Sen. Rand Paul Questions HHS Nominee Rachel Levine On Ability of Minors to Consent to Medical Transition

Joe Biden recently nominated Dr. Rachel Levine, the former secretary of health for Pennsylvania, to serve as assistant secretary of health. During Dr. Levine’s Senate confirmation hearing on February 25, Sen. Rand Paul (R., Kentucky) asked Dr. Levine about the ability of minors to consent, specifically, to “puberty blockers,” cross-sex hormones, and surgery. As the Mayo Clinic notes, “puberty blockers” and cross-sex hormones cause changes to a person’s genitalia. Sen. Paul began his line of questioning by stating the following:

“Genital mutilation has been nearly universally condemned. Genital mutilation has been condemned by the WHO, United Nations Childrens Fund, [and the] United Nations population fund. According to the WHO, genital mutilation is recognized internationally as a violation of human rights. Genital mutilation is considered particularly egregious because, as the WHO notes, it is nearly always carried out on children and it is a violation of the rights of children.”

Sen. Paul went on to explain that “[m]ost genital mutilation is not typically performed by force, but as [the] WHO notes… by social convention, social norm, the social pressure to conform, to do what others do and have been doing, as well as the need to be accepted socially.” Sen. Paul notes that American institutions are increasingly permitting the prescription of “puberty blockers” and cross-sex hormones to minors.

Sen. Paul further noted that this is despite the fact that “hormonal interruption of puberty can permanently alter and prevent secondary sexual characteristics.” Further, Sen. Paul notes that a reported 80-90% of pre-pubertal, gender-dysphoric children will desist in their dysphoria by late adolescence, so long as they are not subjected to medical intervention or the affirmative model of care. 

For this reason, Sen. Paul asked Dr. Levine the following question: “[D]o you believe minors are capable of making such a life changing decision as changing their sex?” Dr. Levine responded that “transgender medicine is a very complex and nuanced field with robust research and standards of care that have been developed…” Sen. Paul then accused Dr. Levine of avoiding the question.

Sen. Paul went on to discuss the recent Keira Bell case in the United Kingdom (U.K.). Keira Bell is a 23-year-old woman who transitioned at the age of 16 in the U.K. under the care of Tavistock, the National Health Service (NHS) gender clinic. Bell has since detransitioned and initiated a legal case against the NHS. In her case, Bell argues that the NHS failed to properly investigate and challenge her claims about her gender and that minors are incapable of giving informed consent to transition. 

Sen. Paul expressed alarm that Dr. Levine was not willing to oppose a minor’s desire to amputate his or her genitalia or breasts. He emphasized that the government, for most, if not all, of its history, has seen minors as incapable of legally consenting and as needing the advice and guidance of their parents. Dr. Levine did not address Sen. Paul’s concerns; she just repeated her above response. 

According to Sen. Paul, there are no long-term studies on the effects of cross-sex hormones. All the medications used to provide cross-sex hormones have not been studied for this purpose and are therefore prescribed off-label. Sen. Paul also reminded his audience that Democrats strongly opposed the off-label use of hydroxychloroquine to treat COVID-19, less than a year prior.

Democrat Senators took issue with Sen. Paul’s statements. Sen. Patty Murray (D-WA) praised Dr. Levine’s response, saying that she “appreciated [Dr. Levine’s] thoughtful and medically-informed response.” She went on to say that confirmation hearings should focus on “qualifications and the work ahead of us rather than on ideological and harmful misrepresentations.”

Long-term follow up studies do not suggest that medical transition is an effective means of resolving the issues that trans-identifying individuals face. A 20-year study of 324 individuals in Sweden found that, despite reducing feelings of gender-dysphoria, surgery appeared to increase suicide rates in the sample population. Another, UK-based, group concluded that there is not strong evidence to support medical transition. Their investigation into the findings of over a hundred follow-up studies found that none of the studies provided conclusive evidence to support the effects of medical transition as a treatment for gender-dysphoria.

Correction: After publication, it came to our attention that the article incorrectly referred to Sen. Patty Murray (D-WA) as “he.” This has since been corrected.