Florida medical board votes to ban gender-affirming care for transgender minors

After five hours of tense testimony and protests, Florida’s medical board voted Friday to begin drafting a rule that would ban all minors in the state from receiving puberty blockers, hormone therapy or surgery as a treatment for gender dysphoria.

Florida’s medical board is the first in the nation to enforce such a rule, but Florida is among a wave of states where officials have tried to restrict gender-affirming medical care for transgender minors.

At the end of Friday’s five-hour meeting, protesters began shouting “Shame!” at the board members, and some staged a “die-in” in the lobby of Orlando International Airport, where the meeting was held.

Protesting phase a "die" in the lobby of Orlando International Airport on October 28, 2022.
Protesters staged a “die-in” in the lobby of Orlando International Airport on October 28, 2022.Courtesy of Kat Duesterhaus

The vote is the latest update in a months-long effort by Gov. Ron DeSantis’ administration to limit transition-related care to those under 18.

The effort to curtail such care began in April, when DeSantis and Florida Gov. Joseph Ladapo issued nonbinding guidelines through the Florida Department of Health that sought to ban both “social gender reassignment” and gender-affirming medical care for minors.

The guidelines have drawn opposition from LGBTQ advocates and medical professionals. Accredited medical groups—including the American Medical Association, the American Academy of Pediatrics, and the American Psychological Association—support gender-affirming care for transgender youth.

Despite this support, the Florida Health Care Agency released a report in June that “found that several services for the treatment of gender dysphoria—ie, sex reassignment surgery, cross-sex hormones, and puberty blockers—are inconsistent with widely accepted professional medical services.” standards and are experimental and research with the potential for harmful long-term effects.

Just hours after the report was published, Ladapo sent a letter to the Medical Council asking it to establish a standard of care “for these complex and irreversible procedures”.

The board first met on the issue in August and on Friday officially voted to ban some gender-affirming therapies for minors. The proceedings began with an expert opinion in favor of and against such care.

Dr. Michael Laidlaw, an endocrinologist in Rockland, California, cited oft-criticized research that found that 50% to 90% of children whose gender identity does not match their assigned sex at birth grow out of this condition into adulthood.

“The fundamental problem with this treatment, as I see it, is, ‘What happens when you push a square peg into a round hole?'” he said. “You end up injuring or destroying the pin.

Dr. But Meredithe McNamara, an assistant professor of pediatrics at Yale School of Medicine who treats transgender people ages 10 to 25, told the committee that the research cited by Laidlaw and the June report issued by the Florida Agency for Health Care Administration are methodologically flawed.

“None of the authors of the state report are subject matter experts,” McNamara said. “One person is a dentist. The other is a postdoctoral fellow in biostatistics. At the very least, a systematic review should be conducted by those qualified to assess the literature. For example, I would not trust a dermatological review of the literature on neurosurgery.’

After the expert testimony, the board opened public comment, which several participants said was expected to last two hours.

The first nine participants who spoke were in favor of limiting gender-affirming care for minors. Eight of them said they had lost their trans, or had identified with their assigned gender at birth after previously identifying as trans. Only one in eight received gender-affirming medical care as a minor.

Chloe Cole, who described herself as an 18-year-old detransitioner from California, said she started transitioning at 12 and had a double mastectomy at 15. At 16, she said, she realized she regretted her transition.

“All this talk about mental health, self-perception, pronouns and ideology leads me to wonder why the mental health epidemic isn’t being addressed through mental health treatment to address the root causes of why teenage women like me want to reject their bodies? ?” Cole said.

The committee also heard from parents of transgender youth. Hope McClay, who has a 9-year-old trans daughter, said she had to force her daughter to get a short haircut before coming out as trans.

“At one point, when she was about three and a half years old, she came to me and cried and begged me, saying, ‘Please don’t make me be like this again. This is not who I am. I want to die,” McClay said.

She said she and her family consulted with medical experts about their daughter’s medical care and determined that putting her through male puberty would be “psychologically damaging.”

“So we don’t make these decisions lightly, but these decisions should be made by the families, not by the state and not by the board,” McClay said.

Jude Spiegel, the only transgender person to testify at Friday’s meeting, read the names of 17 trans teenagers who died by suicide “as a result of living in a world that refused to recognize or accept them.”

About 45 minutes remained until the end of the period for public comments, and board member Dr. Zachariah P. Zachariah said that only one other person would be allowed to testify. The crowd protested and he offered to provide an email where they could share their testimonies.

At one point an audience member shouted that trans youth would suffer if the board voted to take care of the bar: “Blood is on your hands! To which Zechariah replied, “That’s all right.”

Emile Fox, a trans non-binary person from Orlando who uses the pronouns “they” and “he,” said they signed up to testify and couldn’t, which frustrated them after the first eight people who testified were all in favor of limiting care. , but none of them were from Florida.

“What was so appalling to me is how obviously staged it all was,” Fox said, adding that board members didn’t seem to know much about gender-affirming therapies. “They fed on the narrative and ate it up.

The board did not immediately return a request for comment on how the order of speakers was chosen.

After the public comment period expired, the board tried to come up with a rough draft of the rule. Initially, members considered exempting trans youth who were already receiving gender-affirming medical care from the ban if they underwent an informed consent process, but decided to scrap the proposal.

Then, in a hurried exchange that attendees described as confusing, Zachariah pushed through the vote, even as some board members asked for the motion to be read aloud one more time. He then said the proposal was accepted without saying what the final result was.

Florida Rep. Anna Eskamani, a Democrat whose district includes parts of Orlando, said there will be another meeting Nov. 4 at the Holiday Inn, Disney Springs, to discuss the proposed rule, followed by 28 days of approval. a process that would include more time for public comment.

He believes the timing of the rulemaking process — right before an election — is deliberate.

“It’s so clearly deliberately designed to create a news cycle that further polarizes and politicizes gender-affirming care, to distract from the affordable housing crisis, to distract from the impact of Hurricane Ian and property insurance rates,” she said. “We have some real real issues that we need to address, major health disparities that we need to address, and yet instead of talking about those real issues, trans issues are going to be front and center, and that’s really designed to continue to divide us . .”

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