Florida gender-affirming care memo goes against federal guidelines

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This story has been updated.

In a surprise move Wednesday morning, Florida’s surgeon general issued a memo to healthcare workers about gender-affirming care. This advises doctors against prescribing puberty blockers or hormone therapy to transgender youth and states that social gender transition – a non-medical process in which a person uses a name, pronouns and/or clothing that matches their identity gender – should “not be a treatment option for children or adolescents”.

The memo directly contradicts U.S. Department of Health and Human Services guidelines on gender transition, as well as best practices outlined by the nation’s top medical organizations. In a statement released alongside a “fact check” of the evidence, Florida Surgeon General Joseph Ladapo questioned HHS guidelines and its motives, accusing it of “injecting political ideology into the health of our children.” “.

“Children with gender dysphoria should be supported by their family and seek advice, not pressured into making an irreversible decision before they turn 18,” Ladapo said.

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The memo, which is not legally binding, rejects evidence that supports the benefits of gender-affirming care, including its impact on the mental health of trans youth.

“Systematic reviews of hormone treatment for young people show a tendency for low-quality evidence, small sample sizes, and moderate to high risk of bias,” state new guidelines state.

Citing a lack of “conclusive evidence”, as well as the potential for irreversible long-term effects, the state’s surgeon general advises against prescribing puberty blockers and hormone therapy to anyone under 18; states that gender reassignment surgery should not be an option for children or adolescents; and affirms that social transition should not be a treatment option.

The note adds that the new guidelines do not apply to intersex children or adolescents.

Doctors’ groups, trans rights advocates and civil rights groups denounced the memo, which they said was a politically motivated attempt to confuse established medical practices. The American Civil Liberties Union called management a “desperate effort to sow lies and fear about transgender youth, their parents and their health care.”

“The Florida Department of Health is attempting to demonize vital, critical, and medically necessary health care for transgender youth,” Daniel Tilley, chief legal officer for the ACLU of Florida, said in a statement.

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The Endocrine Society, a global organization representing more than 18,000 doctors who specialize in the study and treatment of hormonal issues, called on the public health agency to rescind its bulletin and “allow doctors to provide care based on proofs”.

“Medical evidence, not politics, should inform treatment decisions,” the group said in a statement shared with The Washington Post. “The Florida Department of Health bulletin cites only a handful of studies. This contrasts with official medical guidelines which conform to the standards of the Institute of Medicine. Our clinical practice guideline meets these national standards and cites over 260 scientific studies.

The councils come amid an unprecedented wave of laws aimed at restricting the rights of LGBTQ Americans, especially those of trans youth. Conservative state lawmakers have increasingly proposed bills that would criminalize gender-affirming care for minors, including in Florida. State Rep. Anthony Sabatini (R) introduced such legislation last year, but the bill was never returned from committee.

Legislation is not the only tool used by politicians. In Texas, Governor Greg Abbott (R) issued a directive earlier this year ordering the state’s child welfare agency to investigate reports of children receiving gender-affirming care as “child abuse”.

The Biden administration has spoken out against such actions. Last month, the White House affirmed that trans people have a constitutional right to gender-affirming health care.

The nation’s top medical organizations — including the American Medical Association, the American Psychiatric Association and the American Academy of Pediatrics — have publicly supported gender-affirming care. For trans minors, this usually includes social transition and may include non-surgical treatments, such as puberty blockers or hormone therapy.

The Endocrine Society notes that only reversible treatments to delay puberty are recommended for young adolescents, and that the same treatment has been used for decades to treat precocious puberty for cisgender girls.

“While Florida Department of Health policy is concerned about surgery being offered to adolescents under the age of 18, the reality is that gender-affirming surgery is generally limited to adults who meet the medical and psychological requirements “, he said in his press release.

While conservative lawmakers across the country have argued that gender-affirming treatments such as puberty blockers are “experimental,” few bills have explicitly challenged social transition. For gender-differentiated minors, this usually means changing their hairstyle or clothing, and HHS guidance indicates “gender-affirming hairstyles” for example.

Florida’s advice is full of misinformation, said Jack Turban, a research fellow in child and adolescent psychiatry at Stanford University School of Medicine, where he studies the mental health of trans youth.

“It is shocking to see a public health organization spreading misinformation about health care,” Turban said in an email to the Post. “There are misrepresentations on almost every line of this document.”

Turban said Ladapo cited “outdated and irrelevant” review articles, as well as key evidence published in recent years that linked gender-affirming medical care to improved mental health outcomes.

Ladapo’s advice cites a controversial article published in the International Review of Psychiatry which found that 80% of those who seek clinical care for gender issues “will lose their desire to identify with unrelated sex at birth”. . The paper has been criticized by Turban and other experts for its methodology: They say the study includes a large cohort of children who didn’t actually meet the criteria for gender dysphoria, meaning they don’t weren’t transgender.

A 2021 study by Turban and researchers from the Fenway Institute and Harvard Medical School found that 13.1% of people who identify as transgender have “detransitioned” at some point in their lives, but that doesn’t is not motivated by regret, but by discrimination, stigma and family pressure.

Ladapo, the state’s top doctor, has been the subject of controversy since being confirmed by the Florida State Senate earlier this year. He criticized pandemic-era safety measures adopted by the vast majority of the medical community, including quarantines, vaccines and the wearing of face masks.

Jeremy Redfern, press secretary for the Florida Department of Health, answering questions about why the new office the recommendations run counter to those of the wider medical establishment, repeated Ladapo’s assertion that the evidence was inconclusive.

“The burden of proof rests [major medical institutions] to back up their claims,” Redfern said. “We have provided an analysis of the current evidence and made recommendations based on that evidence.”

Chandler Martin, a second-year medical student at Fort Lauderdale, said receiving Wednesday’s memo from an official health care governing body “was incredibly shocking and disturbing.”

The part of the memo according to Martin that is most likely to cause harm is the advice against social transition.

“It’s well known to anyone familiar with trans issues that trans suicide rates are among the highest of any minority cohort,” Martin said. “These rates are highest among trans people of color and trans youth.”

“The best way to mitigate trans suicide rates, outside of any medical intervention or hormone therapy, is to create an accepting and loving environment for these at-risk populations, and allow them to live as they truly feel,” did he declare. added.

Turban echoed that sentiment.

“The suggestion that social transitions should be avoided for trans youth goes against all existing medical guidelines and data,” he said. “Refusing to allow a child to make the social transition results in shame, damaged relationships between the child and the [provider]and damaged parent-child relationships – all of which lead to anxiety, depression and poor mental health outcomes.

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