Tomorrow, the Florida Board of Medicine will meet to discuss thoroughly debunked rule changes proposed by the Florida Department of Health’s (FDOH) that would — contrary to all medical best practices — deny gender-affirming care to Florida's transgender youth. The FDOH, an agency under the control of Governor DeSantis, is pressuring Board members to reject their best medical judgment and impose political barriers to accessing life-saving care for transgender youth and adults. The Human Rights Campaign (HRC) — the nation’s largest lesbian, gay, bisexual, transgender and queer (LGBTQ+) civil rights organization — denounced the transparently political move that seeks to take decisions about best care practices out of the hands of medical professionals and patients.

“Florida Governor Ron DeSantis's assault on transgender Floridians – an effort to create a wedge between parents, children, and their teachers and doctors – is now being taken up by state agencies. Weeks ago, the Agency for Health Care Administration proposed to deny Medicaid coverage for lifesaving, gender-affirming care to transgender Floridians. Now, the Board of Medicine is facing pressure to adopt guidance that is inaccurate and dangerous to transgender youth,” said Sarah Warbelow, Human Rights Campaign Legal Director. “Science, medicine, and evidence-based approaches have demonstrated time and time again that transition-related care is medically necessary and life-saving care, and if this proposal is adopted, it will go against the recommendation of every major medical association. The truth matters and so does protecting Florida’s youth and their families.”

Friday’s meeting is being held after Florida Surgeon General Ladapo asked the board to establish a standard of care for transition-related treatments such as gender-affirming surgery, hormone therapy and puberty blockers based on Florida Department of Health guidance–guidance which was politically motivated, full of inaccurate and misleading reporting, and drew faulty conclusions from a biased read of the scientific literature.

Despite the flaws and inaccuracies in the previous reports issued by the Florida Department of Health, they have filed a Petition to Initiate Rulemaking Setting the Standard of Care for Treatment of Gender Dysphoria (see page 870), to be discussed on Friday. If the Petition is upheld by the Board of Medicine, it would ban doctors from providing life-saving, age-appropriate transition related medical care to transgender youth under the age of 18, and would require transgender adults seeking medical or surgical transition care to undergo a 24-hour waiting period before receiving care and complete an additional consent form which is full of extreme and misleading statements. As with the Department of Health’s previous reports, the language of the Petition contains numerous lies and misleading statements about gender-affirming care, topline points of which are listed–and refuted–below:

LIE #1: “Only a minority of children who are diagnosed with gender dysphoria remain gender dysphoric as adults.”

• REALITY: Numerous published studies have noted that detransition is rare, with those who begin transitioning in adolescence the least likely to detransition.

LIE #2: “There is a lack of quality evidence and certainly no conclusive research to support the medical transition of children to the opposite gender as a treatment for gender dysphoria.”

• REALITY: There is, in fact, overwhelming evidence that supports the provision of gender-affirming care to transgender youth. Previous research has found that transgender youth who receive gender-affirming care, including puberty blockers and/or gender affirming hormones (GAH), report lower levels of suicidal ideation and depression, reduction in gender dysphoria, and improved psychological well-being and global functioning.

LIE #3: The Agency found that puberty blockers are not approved by the FDA for the treatment of gender dysphoria, are not medically efficacious for the treatment of gender dysphoria, and have permanent side effects.”

• REALITY: Puberty blockers are not experimental, new, or illegal, or unsafe. They have been used safely and effectively with cisgender youth for decades under FDA approval, with minimal side effects. They have been used safely and effectively to delay puberty in transgender youth since 1998.

  • Puberty blockers remain the “gold-standard treatment” for precocious puberty in cisgender youth, approved by the FDA in 1993. In the FDA labeling information for the puberty blocker LUPRON DEPOT-PED, they note that adverse reactions are minimal, with the most common being “injection site pain, weight increased, headache, mood altered, and injection site swelling.”
    

• REALITY: Lack of FDA approval does not indicate its use is experimental, illegal, or unsafe. So-called ‘off-label’ use of drugs is regular practice, with “examples of widely practiced off-label drug use in every specialty of medicine.” Off-label use of puberty blockers for transgender youth is in line with typical clinical practice regarding off-label drug use

• REALITY: Puberty blockers are fully reversible, and their use with transgender youth is supported by every major medical association.

LIE #4: “The stark contrast between claims about the efficacy of so-called "gender-affirming" care for treating gender dysphoria and the lack of quality evidence supporting those claims has created confusion in the community.”

• REALITY: There is no confusion in the scientific and medical community. Every single major medical association supports the provision of gender-affirming care to transgender youth and adults, including the American Academy of Pediatrics, the American Medical Association, the American Psychiatric Association, representing millions of doctors, researchers, and psychologists across America.

  • In April, even the Florida chapter of the American Academy of Pediatrics issued a statement immediately condemning Florida’s attempts to begin banning gender-affirming care for youth, noting that “appropriate gender-affirming care, conducted in close coordination with pediatricians and parents, is safe and effective for treating patients experiencing gender dysphoria.”

