Florida doctors can no longer provide gender-affirming treatments for transgender minors

Florida’s medical doctors could have to follow dueling rules when it comes to gender-affirming care after the state’s two medical boards voted to adopt different standard-of-care policies.

At a joint meeting in Orlando Friday members of the Board of Medicine agreed to alter the standard-of-care rules to ban doctors from performing gender-confirming surgeries on anyone under the age of 18 and from providing puberty blockers and hormones to anyone under the age of 18. 

Over the objections of chairman and oncologist David Diamond, members of the Board of Medicine voted Friday to remove from the proposal an exemption that would have allowed physicians to treat patients with puberty blockers and hormones if they agreed to participate in Institutional Review Board-approved, investigator-initiated clinical trials at one of Florida’s medical schools.

Members of the Board of Osteopathic Medicine, though, voted to maintain the exemption.

It is one of the first times, according to the medical boards’ legal staff, that there could different standard of care rules based on whether someone is a medical doctor or an osteopathic physician.

The boards’ votes mark the beginning of the official rule-making process. The changes are just proposed until they become final, a process that could require additional public meetings.

When a Joint Legislative Rules Committee agreed last week to draft a similar proposal it proposed allowing minors to continue to access puberty blocking hormone or hormone antagonist therapies so long as they agreed to participate in research. But Board of Medicine members Hector Vila, a Tampa anesthesiologist, and Patrick Hunter, a Pensacola pediatrician, said they were not comfortable with the exemption for research.

Hunter, who initially advocated for the research exemption, said Friday he wasn’t sure minors with gender dysphoria should be asked to consent to gender-affirming care. He also questioned whether research on gender-affirming care could be done safely and ethically given the treatments he said are known to lead to sexual dysfunction and sterility.

“We need to return to the community standard of care for treating distress and that is psychotherapy — ethical, compassionate psychotherapy that respects the child’s experience, Let me say that again. Ethical, compassionate psychotherapy that respects the child’s experience,” Hunter said in support of an all-out ban on providing minors with gender-affirming care.

Diamond, a clinical oncologist, acknowledged that there’s a substantive dispute over the best treatment for gender dysphoria. But he said that underscores the need for research.

“I say let us study it. Let us study it well. Let us use the advantages that we have of having distributed high-quality medical schools throughout this state and let us be the light to the world …”  Diamond said. “Otherwise we will never know.”

Gender dysphoria refers to psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity. And though gender dysphoria often begins in childhood, some people may not experience it until after puberty or much later, the psychiatry association maintains.

Members of the Board of Medicine and Board of Osteopathic Medicine, some of whom have contributed to Gov. Ron DeSantis, agreed to develop Florida guidelines for the treatment of gender dysphoria in August at the request of state Surgeon General Joseph Ladapo.

LGBTQ advocates have decried the proposed ban as transphobic and say it will harm transgender people.

“With young lives on the line, another state agency has placed the political ambitions of Ron DeSantis over its duty to protect Floridians,” said Nikole Parker, Equality Florida’s Director of Transgender Equality. “These rules, as written, put transgender youth at higher risk of depression, anxiety, and suicidality. Those are the facts purposely ignored by a Board of Medicine stacked with DeSantis political appointees who have put their toxic politics over people’s health and wellbeing. Transgender Floridians exist. We are part of this community. Gender-affirming care is lifesaving care — and it is care that is supported by every major medical organization, an overwhelming majority of medical providers, and should be left to young people, their families, and their doctors. Not politicians. Shame on the Florida Boards of Medicine and Osteopathy for trading the suffering of transgender youth and their parents for cheap political points.”

Meanwhile, the Florida Medicaid program no longer provides coverage for gender-affirming health care after Medicaid Director Tom Wallace determined gender-affirming care was experimental. Wallace made that determination based on what he said was a thorough report of assessments of the benefits of gender-affirming care.

That rule has been challenged in federal court.