Florida advises no social, hormonal treatment of transgender children

In a move that goes against federal guidance, the Florida Department of Health on Wednesday released guidelines that advise against treatment of gender dysphoria for children and adolescents outside of counseling.

The state’s guidance recommends against gender-affirming treatment for people under the age of 18, including surgery as well as the prescription of hormone therapy or puberty blockers, which suppress the release of testosterone or estrogen.

Florida’s updated guidance also said social transition — things like using a different name, pronouns or style of dress — should not be a treatment option.

Gender dysphoria is the stress an individual feels when their gender identity does not match the sex they were assigned at birth.

In a statement, Christina Pushaw, a spokesperson for the governor, said the guidance, by its definition, is not enforced by the state, but rather a way to offer and explain recommendations to families and health care providers. Gov. Ron DeSantis supports the issued guidance, she said.

“Physicians may use guidance from different authoritative sources, including government entities and professional associations, in determining the best course of treatment for their patients,” Pushaw said.

The state’s guidance runs counter to recommendations from major medical organizations, including the American Medical Association, the American Academy of Pediatrics and the American Psychiatric Association, who follow guidance on the treatment of gender dysphoria released by the World Professional Association for Transgender Health.

Guidance issued by the Office of Population Affairs, which falls under the US Department of Health and Human Services, says research shows that gender-affirming care like social transitions and hormone therapy can improve the mental health and well-being of transgender and nonbinary children and teenagers.

The Florida Department of Health on Wednesday put out a document disputing the federal Health and Human Services guidance and the studies it used.

Florida Surgeon General Joseph Ladapo said in a statement that the federal government’s guidance was “about injecting political ideology into the health of our children.”

In a statement, Equality Florida said DeSantis’ administration was playing with “political propaganda” and that the guidance “demonizes life-saving, medically-necessary care, and asserts that the government, not parents, knows best when it comes to health care for our children.”

Alex Keuroghlian, director of the Massachusetts General Hospital Psychiatry Gender Identity Program, said treatments like hormone blockers weren’t invented for transgender kids and are used routinely for a variety of children, like those who start puberty too early.

But people only object to their use when it comes to gender-nonconforming children, he said.

He said such hormone blockers aren’t used until the age of puberty, and hormone therapy is often not prescribed until an adolescent is older. Young children don’t receive medical interventions, he said.

“You initiate medical gender affirmation with a medical professional, a pediatric clinician, so it’s not like this is something that’s happening in the absence of highly expert clinical guidance and care,” Keuroghlian said. “This notion that it’s happening willy-nilly or thoughtlessly is patently false.”

Keuroghlian is also the director of the National LGBTQIA+ Health Education Center at the Fenway Institute. Responding to assertions that some children could go through gender-affirming therapies and then later regret it, he said it’s rare for transgender teenagers to identify differently in adulthood.

Lucas Wehle, a transgender activist who for several years organized support and counseling groups for transgender children and their parents at local nonprofit Metro Inclusive Health, said denying children access to treatments that enable their appearance to correspond with how they identify could result in an increase in commit suicide

”These are life-saving and life-changing services,” he said. “When barriers are put up and these services are not provided to the kids who need it, we quite literally lose lives.”

Wehle, a transgender man, said he is particularly concerned about recommendations against the use of puberty blockers. The physical changes brought on by puberty can increase a child’s distress at their external appearance of her. Blockers delay puberty but are reversible, Wehle said.

Wehle said Florida’s guidance will make medical professionals wary of treating transgender children.

“They want to erase us, to erase trans people,” he said.

Florida is not the first state to go after gender-affirming care for transgender children. For instance, in Texas, Gov. Greg Abbott ordered that facilities that give medical care to transgender children be investigated.

On Monday, a group of doctors in Alabama filed a lawsuit against the state government seeking to overturn new legislation that bans gender-affirming care for children.

The Alabama Vulnerable Child Compassion and Protection Act makes it a felony for doctors to carry out gender-affirming treatments like surgery, puberty blockers or hormone therapies. Violation of the law, which goes into effect on May 8, is punishable by up to 10 years imprisonment or a fine of up to $15,000.

Brittany Bruggeman, an associate professor of pediatric endocrinology and an employee at the University of Florida Youth Gender Program, said because the guidance is not binding, it shouldn’t affect their care of patients.

The Youth Gender Program offers guidance and assistance on social and medical transitioning for gender-nonconforming children and young adults.

Bruggeman said she has heard worries from physicians who fear it possibly signals further future action.

“This is going to be a point of confusion for a lot of our families and our patients we see, because this recommendation is in direct contradiction to national guidelines,” Bruggeman said.

In the Youth Gender Program, decisions are made in tandem with medical professionals, mental health professionals, the parents and the child, Bruggeman said. Risks are explained thoroughly, and before a teenager can begin hormone therapy, they have to have the mental capacity to consent.

This is not the first time DeSantis’ administration has injected itself into the debate over transgender individuals.

Last year, DeSantis signed a bill banning transgender women from competing in women’s and girls’ school sports. Last month, he issued a proclamation declaring the runner-up in the NCAA 500-yard women’s freestyle event the winner after Lia Thomas, a transgender woman, won the event.