On Friday, the Florida Board of Medicine will consider establishing a new standard of care for transgender youth that conflicts with recommendations from major medical associations and is inconsistent with mainstream science in what critics have called a political ploy led by Gov. Ron DeSantis’ (R) administration.
The meeting comes just under a week after Florida’s Health Department filed a petition to initiate rule-making on the issue, citing a lack of “quality evidence” regarding the effectiveness of treatments, including puberty blockers and hormone therapy for gender dysphoria.
“Given the lack of quality evidence in support of gender transition treatments, the use of such treatments for gender dysphoria should be considered experimental and should require the fully informed consent of the risks and limitations,” the petition states, adding that children younger than 18 years old do not possess the “cognitive or emotional maturity” to comprehend the consequences of receiving gender-affirming medical care.
The department in April issued new guidance suggesting that gender-affirming health care should not be accessible to minors at all and accused the federal government of “injecting political ideology into the health of our children” by publishing a fact sheet providing evidence to the contrary.
Florida Health Department officials in the guidance said children should not be socially affirmed in their gender identity, citing a statistic from a 2015 study published in the International Review of Psychiatry that 80 percent of youth seeking gender-affirming clinical care “will lose their desire to identify with the nonbirth sex.”
That’s not entirely true, Michael Haller, chief of the division of pediatric endocrinology at the University of Florida, said Friday.
“The state’s implication that the majority of children resolve their gender dysphoria is a gross misrepresentation of the data,” Haller said during a press conference held by the group Equality Florida outside the Marriott Fort Lauderdale Airport Hotel, where the state Board of Medicine is scheduled to meet.
“Yes, 80 percent of prepubertal children who express transgender identities return to their original gender assignment,” Haller said, “but 90 percent of those with a transgender identity following puberty – which is when we treat children medically – persist with a trans identity indefinitely.”
According to guidelines from the World Professional Association for Transgender Health (WPATH) and the Endocrine Society, social transition – non-medical interventions including haircuts or changes to clothing, names or pronouns – is the only acceptable treatment for gender dysphoria in children that have not yet started puberty.
“What kind of world would we be living in if the Department of Health dictates what haircuts and clothes kids can have?,” Jeanette Jennings, a transgender rights advocate and the mother of Jazz Jennings, a transgender television personality, said Friday during the Equality Florida press conference.
Using the state Health Department’s guidance, Florida’s Agency for Health Care Administration (AHCA), which controls most of the state’s Medicaid program, in June published a notice for a proposed rule to eliminate coverage for gender-affirming health care.
The agency also released its own report on gender-affirming care that has been widely criticized as “unscientific” by doctors with clinical experience treating transgender youth. The AHCA report has also been accused of using research from doctors with anti-transgender biases, including Quentin Van Meter, the American College of Pediatricians president – an organization designated as a hate group by the Southern Poverty Law Center (the group has contested this designation).
Van Meter, also a pediatric endocrinologist, has advocated for the use of conversion therapy to treat gender dysphoria in children, a practice that has been discredited by most of the medical community.
In emailed comments to Changing America, Van Meter argued that those pushing to protect gender-affirming medical interventions are the ones who are “actually trying to convert” youth assigned male or female at birth. According to Van Meter, that is “a feat that is impossible and which causes documentable harm.”
Providers of gender-affirming clinical care have acknowledged that treatments for gender dysphoria come with a set of risks but argue that those risks are no more dangerous than those associated with other forms of pediatric care.
“In pediatric care, there are gaps in our knowledge base, there are inherent risks, and the government is not trying to interfere in that,” Meredithe McNamara, an assistant professor of pediatrics at Yale University, told Changing America.
McNamara was part of a team of medical and legal experts at Yale that authored a June report accusing Florida’s attempts to heavily restrict access to gender-affirming health care of being part of a “political agenda.”
In June, DeSantis appointed four doctors to serve on the state Board of Medicine, including Patrick Hunter, who, in a lawsuit challenging Alabama’s felony ban on gender-affirming care, declared that he believes gender-affirming medical care for transgender youth “cannot be ethically justified.”
Should Florida’s Board of Medicine choose to adopt the state Health Department’s standards of care on Friday, gender-affirming surgical or “any other procedure that alters primary or secondary sexual characteristics for the treatment of gender dysphoria” will be prohibited for patients younger than 18 years old.
Puberty blockers and hormone therapy will also be off-limits for minors, and gender-affirming medical interventions for transgender adults will be administered only after a mandatory 24-hour waiting period – a nod to a debunked hypothesis that youth and adults may experience “rapid onset gender dysphoria.”
Doctors in the state who continue to provide gender-affirming care could face lawsuits and potentially have their medical licenses revoked. On Thursday, Andrew Warren, the elected state attorney of Hillsborough County, Fla., was suspended by DeSantis for refusing to enforce the state’s ban on abortion and gender-affirming care.
“I’m not personally afraid,” Haller, the pediatric endocrinologist from the University of Florida, told Changing America, adding that he believes the courts will side with him and other doctors whose medical licenses may be taken by the state.
“I’m scared for my patients,” he said. “I’m terrified for them.”