Dr. Sujatha Prabhakaran could barely get her words out through the tears.
“As a physician caring for these patients, I know that this guidance from the Florida Department of Health puts youth in harm’s way,” she said, her voice cracking as the tears came. “It’s cruel to use the health care of children and adolescents as a political playground to attack and attempt to erase the trans and gender diverse community from Florida.”
Prabhakaran joined a panel of speakers Thursday for a zoom conference sponsored by the Florida Coalition for Transgender Liberation. The call was a response to DOH guidelines released Wednesday that discourages treatment of gender dysphoria for children and adolescents with hormone therapy, puberty blockers, or social transitioning. All three are treatments medical professionals and members of the transgender community say are crucial to the safety and health of trans youth.
The guidelines run counter to the U.S. Department of Health and Human Services’ own guidelines released in March that support gender-affirming care for trans youth.
The Florida guidelines said the state used the most up-to-date scientific data available. The guidelines cite a 2015 study that found “80% of those seeking clinical care will lose their desire to identify with the non-birth sex.” And another review says, “hormonal treatments for transgender adolescents can achieve their intended physical effects, but evidence regarding their psychosocial and cognitive impact is generally lacking.”
“The studies that they use are flawed,” Emily Gray, transgender outreach coordinator for the Bay County LGBTQ Center, said. “They don’t delve into the actual science of it.”
In 2021, Frontiers in Psychiatry published a study that followed up on the 2015 study cited by the DOH and other studies. That study took note of an important shift in treatment. Doctors like Prabhakaran have only been using puberty blockers and hormone therapy for less than a decade.
But the studies began nearly 15 years ago.
“It can, however, be said with certainty that the vast majority of boys were seen during a particular period of time when the therapeutic approach of recommending or supporting a gender social transition prior to puberty was not made,” the 2021 study said.
Adding: “In contrast, in recent years, it has become more common for some clinicians to recommend a gender social transition prior to puberty; for discussion. It has also become more common for parents to have already implemented a gender social transition on their own, without any formal input from a health professional … this is a very different type of psychosocial treatment designed to reduce gender dysphoria when compared to the other kinds of treatments noted above that have been recommended over the years.”
The study found more research needs to be conducted now that such treatments are available to assess the accuracy of the 80% finding, suggesting it could be much different when treatment supports transition.
One form of transition — social transitioning — now discouraged by the DOH is already having major impacts on the mortality of transgender youth, many of the panelists said. Social transitioning can vary greatly from person to person, but generally consists of people surrounding someone transitioning acknowledging and supporting that transition. It does not require any medical treatment.
Coalition Member Cyrus Bressack said they were alarmed to see social transitioning discouraged.
“The very thing that, when met with acceptance, has already been shown to cut in half the already astronomically high suicide rate and it does so with zero medical intervention. Point blank, this guidance is fearmongering,” they said. “It will come at the expense of our children. In its aftermath, we will see a rise in the trans youth suicide rate. It has been made painfully clear that trans people — and specifically trans youth — are not safe in Florida.”
Studies conducted by The Trevor Project have found elevated rates of suicide or suicide ideation among trans youth. In 2019, it found 54% considered suicide and 29% attempted it. The Trevor Project found that something as simple as acknowledging a name change had a profound impact.
“Usage of chosen name resulted in a 29% decrease in suicidal ideation and a 56% decrease in suicidal behavior for each additional context in which it was used,” a Trevor Project report said.
Allison Yager, Executive Director of the Florida Health Justice Project said she sees firsthand how this policy will impact families.
“When I shared the news of this policy with my 12-year-old trans child they said to me, ‘just let me live. Just let me live.’ Our Governor this Session has signed into law the ‘Don’t Say Gay’ bill which was passed in the name of parental rights,” Yeager said. “But I say what about my parental rights? What about my family’s right to choose what is right for our child without the interference of the state in the name of culture wars? We’re being told that Florida is the freest state. This is not freedom. This is the inverse of freedom.”