A radio ad targeting care for transgender kids 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 ads, 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 aimed directly at a Biden administration policy and highlights what’s become a hot topic on the midterm elections campaign trail 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 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.

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 is 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 right 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, the academy’s president, has been fending off what she calls "extremists."

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"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.

The America First Legal ad points specifically to 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 a minor for genital surgery.

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 skeptical of the acceleration in gender-affirmation 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 adleaves 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." Ensuring a treatment option is available doesn’t mean it’s being pushed, and to cast it as such is hyperbolic.

We rate this claim False.