“Joe Biden and the New Left even promote surgery on teens and young adults, removing breasts and genitals.”
America First Legal radio ad, Oct. 9, 2022
A radio ad targeting care for transgender youth began airing in cities around the country this fall — from Spanish-language stations in Corpus Christi, Texas, to sports talk shows in Tennessee to pop radio in Detroit. The ad, paid for by a political advocacy group founded by Stephen Miller, a longtime speechwriter and senior adviser to former President Donald Trump, were deemed so incendiary by one radio station owner that they were pulled in major markets.
The minute-long script from America First Legal, titled “Not Anymore,” accuses President Joe Biden of “pushing radical gender experiments” with hormone therapy.
“Joe Biden and the New Left even promote surgery on teens and young adults, removing breasts and genitals,” the ad claims.
With a man’s voice speaking over ominous music, the ad says the White House is pushing boys to appear more feminine by taking estrogen and girls to grow facial hair by taking testosterone. The ad also suggests Democrats are pushing puberty blockers “to keep kids from developing into normal men and women.”
In August, PolitiFact rated a similar statement by Florida Gov. Ron DeSantis as “Mostly False.” The state’s medical boards, appointed by DeSantis, in early November banned hormonal treatment and surgeries for minors. But because the America First Legal ad is directly aimed at a Biden administration policy and highlights what became a hot topic ahead of the midterm elections and in broader cultural debates, we decided to investigate further.
First, we checked with America First Legal about the basis for its statements. The group didn’t respond to repeated emails and phone calls. But its general counsel, Gene Hamilton, released a statement to Politico regarding a news report about the ad: “We believe in biology and we believe that confused children should not be harmed permanently by individuals with radical agendas.”
A document from America First Legal that was filed by Detroit radio station WDRQ-FM with the Federal Communications Commission and obtained by KHN and PolitiFact revealed more specific justifications for the ad’s claim.
It cites a two-page explainer published by the Department of Health and Human Services Office of Population Affairs in March 2022. The first two paragraphs explain that gender-affirming care “consists of an array of services that may include medical, surgical, mental health, and non-medical services” for transgender people, and that “early gender-affirming care is crucial to overall health and well-being as it allows the child or adolescent to focus on social transitions.”
The document seems to communicate that gender-affirming care is important for transgender and nonbinary kids but makes no specific endorsement of surgeries.
What Exactly Is the White House Policy?
The Biden administration was asked about the ad in a White House briefing, and spokesperson Karine Jean-Pierre said simply: “Transgender rights are indeed human rights.”
HHS declined to explain its position on gender-affirming surgeries but released a statement to KHN describing what spokesperson Adam Sarvana called “a disturbing wave of radical attacks on some of our country’s most vulnerable children.”
“The Biden-Harris administration trusts parents, but we are unfortunately seeing interference in people’s medical decisions that jeopardizes potentially life-saving care,” he said.
The message suggests unequivocal support for gender-affirming care, especially to address the high rate of suicide among trans teens. One White House fact sheet says the administration is “confirming the positive impact of gender affirming care on youth mental health.” The White House frames access to care as a civil rights issue for transgender people.
The White House statements largely echo those of leading medical groups, including the American Academy of Pediatrics. The professional association representing 67,000 pediatricians has similarly been accused of pushing gender-affirming care, but Dr. Moira Szilagyi, AAP president, has been fending off what she calls “extremists.”
“Critics of our gender-affirming care policy mischaracterize it as pushing medical or surgical treatments on youth; in fact, the policy calls for the opposite: a holistic, collaborative, compassionate approach to care with no end goal or agenda,” she wrote in an August blog post.
What About the Guidelines?
The America First Legal ad specifically points to the issue of surgery for teens and young adults. This, in itself, is complicated.
The guidelines from the World Professional Association of Transgender Health were updated in September, and they do broaden allowances for genital surgery for minors. But such surgeries are rare. Vanderbilt University Medical Center, which has been at the center of a firestorm over its pediatric transgender care clinic, said it has never performed genital surgery on a minor.