LIE #5: “This confusion has caused practitioners to forgo less invasive treatment options and rush patients into immediate chemical regimens and surgical procedures without full consideration of their efficacy, safety, and long-term repercussions.”

• REALITY: Gender-affirming medical care for trans youth and adolescents under 18 is largely concentrated to non-invasive, fully reversible social transition – meaning allowing a person to change their haircut, individual’s name, pronouns, and gender expression. The Florida Department of Health recommended against this non-invasive form of gender transition in their April `fact sheet.’

  • However, for some youth, transition may involve safe, age-appropriate, life-saving medical care such as gender-affirming hormones and puberty blockers, many of which have been safely used with cisgender youth for decades, and which have proven safe and effective, with minimal to no long-term negative health consequences among transgender youth. Any form of gender affirming care received by transgender youth—be it supportive mental health care, puberty blockers, or cross-sex hormones—is administered after consultation with medical and mental health professionals and their parents/guardians.

LIE #6: “Even in adults, who possess the capacity to consent to experimental treatment, research supporting chemical and surgical interventions for treatment of gender dysphoria is insufficient to demonstrate long-term efficacy and safety, and there is a risk of irreversible physical changes, including infertility or sterility.”

• REALITY: As with transgender youth, transgender adults who receive gender-affirming medical care, including gender-affirming hormones and gender-confirming surgery, experience numerous positive mental health and quality of life benefits.

• REALITY: Treatments are also safe: Multiple studies, using large samples and rigorous study designs, have found cross-sex hormones to have no impact on cardiovascular risk for transgender men. For transgender women, evidence on cardiovascular disease is mixed—however routine monitoring by a health provider can greatly reduce, if not control, this risk.

  • Other studies have demonstrated that gender-affirming surgeries–which include many procedures routinely done on cisgender adults, such as mastecomies, breast reconstruction, and facial surgeries–are also quite safe, and carry minimal complication rates.

• REALITY: Many of the physical changes after gender-affirming hormone therapy are reversible. However, for those seeking to medically and/or surgically transition, the physical changes are, in fact, the point. And in doing so, they are happy and affirmed in their choice to have surgery: a systematic review/meta-analysis of 27 studies including over 7,900 transgender patients who underwent gender-affirming surgery (of any type), found that a total of 77 patients–less than 1% who underwent transmasculine surgeries and 1% who underwent transfeminine surgeries–had any regret.

• REALITY: Fertility preservation options exist (many of which are the same as those used with cisgender adults) for those who are at risk of becoming infertile or sterile as a result of transition-related medical care. Patient-provider conversations about fertility preservation are part of the decision-making discussions and protocols before gender-affirming care is initiated.

Florida’s Board of Medicine is the 15-member medical board responsible for licensing Florida doctors; setting rules for physicians, and disciplining them for infractions such as health care fraud or false advertising. State law says the board can establish standards of care for medical practices via a rule-making process and can discipline doctors for violating its rules. Among other penalties, the board has the power to revoke medical licenses or impose fines. The board is part of the Department of Health, which Ladapo oversees. DeSantis appoints board members, who are confirmed for four-year terms.

After the preliminary report was published in April, HRC responded with a corrected version that debunked the lies and misinterpretations that abounded in the two-page document. HRC’s response noted that the preliminary report drew inaccurate conclusions from cited research, used obsolete terminology, took data out of context and cherry-picked misleading data. To learn more about gender affirming care, see HRC’s fact sheet and video.

In June, the Florida Agency for Health Care Administration, bowing to the wishes of the openly discriminatory DeSantis Administration, released proposed rule changes that would — contrary to all medical best practices — deny gender affirming care to Floridians of all ages who rely on Medicaid. The moves by the AHCA follow the signings by Gov. Ron DeSantis earlier this spring of the “Don’t Say Gay or Trans” bill and the “Stop WOKE Act.”

The “Don’t Say Gay or Trans” bill seeks to silence teachers from talking about LGBTQ+ issues or people, further stigmatizing and isolating LGBTQ+ kids and also undermining existing protections for LGBTQ+ students. The legislation — which has triggered a major backlash from educators and students across Florida and the country — prevents teachers from providing a safe, inclusive classroom for all students.

The “Stop WOKE Act” limits protected speech in workplaces and classrooms by censoring honest dialogue about systemic racism, gender, and race discrimination. The legislation also changes Florida’s employment discrimination statutes to give employees the ability to file discrimination claims against an employer engaging in trainings or discussions about Black history, LGBTQ+ issues, and other concepts of injustice and discrimination.

The Human Rights Campaign is America’s largest civil rights organization working to achieve equality for lesbian, gay, bisexual, transgender and queer people. HRC envisions a world where LGBTQ+ people are embraced as full members of society at home, at work and in every community.

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