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A Florida medical board advances a plan that would ban treatments for transgender youths

Florida Surgeon Gen. Dr. Joseph A. Ladapo wrote that federal agencies should not be controlling or limiting options to combat COVID.
Chris O'Meara
Florida Surgeon Gen. Dr. Joseph A. Ladapo wrote that federal agencies should not be controlling or limiting options to combat COVID.

Amid an outcry from the LGBTQ community and harsh criticism from a host of physicians and health-care professionals, the Florida Board of Medicine on Friday advanced a plan that would ban doctors from providing treatments such as puberty blockers and hormone therapy to transgender people under age 18.

Friday’s decision came after the Florida Department of Health last month filed a petition asking the medical board to initiate a rule-making process on the contentious issue. The Board of Medicine also moved forward as the state Agency for Health Care Administration plans to prevent the Medicaid program from covering such treatments for gender dysphoria for adolescents and adults.

As his political presence on the national stage continues to skyrocket, Gov. Ron DeSantis is among Republican leaders throughout the country targeting transgender treatments for youths. The governor, who is seeking re-election in November, contends that children are prematurely being allowed to pursue treatments that can have harmful lasting effects.

But many medical professionals --- including numerous medical societies --- are blasting the DeSantis administration’s moves, saying the state’s assertions are contrary to established standards.

People on both sides of the issue crowded into Friday’s Board of Medicine meeting in Broward County, with supporters of the Department of Health proposal wearing “Let Kids Be Kids” decals. Opponents held a rally before the meeting and pleaded with the board to reject the petition.

Addressing the board, Department of Health Secretary Joseph Ladapo acknowledged the “strong feelings about the issue” in the room.

But Ladapo, who serves as the state’s surgeon general, argued that current standards of care are a “substantial departure” from “the level of evidence and data surrounding this issue.”

“It is very clear that … the effectiveness is completely uncertain,” Ladapo, who said his views on the topic had “evolved,” argued. “I mean, maybe it is effective, but the scientific studies that have been published today do not support that. … Could that change in the future? It’s possible. I think it’s very unlikely considering what I’ve reviewed, but it’s possible.”

Quentin Van Meter, a pediatric endocrinologist who served as an expert for the state on the issue, warned the board that an increasing number of children are seeking puberty blockers or other medical interventions.

“This is what we are dealing with. We’re dealing with a monumental epidemic of increasing proportions,” said Van Meter, who is an outspoken critic of transgender treatment for young people. “This is a giant experiment on United States children.”

Van Meter also said Sweden, Finland and the United Kingdom have halted treatment for transgender youths because “they found that there was far more harm than any benefit in allowing these children to receive any kind of medical intervention.” According to Van Meter, roughly 127,000 children throughout the U.S. are receiving gender-affirming treatment.

But Michael Haller, a professor and chief of pediatric endocrinology at the University of Florida, disputed Van Meter’s comments, saying fewer children are receiving gender-affirming hormones or other therapy than the public has been led to believe and that the numbers aren’t growing.

Haller and other doctors also have argued that standards of care for trans youths were developed by professional medical societies after years of vigorous scientific debate.

Questioning Haller, board Chairman David Diamond noted that other countries have changed their approaches to treatment of gender dysphoria, which the federal government defines clinically as “significant distress that a person may feel when sex or gender assigned at birth is not the same as their identity.”

“Do you have any sense what the scientific underpinning may be, why they have modified their opinions, or is it your contention it was not a scientific decision but rather based upon other factors?” Diamond asked.

“I think it’s impossible to fully separate the political decision-making from the science,” Haller said.

Diamond, an oncologist, pointed to breast-cancer treatments adopted in the 1990s that later were discovered to be harmful.

“The bottom line is, just because you think something works, does not mean it works,” the board chairman said. “The point is … we must continuously assess what we’re doing and have the capacity to say maybe what we’re doing is wrong. Maybe our beliefs are wrong. Maybe we can listen to the other person on the other side or accept the newer data and potentially make our position a little bit better, a little more refined, to better seek the truth.”

Diamond asked Haller and his UF colleague, Kristin Dayton, if they believed the board should adopt guidelines or rules for gender dysphoria.

Dayton, a pediatric endocrinologist who specializes in gender dysphoria, said such a plan would be “redundant” because standards of care already exist. But Haller indicated he didn’t trust the state to advance its own plan.

“If the redundancy were such that it was in line with the general practices and data, then I think it would be adequate. But it’s clear that is not the intent of the state,” Heller said. “They have provided you with a recommendation for a rule that is contrary to what almost all reasonable providers of gender-affirming care and gender care in general would say is the standard of care.”

If guidelines are finalized, Florida would be the only state in the country where a medical board has barred transgender treatments for adolescents, according to Yale School of Medicine professor Meredithe McNamara.

A handful of other states have passed laws blocking the treatment, but McNamara, who specializes in adolescent medicine, told The News Service of Florida this week that she’s “never heard of” a state medical board prohibiting such care.

“Standards of health care don’t come from states, don’t come from governments. They come from clinical research that gets reviewed and vetted and discussed in relevant groups of experts and published and spread widely and adopted by people everywhere,” she said.

Many of Friday’s attendees urged the board to accept the health department’s petition, but Kaleb Hobson-Garcia said he made the seven-hour drive from Tallahassee to share his experiences with the panel.

“I wasn’t always the 20-year-old man you see standing in front of you. … I used to be an 11-year-old kid who had just changed his name to Kaleb,” he said.

Hobson-Garcia, 20, said he and his parents consulted with a doctor for a year before he began medical treatment. He said began taking puberty blockers at age 12, hormone suppressants at age 13 and underwent “top surgery” at age 14. Despite his experiences, Hobson-Garcia said he agrees with current guidelines that recommend a minimum age of 16 for “top” surgery and 18 for “bottom” surgery, or penis removal.

“The medical treatment I received as a minor was integral to me climbing out of my depression and becoming the happy and healthy person I am today,” Hobson-Garcia said. “My identity is not an epidemic. We cannot stand to lose progress towards a happier, healthier future for all Floridians.”

Kevin Cairns, an interventional pain specialist who serves as the board’s vice chairman, was the sole member of the board to vote against granting the Department of Health’s petition to begin the rule-making process.

Ernie Sauve was among the people who asked the board to move forward with the plan. As someone who speaks Spanish fluently, Sauve said he “could identify” as a Spanish person, but that does not make him Spanish.

“Back in my day, women were women. Let children be children. … Let’s get back to reason, to common sense, and to truth,” he said.

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Dara Kam - News Service of Florida