EXCLUSIVE – A key Republican senator is increasing the pressure on medical associations that are still advocating surgical procedures for youth with gender dysphoria in light of the Trump administration’s efforts to ban such treatment for those under 19.

Health, Education, Labor and Pensions Committee chairman Bill Cassidy (R-LA) on Tuesday sent a letter, obtained by the Washington Examiner, to the president of the World Professional Association for Transgender Health regarding the organization’s continued advocacy for so-called “gender-affirming” procedures, including double mastectomy and vaginoplasty.

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“WPATH continues to advocate for irreversible gender transition procedures for children despite weak scientific research on the effects,” said Cassidy in a statement. “Americans and their health care providers deserve to know that treatment guidelines, especially for children, reflect the best scientific evidence available and are not influenced by extreme ideology.” 

President Donald Trump issued an executive order in January directing the Secretary of Health and Human Services to “take all appropriate actions to end the chemical and surgical mutilation of children,” meaning surgical and hormonal treatments for treating gender dysphoria in minors. 

The order was quickly blocked by the courts, but HHS has carried forward with clinically and financially dissuading medical professionals from providing transgender procedures to minors, regardless of guidance from WPATH or other medical organizations. 

On March 5, the Centers for Medicare and Medicaid Services issued guidance to hospital providers and other healthcare entities, claiming that gender procedures for minors proliferated based on “an underdeveloped body of evidence,” adding that these treatments are “now known to cause long-term and irreparable harm to some children.”

“The [United States] is now an outlier in the treatment of gender dysphoria in children,” reads the CMS guidance. “The United Kingdom, Sweden, and Finland have recently issued restrictions on the medical interventions for children, including the use of puberty blockers and hormone treatments, and now recommend exploratory psychotherapy as a first line of treatment.”

Shortly after issuing the CMS guidance, the Trump administration announced it would be reviewing $367.2 million in grant funding awarded in fiscal 2024 to 59 children’s hospitals across the country in the light of updated medical guidance for trans-identified minors. 

Cassidy wrote to WPATH President Dr. Asa Radix that “the ground has shifted significantly for providers” since the Trump administration took over.

“It is critical that medical standards of care for the treatment of children reflect the best scientific evidence available at present, consistent with current regulatory requirements for providers,” Cassidy wrote. “Providers may be confused by the conflicting provisions of [WPATH’s standards of care] in that regard, as they seek to comply with applicable federal rules and guidelines.”

WPATH did not respond to the Washington Examiner’s request for comment on Cassidy’s letter.

In October, Cassidy launched an investigation into the development of standards of care for trans-identified youth from WPATH, the Endocrine Society, and the American Academy of Pediatrics, all of which at the time supported both hormonal and surgical interventions to treat gender dysphoria in minors. 

Cassidy’s new letter to Radix indicates that the organization did not respond to several of the committee’s questions, including about partnerships with academic institutions and research on adolescents undergoing gender transition that helped develop their standards of care guidelines. 

According to Cassidy, Senate Health Committee staff and WPATH’s outside counsel met in mid-February to discuss the medical organization’s guidance in light of the Trump executive order, but WPATH representatives said there were no plans to change the guidelines.

Last year, email exchanges between top Biden administration HHS officials and WPATH staff revealed that the chief of staff for former Assistant HHS Secretary Rachel Levine pressured WPATH members to remove age recommendations for gender transition surgeries. 

Levine underwent a male-to-female gender transition in the 2010s.

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More than 20 states since 2021 have implemented some form of age restriction or outright prohibition of gender transition surgical procedures for minors.

According to the medical advocacy group Do No Harm, which is against gender transition medical procedures for minors, nearly 14,000 minors nationwide underwent sex change treatments, including more than 5,700 undergoing surgical procedures.