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Reps. Jason Zachary (R-Knoxville), center, and Scott Cepicki (R-Culleaoka), right, attend a briefing in Nashville on March 16, 2020. (Erik Schelzig, Tennessee Journal)

Vanderbilt University Medical Center says no minors have undergone genital surgery at its transgender clinic and all patients are at least 16 years old and have parental consent. The hospital told Rep. Jason Zachary (R-Knoxville) it would pause gender-affirming surgery on patients under 18 while it seeks advice from local and national experts, a process that could take several months.

“We understand that this matter will likely be addressed by the General Assembly in its next legislative session,” Deputy Director General C. Wright Pinson wrote.

Here is the letter:

Representative Zachary,

I am writing in response to your letter dated September 28, 2022 on behalf of Vanderbilt University Medical Center (“VUMC”) and its Board of Trustees regarding concerns regarding the surgical care provided by the Transgender Clinic to persons under the age of 18 .

VUMC launched its Transgender Health Clinic in 2018 because transgender people are at high risk for mental and physical health issues and have historically been underserved by our country’s healthcare systems. Among patients under the age of 18 receiving transgender care, an average of 5 per year underwent gender-affirming surgeries. Contrary to some media reports, all were at least 16 years old, none underwent genital procedures, and parental consent for these surgeries was obtained in all cases. None of these surgeries were paid for by state or federal funds; revenue from this limited number of surgeries represents an intangible percentage of VUMC’s net operating revenue.

VUMC approaches its responsibility to care for patients by following the most widely recognized national and international standards of care, while doing so at all times in accordance with state and federal laws. Our clinical teams provide transgender care that is informed by professional practice standards and guidance established by leading medical specialty societies, such as the Endocrine Society and the World Professional Association of Transgender Health (WPATH). We fully comply with the requirements of legislation passed by the General Assembly in 2021, now codified in Tenn. Ann.Code §63-1-169, which prohibits providing hormone therapy to prepubertal children.

VUMC serves as an employment home for more than 40,000 people, and our employees voice their views in numerous forums, including hundreds of open conferences at our campus facilities each year. Comments from videos posted on social media obtained at such events should not be construed as statements of VUMC policy. VUMC’s policies and practices allow employees to request accommodation to be excused from participating in surgeries or procedures that they deem morally wrong. We do not tolerate discrimination against employees who choose to request accommodations.

You demanded that VUMC stop permanent gender affirmation surgeries performed on underage children. On September 6, 2022, WPATH published a new version of its recommendations for healthcare professionals for the treatment of transgender people, known as SOC-8. In light of these new recommendations, and as part of the completion of our internal clinical review of the SOC-8 guidelines in patients under 18, we will seek input from local and national clinical experts. We are suspending gender affirmation surgeries for patients under 18 while we complete this review, which may take several months.

Furthermore, we understand that this issue will likely be addressed by the General Assembly in its next legislative session. As always, we will ensure that VUMC’s programs comply with any new requirements that may be established under Tennessee law.

I hope this letter has addressed the concerns that have been raised with you and your colleagues.



C. Wright Pinson, MBA, MD

Deputy General Manager and Director of the Health System