The Florida medical board committee on Friday approved a prospective rule that will ban medical or surgical gender affirming care for trans youth under the age of 18. The committee’s recommendation will be passed to the board, who will make the official ruling next Friday.
The meeting, open to the public, was met with boisterous and emotionally-charged commentary on both sides of the proposed rule. Uproar ensued when the opportunity to provide public testimony was cut short, with several attendees still awaiting a chance to address the committee.
“I wasn’t allowed to speak at all during the meeting today. And not to toot my own horn, but I do feel like I was one of the qualified people to speak in there as a transgender minor,” Jacob Wiley, a trans teenager, said afterwards at an Equality Florida press conference.
Prior to the ruling, the board heard testimony from those in support and opposition. A number of adults in different stages of de-transitioning spoke in support of the rule, citing multiple mental and physical complications they experienced as a result of gender affirming care. Oppositional testimony came from transgender individuals or trans youth advocates that cited the risk to a youth’s mental health, including increased risk of suicide, if gender affirming care were to be limited or prohibited.
If approved, the rule would limit care for the treatment of gender dysphoria in Florida. Gender dysphoria is when a person experiences emotional distress because because of misalignment between their biological sex and their gender identity.
The rule would prohibit puberty blockers, hormones, cross hormone therapy and gender affirming surgery for people under the age of 18, with an exception for individuals enrolled in IRB-approved, university-centered clinical research trials. There are currently no active clinical trials in Florida related to the provision of gender affirming care, and whether the length of these trials would be adequate to allow full transitory care cannot be guaranteed.
Concerns over irreversible consequences of care including hormonal therapy and gender affirming surgery were raised in the meeting; however, for those who have not yet gone through puberty or are undergoing puberty, the usage of “blockers” are often the first step in medical transition and according to the AAP, these are known to be safe, temporary, and reversible.
The board brought in several experts to talk about the research that has been done on the effects of gender affirming care on transgender youth.
Meredithe McNamara, a pediatrician and assistant professor at the Yale School of Medicine, criticized the Florida Agency for Health Care Administration for their recommendation in banning gender affirming care in June during her presentation, saying it contradicted the general medical consensus on the importance of care for trans people. Specifically, the Florida AHCA report stated that there was not enough research to prove gender affirming care was effective or safe.
However, McNamara pointed to the list of accredited medical institutions, including the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry, alongside the U.S. Department of Health and Human Services, that deem gender affirming care as safe and valuable for gender-diverse people.
“This consensus is based on a solid body of evidence with more than 16 studies confirming that standard medical treatments for gender dysphoria are safe and effective,” McNamara said.
Medical research on the transgender community is limited, but studies on transgender adults suggest gender affirming care, including surgery, results in significantly lower odds of psychological distress, tobacco smoking, and suicidal ideation.
Research shows that people who have gender-affirming surgery had significantly lower odds of psychological distress, tobacco smoking, and suicidal ideation compared with trans people with no history of gender-affirming surgery.
An endocrinologist, Michael Laidlaw, supports sole treatment with mental health care in lieu of this care in combination with pharmacological and/or surgical interventions for transgender youth. He told the board that some of the effects of gender affirming care are irreversible and can cause severe complications such as infertility. However, pediatricians and endocrinologists have told ABC News that puberty blockers only present real risks after puberty and are not a risk to youth. Additionally, hormone blockers alone do not impact future fertility, according to the AAP.
Prior to this ruling, transgender Floridian residents had already been barred from using Medicaid to pay for gender-affirming care starting on August 21.
The move comes as Florida legislators, backed by Gov. Ron DeSantis, continue to crack down on LGBTQ protections and identities. Studies have found that discrimination contributes to the high rates of mental health conditions, suicidal ideations and more among LGBTQ populations.
Alicia Zellmer, MD, is a resident physician in Internal Medicine, and a member of the ABC News Medical Unit.