Breast removal is also more acceptable for older teens under the new WPATH guidelines. The numbers have grown in recent years but remain relatively small compared with hormone therapy, which is a far more common treatment for teens. Data analysis of insurance claims by Reuters found “top surgery” — which refers to the removal of the breasts — is growing each year, but fewer than 300 minors a year are having the operations.
Dr. Michele Hutchison, chief of pediatric endocrinology at the University of New Mexico Health Sciences Center, laughed at the notion the Biden administration is pushing such surgery.
“The only people that I’ve ever met that push it are the patients,” said Hutchison, who also cared for transgender youth in Arkansas. “If anything, it’s usually us, as medical professionals, saying, ‘Hey, let’s take a beat. Let’s stop and think about it.’”
Hutchison said she has never recommended genital surgery for a minor.
Does the Policy Equal Promotion?
The ad’s truth hinges on whether the White House is promoting or pushing gender-affirming care. What concerns Dr. Michael O’Brien, a pediatrician in South Carolina and an LGBTQ+ advocate, is that the materials used to justify the ad read like “objective information.”
“The document from HHS does not promote or push any medical treatment so much as it describes it in technical terms,” he said.
Even leaders of the Society for Evidence-based Gender Medicine, who are wholly skeptical of the acceleration in gender-affirming care, said “it is not accurate to say that the Biden administration is pushing these interventions on kids.”
“Presumably, children don’t read the statements by the administration endorsing gender-affirming care,” a society spokesperson said. “We find the politicization of transgender health deeply problematic and unhelpful. Unfortunately, much of the U.S. has taken a politicized approach, on both sides of the debate.”
The ad says: “Joe Biden and the New Left even promote surgery on teens and young adults, removing breasts and genitals.” Experts in the field, LGBTQ+ advocates, and even critics of gender-affirming care say they find the message misleading.
Some media outlets such as the Florida-based Beasley Media Group took the ad off the air, noting in internal emails published in FCC filings that the company’s attorneys found “the substantiation is inadequate to support the claims” and that the spot is “not in the best interest of our company and or listeners.” Some of the ad spots also were pulled by iHeartMedia stations in Pittsburgh.
The Biden policy specifically lists surgery among the “array of services” that should be available and notes that “early gender-affirming care is crucial.” But the ad leaves out other types of care — such as mental health services — that are considered the starting point for caring for this at-risk population.
The ad’s key factual problem is the use of the words “promote” and “push.” Making sure a treatment option is available doesn’t mean it’s being pushed, and to cast it as such is hyperbolic.
We rate this claim as False.
Federal Communications Commission/Katz Media Group, filing that includes ad justification from America First Legal, accessed Oct. 27, 2022
Federal Communications Commission/Katz Media Group, filing regarding ad cancellation in Philadelphia and Detroit, accessed Oct. 27, 2022
Office of Population Affairs and the U.S. Department of Health and Human Services, “Gender-Affirming Care and Young People” guidance, March 2022
Phone interview, Dr. Michele Hutchison, division chief of endocrinology at the University of New Mexico Health Sciences Center, Oct. 27, 2022
Direct-message interview with Dr. Michael O’Brien, a pediatrician in training at the Medical University of South Carolina, Nov. 3, 2022
Phone interview, Aurea Bolaños Perea of LGBTQ+ advocacy group COLOR Latina in Colorado, Oct. 27, 2022
American Academy of Pediatrics president Moira Szilagyi blog post, Aug. 10, 2022
Email statement from Adam Sarvana, communications director of the HHS assistant secretary of health, Oct. 27, 2022
PolitiFact, “‘They Are Literally Chopping Off the Private Parts of Young Kids,’” Aug. 10, 2022
Endocrine Society, “Gender Dysphoria/Gender Incongruence Guideline Resources,” Sept. 1, 2017
World Professional Association for Transgender Health, Standards of Care, 2022
Email response, Society for Evidence-based Gender Medicine, Oct. 24, 2022
This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.