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Trans care limits receive backing from medical boards' joint committee

 Trans advocates hold up signs at a joint meeting of the Florida Board of Medicine and Florida Board of Osteopathic Medicine.
Daylina Miller
WUSF Public Media
Trans advocates hold up signs at a joint meeting of the Florida Board of Medicine and Florida Board of Osteopathic Medicine.

Members of the Florida Board of Medicine and Board of Osteopathic Medicine voted on a draft rule that would ban doctors from providing gender-affirming treatments to people younger than 18.

Jacob Riley took the day off school and made the drive from Gainesville to Orlando on Friday to speak out at a joint committee meeting of the Florida Board of Medicine and Florida Board of Osteopathic Medicine on the topic of gender-affirming care for transgender youth.

Wiley, 17, started hormone treatment therapy when he was 15, after two years of therapy and social transition, which typically includes changing one’s name, pronouns and gender expression.

“I wouldn't be able to be here at all if it wasn't for me being able to start at such a young age,” he said.

 Jacob Wiley, 17, a Gainesville resident, attended Froday's meeting to testify but the public comment period was cut short.
Daylina Miller
WUSF Public Media
Jacob Wiley, 17, a Gainesville resident, attended Friday's meeting in Orlando to testify, but the public comment period was cut short.

But he didn’t get a chance to speak. After nearly five hours of contentious presentations by six experts and dozens of testimonials, members of the boards cut the public comment period short after letting several anti-trans advocates speak out.

In the end, members of both boards voted on a draft rule that would restrict Florida doctors from providing treatments to transgender people under age 18. The full medical boards meet in a week, Friday, Nov. 4, for a final decision and to reveal the rule’s language.

If finalized, it will ban Florida doctors from providing reversible puberty blockers, hormone therapy treatments, and surgery for trans youth — surgery that experts say is rare.
The proposal will allow children already receiving hormone therapy or puberty blockers to continue their treatment. The joint committee discussed requiring parents to sign a consent form for such treatments to continue but did not finalize guidelines.

The committee also added a provision that would allow minors to begin receiving treatments such as puberty blockers if they participate in a federally approved clinical trial at a university-affiliated center. No such trials are underway in Florida, according to an initial review.

LGBTQ advocates said the rule, if given final approval, would be challenged in court.

In July, the Florida Department of Health filed a petition seeking a rule-making process on the issue of treatment for gender dysphoria, which the U.S. government defines as “significant distress that a person may feel when sex or gender assigned at birth is not the same as their identity.”

In August, the state Agency for Health Care Administration banned Medicaid from covering gender-affirming treatments for minors and adults, forcing many low-income transgender people to detransition, use black market hormones or move elsewhere for care.

During the meeting’s public comment period, several individuals testified on their experience detransitioning — or regretting their decisions to get hormonal or surgical interventions, and stopping the treatments.

These individuals were all flown in by the state, said Simone Chriss, the director of the Transgender Rights Initiative at Southern Legal Counsel. She said they are witnesses for the state in a case that her firm filed against AHCA over the Medicaid ban.

“None of these individuals are Florida residents, and none of them have received their treatment in the state of Florida and therefore, their opinion should have absolutely no basis on Florida's standards of care,” Criss said. “And it is appalling that the actual Florida residents who have experience with this care who are not flown in by the state of Florida as political props were not given a chance to speak today."

Chloe Cole, an 18-year-old from California, was among the detransitioners who told of worsening mental health problems, complications after surgery and lax medical care during or following treatment. Cole said she had a double mastectomy at age 15 and urged the committee to adopt the proposal.

“All of the talk about mental health, self-perception, pronouns and ideology leads me to this question: Why is the mental health epidemic not being addressed with mental health treatment, to get at the root causes for why female adolescents like me want to reject their bodies?” Cole said.

 Trans advocates staged a "Die-In" at the Hyatt Regency Hotel at Orlando International Airport.
Daylina Miller
WUSF Public Media.
Trans advocates staged a "Die-In" at the Hyatt Regency Hotel at Orlando International Airport.

Sarah Parker, 29, is cisgender, which means she identifies with the gender assigned at birth. She drove from Sarasota to speak about her rights as a parent to treat her son.

“I was in the NICU (neonatal intensive care) for 52 days with my son — 52 days. My son was 2 pounds and 5 ounces. You know what I did? I sat with doctors, several doctors, and they all gave me different options. And then I decided what was best for my family and my son.”

“Now, if my son decides that he's trans, you're going to tell me that I don't get that same right and privilege to go sit like I sat with him when he was in the NICU and make a decision with doctors?”

Dr. Meredithe McNamara, an assistant professor of pediatrics at the Yale University School of Medicine, was one of three experts who spoke out against the draft proposal Friday. When a board member asked her why so many gender clinics have opened since 2007, and why there are so many more trans children, she addressed the falsehood of “social contagion.”

“We live in a more forgiving and nurturing environment than we did 20 years ago. …There are trans and nonbinary role models, people who are trailblazing and showing young people it’s safe to be who they are. The data does not back up social contagion.”

McNamara also said that gender-affirming care is “not experimental or investigational,” with more than 16 studies confirming that standard medical treatments for gender dysphoria are safe and effective.

She’s also one of the authors of a paper that critically reviewed the June Florida Medicaid report on the medical treatment of gender dysphoria.

In it, the authors said, “We are alarmed that Florida’s health care agency has adopted a purportedly scientific report that so blatantly violates the basic tenets of scientific inquiry. The report makes false statements and contains glaring errors regarding science, statistical methods, and medicine.”

A study in the medical journal the Lancet this month showed that 98% of 720 participants diagnosed with gender dysphoria and prescribed hormone treatment as adolescents continued therapy into adulthood.

Mary Flynn, a consulting psychologist whose 12-year-old daughter is transgender, defended gender-affirming care for children, when appropriate.

“It’s a joy to raise this beautiful child, and everything we’ve heard before is nothing that I’ve ever heard before in any support group, by any physician, by anything,” Flynn said. “If we did not have this medicine, she would not be alive. ... What you’re talking about is waiting until age 18. Well, they won’t be here. This group commits suicide.”

Dara Kam of News Service of Florida contributed to this report.

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Daylina Miller is a multimedia reporter for WUSF and Health News Florida, covering health in the Tampa Bay area and across the state.