Biden administration officials attempted to pressure an international group that sets guidance on transgender health issues to remove the minimum age recommended for gender-affirming care, according to emails released in an Alabama court case challenging the states ban on gender-affirming care for minors.

Adm. Rachel Levine, assistant secretary for health with the U.S. Department of Health and Human Services, was “very concerned” that a minimum age for such surgeries “will affect access to health care for trans youth,” according to the emails.

Levine is the first Senate-confirmed transgender official in a presidential administration.

See also: Lawyers who ‘judge shopped’ in Alabama gender-affirming care case ordered to hand over comments on ruling

“Assistant Secretary for Health Dr. Rachel Levine strongly pressured WPATH [World Professional Association for Transgender Health] leadership to rush the development and issuance of SOC-8 [Standards of Care, Version 8], in order to assist with Administration political strategy,” stated the email from an unnamed member of the World Professional Association for Transgender Health and obtained by James Cantor, a psychologist and critic of gender-affirming care for minors.

Sarah Boateng, Levine’s chief of staff, told WPATH that the “biggest concern” of the new Standards of Care “is the section below in the Adolescent Chapter that lists specific minimum ages for treatment, she is confident, based on the rhetoric she is hearing in DC, and from what we have already seen, that these specific listings of ages, under 18, will result in devastating legislation for trans care,” according to the email.

“She wonders if the specific ages can be taken out and perhaps an adjunct document could be created that is published or distributed in a way that is less visible than the SOC8, is the way to go,” the missive went on to say.

While Levine was generally pleased by the new standards, according to the email, “she was very concerned that having ages (mainly for surgery) will affect access to health care for trans youth and maybe adults too.

“Apparently the situation in the USA is terrible and she and the Biden administration worried that having ages in the document will make matters worse. She asked us to remove them,” the email stated.

But WPATH told Levine that they could not remove minimum ages for gender-affirming care in the new standards.

“Given that the recommendations for minimal ages for the various gender affirming medical and surgical intervention are consensus-based, we could not remove them from the document,” the email stated. “Therefore, we have made changes as to how the minimal ages are presented in the documents.”

On behalf of the plaintiffs in the Alabama case challenging the state’s ban, the Justice Department asked the judge overseeing the case to prevent Cantor and other experts from testifying in Alabama’s defense of the law. The agency claimed Cantor’s testimony would be irrelevant to the case.

“Dr. Cantor seeks to opine on many matters beyond the scope of his limited expertise in adult psychology. Dr. Cantor is not a medical doctor, does not prescribe medications, and does not treat patients under the age of 16,” the department said. “He is a clinical psychologist whose patients are typically 30-35 years old and he makes no ‘income from the assessment or clinical treatment of children.’ Nonetheless, he seeks to opine on medical care that he has never provided.”

U.S. District Court Judge Liles Burke has yet to rule on whether Cantor and other experts can testify.