Beth Ann Rosica: CHOP or politics? Hospital’s loyalty to Levine and WPATH tops medical caution on child transitions

Earlier this month, the U.S. Department of Health and Human Services (HHS) issued a report on pediatric gender dysphoria and concluded there is little to no evidence to support “gender-affirming care”  — interventions designed to support children and adolescents who believe their gender identity differs from their biology.

This report is strikingly similar to the Cass Review which was commissioned by the National Health Service in England and published a little over a year ago. As a result of that publication, many European countries stopped or significantly limited these services for children.

Meanwhile, the battle over gender affirming care in the U.S. continues to rage, and the HHS report reveals some of the political maneuvering and motivations behind practices and policies.

The debate is front and center in Pennsylvania where some health systems have terminated gender affirming care while others locally have not.  

UPMC and Penn State Health stopped services to children only after threats of losing federal and state funding; however, in the Philadelphia region, gender affirming care is still provided to minors.

Children’s Hospital of Pennsylvania (CHOP) and Hospital of the University of Pennsylvania (HUP) are the largest providers of these services and continue to perform sex reassignment surgeries and prescribe hormones and puberty blockers to children.

Questions remain as to why CHOP and HUP have not stopped these interventions on children that are at the least questionable and at the worst harmful and irreversible.

Neither organization returned a request for comment; however, answers might be found in the comprehensive HHS report that examines the political bias and strident advocacy of the World Professional Association for Transgender Health (WPATH) Standards of Care.

Founded in 1979, WPATH claims to “promote evidence based care, education, research, public policy, and respect in transgender health.” Yet, neither HHS nor the Cass Review found their standards supported in solid research. This is alarming as the WPATH Standards of Care 8 (SOC-8) serve by default as widely accepted guidelines because there is not an accredited gender medicine subspeciality. For example, the American Board of Medical Specialities lists twenty pediatric subspecialty certificates in areas of cardiology, dermatology, etc., but none in gender medicine.

SOC-8 are utilized for a vast array of purposes, including clinical guidelines for medical and mental health practitioners, a tool to secure insurance coverage, and a legal instrument to promote broad access to pediatric medical transition. Additionally, unlike other medical professional organizations, WPATH membership and voting rights are not limited to doctors, nor does the organization strive for balanced perspectives. All members are “advocates” of gender-affirming care.

SOC-8 was revised in 2022 and for the first time ever, included an “Adolescent” chapter. According to HHS, there were internal discussions about minimum age requirements for pediatric interventions.

“Initially, SOC-8 included age minimums for certain interventions: 14 years for cross-sex hormones; 15 years for mastectomy; 16 years for breast augmentation and facial surgery; 17 years for metoidioplasty, orchiectomy, vaginoplasty, hysterectomy, and fronto-orbital remodeling; and 18 years for phalloplasty.” (page 175)

The report claims the minimum requirements were removed because of “significant pressure” from Rachel Levine, then-U.S. Assistant Secretary for Health and former Pennsylvania Secretary of Health.

“In July 2022, WPATH faced significant pressure from Admiral Rachel Levine, the U.S. assistant secretary for health, whose office communicated concern that listing specific, minor ages would trigger restrictive legislative actions.”

Levine, a transgender woman, who transitioned in her forties after fathering two children, pressed WPATH to remove age minimums for political reasons. It is ironic that Levine was unconcerned about adolescents making life-altering decisions that likely lead to sterilization when she had the opportunity to father her own children. Had she transitioned as an adolescent, that option may not have been available to her.

Levine’s political manipulations worked because WPATH changed the age minimums from “recommendations” to “suggestions” despite ethical issues, and while some members “expressed discomfort about acceding to pressure from the federal government,” they ultimately agreed.

While Levine’s actions appear unethical, they are not surprising given her advocacy for pediatric medical transition. CHOP’s Gender and Sexuality Clinic and Levine have a history dating back to her tenure as the state’s Physician General and Secretary of Health.

Levine and then-Governor Wolf were big supporters of CHOP’s Gender and Sexuality Clinic. In 2017, one of the co-founders of the CHOP clinic, Dr. Linda Hawkins, was invited by Wolf to the Governor’s residence for an event where Levine was in attendance.

In 2022, the clinic’s other co-founder, Dr. Nadia Dowshen, gave a presentation highlighting the importance of insurance coverage for puberty blockers, rationalizing that preventing a young woman from developing breasts during puberty could eliminate the need for a mastectomy later in life. Dowshen praised Levine as a “really wonderful advocate” who “has been doing amazing work to make sure young people have coverage of these medications.”

The downgrading of minimum age requirements as a direct result of Levine’s meddling is just one example of the conflicts of interest at play during the writing of SOC-8. Most of the people involved in the process prescribed and recommended the treatments and surgeries. They had a vested interest in ensuring their patients continued to have access to the interventions.

WPATH redefined the term “medical necessity” from a patient “wishing these treatments” to people “in need of these treatments.” SOC-8 also gives explicit instructions for providers to use an “Endocrine Disorder” diagnosis as an alternative for the mental health diagnosis of “Gender Dysphoria” to secure insurance payment.

“Internal documents reveal that SOC-8 authors manipulated guideline language with the explicit aim of shaping court rulings, legislative actions, and insurance coverage decisions, revealing a clear departure from the principles of unbiased, evidence-driven clinical guideline development.” (page 175)

These decisions are consistent with Levine’s advocacy for access to and insurance payment of gender affirming care. Her influence in this field as a transgender person and political appointee cannot be understated.

For example, the American Academy of Pediatrics, taking Levine’s lead, pushed back on any age suggestions and threatened to publicly oppose SOC-8 unless any reference to age was eliminated.

“Under pressure and facing open opposition from a key ally, WPATH leaders capitulated and agreed to eliminate minimum age criteria for all hormonal and surgical procedures (except phalloplasty).” (page 179)

According to HHS, the only medical association to issue a statement against WPATH is the American Society of Plastic Surgeons. Twenty-two other medical associations have stated in writing that SOC-8 is an evidence-based clinical guideline.

Once Levine set the agenda as a politically appointed transgender woman, all but one medical association followed her lead; therefore, it is feasible CHOP is doing the same, especially given their long-standing history.

Under the Biden administration, “politically correct” elevated to unforeseen heights, so much so that to contradict or merely question a transgender person who is also a high-ranking official would have been unfathomable.

As of now, it appears the Philadelphia-based health systems are neither fearful of losing funding nor concerned about harming children. What remains unknown is why. Perhaps, despite all the evidence to the contrary, the organizations believe they are on moral high ground. Or maybe, they are fearful of abandoning Levine, their hero and champion.

Regardless of the reasons, it is time for CHOP and HUP to admit to their mistakes and live up to the Hippocratic Oath to “do no harm.” When researchers on two continents conduct similar analyses and reach the same conclusions about the irreparable harm gender-affirming care is causing, it’s not a coincidence.

Let’s stop using these vulnerable children as pawns in a political game and get them the mental health support they actually need.

Beth Ann Rosica resides in West Chester, has a Ph.D. in Education, and has dedicated her career to advocating on behalf of at-risk children and families. She covers education issues for Broad + Liberty. Contact her at barosica@broadandliberty.com.