Sen. Mike Braun (R-Ind.) pressed Health and Human Services Secretary Xavier Becerra over health care for transgender youth at a budget hearing on Wednesday, during which he characterized gender-affirming surgeries as “almost grotesque” in an exchange.

The moment came as Becerra testified before members of the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies about President Biden’s fiscal 2022 budget for the Department of Health and Human Services (HHS).

Braun, a member of the subcommittee, began his line of questioning by raising concerns about the use of “puberty blocking and hormone therapy drugs for gender transition.”

“Anytime a physician prescribes it, they’re doing it off-label. Would you agree that off-label prescriptions for usages not approved by the FDA [Food and Drug Administration] are potentially dangerous for patients, especially kids?” he asked.

Becerra in response assured that the FDA “would raise alarms if they saw that a particular medicine or treatment were being misused” and added that, “at this stage, what we know is that for a drug to be out there available, it has to be safe and effective, as FDA has found.”

“So what I would simply say with regard to this particular subject is when individuals go in for care it is their physician who is making that decision with them about what type of medicine or treatment they should receive,” he continued.

Braun appeared to make a jab at the Biden administration’s handling of the coronavirus pandemic shortly after, before pressing the secretary about “sex-change surgeries.”

“If you use that same logic on what we’ve just navigated through COVID, it seems like there would have been a different point of view and, to me, for many parents across the country, this has more potentially tragic consequences, and it seems like it’s a double standard,” he began. 

“Let’s look at surgeries that would be even more impactful, and I’m not going to mention the particulars there. It’s almost grotesque to mention what could occur. Could you explain what irreversible top and bottom sex change surgeries are and why that is on the portal as well?” he asked.

Braun’s office confirmed in a statement to The Hill that the senator was specifically referring to a fact sheet the HHS’s Office of Population Affairs released on gender-affirming care and young people last month. 

The page describes gender-affirming care as a supportive form of health care spanning multiple “services that may include medical, surgical, mental health, and non-medical services for transgender and nonbinary people.”

Some examples listed included reversible care like social affirmation, which includes adopting gender-affirming hairstyles, clothing and gender pronouns; hormones that pause pubertal development; partially reversible care like hormone therapy; and nonreversible care like gender-affirming surgeries, such as “top” and “bottom” surgeries. The former surgery, the sheet said, is “to create male-typical chest shape or enhance breasts,” while the latter involves “surgery on genitals or reproductive organs.”

In its fact sheet, the HHS characterizes early gender-affirming care as “crucial” to the health and well-being of transgender and nonbinary adolescents, while noting the significant health disparities they face compared to their cisgender peers. It also notes the increased risk transgender and gender nonbinary adolescents are at for “mental health issues, substance use, and suicide.”

Braun’s office said on Wednesday afternoon that the HHS “is endorsing the use of puberty blockers and testosterone/estrogen hormone therapy for the purpose of gender transition” and that such “usage is not what those drugs were FDA approved for, meaning doctors prescribing these drugs for that purpose are doing so off-label.”

“Secretary Becerra today said that the decision to prescribe should be up to the physician, which HHS has not applied consistently to, for example, off-label COVID treatments such as Ivermectin which the CDC immediately put out a Health Advisory on in August 2021 stressing that ‘Ivermectin is not authorized or approved by FDA for prevention or treatment of COVID-19.’ They have put out no similar health warning about puberty blockers or hormone therapies,” the office said.

The Hill has reached out to HHS for further comment.

Becerra told Braun on the matter during the hearing that, in any case, “no individual, no patient will proceed forward unless his or her doctor has advised of the procedure, and it is considered by the FDA and others who have to go ahead and certify a medicine or procedure to be safe and effective.”

Braun then continued to press the issue, asking the secretary, “In what case would it be appropriate to perform irreversible sex change surgery on kids?”

“Those decisions are made by that individual in consultation with physician and caregivers, and no decision would be made without having consulted appropriately,” Becerra said.

“Kids going through this are having a hard time, we should be maybe focusing more on mental health and not things that are irreversible,” Braun responded. “And, I think, leading the HHS — it might be a little more important to be a little more definitive, rather than making it look like well, a laissez-faire approach and whatever happens, happens. I think that’s out of sync with most of America, and it seems to me it’d be wise to maybe back up a little bit.”

Becerra countered Braun’s questioning by saying he believes the nation “should help those have the life-affirming care that they need,” while noting “there are many transgender youth who have actually gone in the opposite direction taking their life.”

“If we can make a life better for someone in America, we should, especially if, in consultation with their physician, they approve of those procedures,” Becerra added.

The exchange on Wednesday comes months after HHS said child welfare agencies should make gender-affirming care more accessible to help protect trans youth in a guidance in early March. 

Around the same time, Becerra had also released a statement taking aim at a directive issued by Texas Gov. Greg Abbott (R) that ordered state agencies to probe reports of transgender kids receiving gender-affirming care as abuse.