the guidelines, with one WPATH member asking for the minimum ages to be removed, lest they contribute to “devastating legislation for trans care.”

“She wonders if the specific ages can be taken out,” the email reads. Levine’s requests were met with some pushback from WPATH. “I am a little surprised that we would be asked to do this after all the care and endless discussions by experts to reach this consensus on ages for surgeries. Is Sarah a clinician or surgeon?” one member of WPATH wrote, referencing Levine’s then-chief of staff.

Despite some pushback, Levine and his staff successfully lobbied to remove age restrictions in the new guidelines, with WPATH directly crediting their removal to Levine’s efforts. On August 5, 2022, an email from WPATH, apparently to Levine’s office, said, “It was a pleasure to meet with you and your staff on Tuesday 26 July to discuss the SOC8. We appreciate your constructive comments and are fully aware how certain aspects of the SOC8 will affect the lives of many TGD people and their families in the US. More specifically we heard your comments regarding the minimal age criteria… Consequently, we have made changes to the SOC8 in this respect… They are now not a recommendation from the SOC-8 anymore, but they have been written only as suggested minimal ages.”

An email suggested that Levine’s actions to influence WPATH were designed to prevent negative media coverage.

“It doesn’t give them the headline. Less direct focus on age. I mean, we have a very high up politician telling us that having the ages specified front and center would politically lead to more attacks and legislative efforts,” a WPATH committee co-lead wrote.

But the change was just window dressing as they planned to move the ages to an “appendix” where they would be less “obvious.”

“We’re still recommending medical interventions for minors,” one comment said.