TAMPA, Fla. — Florida's surgeon general is recommending against certain types of medical care for transgender children and adolescents, citing "uncertainty about the effects of puberty blockers, cross-sex hormones, and surgeries in young people with gender dysphoria.”
In a letter, sent to the Florida Board of Medicine, he calls for the board to establish guidance and a standard of care for “certain pharmaceutical, non-pharmaceutical, and surgical treatments for gender dysphoria.”
This comes after Florida’s June Medicaid report cited “insufficient evidence” that sex reassignment through medical intervention is a safe and effective treatment for gender dysphoria. The report was issued by the state's Agency for Health Care Administration (AHCA).
In the letter, Surgeon General Dr. Joseph Ladapo asserts “the scientific evidence supporting these complex medical interventions is extraordinarily weak.”
At the federal level, the U.S. Department of Health and Human Services has come out in support of gender-affirming care – including surgical and medical treatments – as a supportive form of health care. Organizations like the American Academy of Children and Adolescent Psychiatry (AACAP), American Academy of Pediatrics, and the Cleveland Clinic generally agree.
“State-based legislation regarding the treatment of transgender youth that directly oppose the evidence-based care recognized by professional societies across multiple disciplines is a serious concern,” the AACAP wrote in a 2019 statement.
But, Ladapo has suggested many of the standards set forth by professional medical organizations have been politicized.
“The current standards set by numerous professional organizations appear to follow a preferred political ideology instead of the highest level of generally accepted medical science. Florida must do more to protect children from politics-based medicine,” Ladapo's letter reads.
Most of these medical organizations agree transition care should not start before puberty in children, however, it should be considered on a case-by-case basis.
“If used in an adolescent, hormone therapy typically begins at age 16. Ideally, treatment starts before the development of secondary sex characteristics so that teens can go through puberty as their identified gender,” the Mayo Clinic says on its website.
Ladapo’s letter goes on the add transition care is “complex and irreversible.”
An informational page from the University of California, San Francisco says many of the effects of hormone therapy are reversible if a person stops taking them. The degree to which they can be reversed depends on how long a person has been taking them. Some breast growth, and possible reduced or absent fertility are not reversible.
The letter and Medicaid report come shortly after the signing of Florida’s “Parental Rights in Education” law, which prohibits schools “from discouraging or prohibiting parental notification and involvement in critical decisions affecting a student's mental, emotional, or physical well-being.”
The bill gives parents the right to pursue legal options if they believe a school’s procedures are infringing on their “fundamental right…to make decisions regarding the upbringing and control of their children.”
Ladapo’s letter has LGBTQ activists pointing out the lack of choice Floridians will have in making decisions about their healthcare if transition care for children is banned.
“This time it is a crusade to deny Floridians their freedom to access healthcare. Governor DeSantis’ agencies have misrepresented findings and distorted data to advance a political agenda, rather than relying on good science,” Equality Florida wrote in a statement.
When it comes to the mental health care of transitioning children, the ACHA Medicaid report says studies claiming these medical services prevent suicide “are either low or very low quality and rely on unreliable methods such as surveys and retrospective analyses, both of which are cross-sectional and highly biased.”
However, organizations like the Gay and Lesbian Alliance Against Defamation (GLAAD) disagree, calling the letter “a shameful and dangerous piece of propaganda that misleads the public and threatens public health.”
Research from the Harvard T.H. Chan School of Public Health found that gender-affirming surgeries are associated with lower rates of psychological distress and thoughts of suicide, as well as lower rates of smoking. The study examined data from nearly 20,000 participants. A study from the Journal of Adolescent Health drew similar conclusions.
The recommendations from Dr. Ladapo directly contradict the standard of care set by the U.S. Department of Health and Human Services under the Biden Administration. In a March letter from the Department of Justice, Assistant Attorney General Kristen Clarke reminded state attorneys general of federal constitutional and statutory provisions that protect transgender youth against discrimination, including when those youth seek gender-affirming care.
It is now up to the Florida Board of Medicine to establish a standard of care on the issue. The board is made up of 12 members, appointed by Gov. DeSantis and confirmed by the Florida State Senate.
“The transgender community, like all people, shouldn’t have their access to basic, medically necessary, and often life-saving care stripped away by extremist politicians hoping to stoke right-wing fervor. Florida should put public health over politics,” Equality Florida said in a statement.