Florida’s excuse on gender-affirming care is troubling
As an adolescent medicine physician, I am glad that the new year starts with publication of a landmark study on the benefits of gender-affirming care for transgender youth. Funded by the National Institute of Health, this study reports positive outcomes for a large population across over several years. It also adds to a wealth of evidence showing that medical treatments for gender dysphoria are associated with improved mental well-being, less suicidality, and healthy social development.
This study also offers another scientific counterpoint to false assertions about gender-affirming care, which now dominate health policy discourse in Florida, Texas, Alabama, and Arkansas among others. In 2022, so many measures banning care for transgender youth were proposed that up to 98,000 minors face loss of safe, standard medical treatments. Without access to the full range of these services, as many as 40% of transgender youth consider suicide. The most convoluted anti-transgender strategy comes from Florida. The Agency for Health Care Administration (AHCA), which oversees Medicaid programs, issued a 2022 report concluding that transgender identity is unstable and medical care for gender dysphoria is experimental. Following this, 9,000 transgender Floridians were denied Medicaid coverage of treatments they’d long received without state objection. And while four transgender plaintiffs have filed suit to reverse this rule, a motion to block its enforcement was denied and a full trial is scheduled for May.
New evidence has emerged that regulatory processes for reviewing medical evidence in Florida were ignored. The cost of producing this report and litigation to defend its flawed findings approaches $1.3 million. This misuse of science harms youth, degrades trust in the medical profession and consumes state resources.
In a line-by-line analysis of the AHCA Report, I worked with my colleagues to document its errors. The authors remain undisclosed, a worrisome sign of biased agenda. Accompanying the report was a rushed and partial review of the literature, performed by a dentist who excluded key studies and misapplied a well-regarded method for grading evidence.
Other appendices to the report were written by those with publicly expressed anti-transgender beliefs and dubious subject-matter expertise. According to state officials, such reports may take years to produce but this one materialized in months. Despite these flaws, the AHCA Report is doing major damage. Florida’s Surgeon General Joseph Ladapo urged the Board of Medicine to prohibit gender-affirming care for youth statewide. The Board hastily complied but its determination is not yet enforced and Floridians have made their opposition resoundingly clear. A new hearing is scheduled for Feb. 10.
For those who do not have close familiarity, gender-affirming care for youth may seem confusing. The nuances of this care are easily obscured by disinformation and political debate. The singular priority is to support youth in achieving an authentic expression of their selfhood. Not all with gender diverse identities experience clinically significant distress known as gender dysphoria. Not all with gender dysphoria have gender affirmation goals that include medication. Surgery is so rarely desired in adolescence that I have never cared for a patient who has wanted a mastectomy or genital surgery during their teenage years. With patients, their parents, and other providers, we assess and reassess the course of care that fosters their well-being. Critically, parents decide on gender-affirming medications after expert assessment. Pediatricians of all specialties know the critical role of family support in helping youth flourish. No other country in the world has prohibited gender-affirming care for youth, but the active Medicaid ban in Florida put the United States out of step with international practice. Reason for hope comes from ever-advancing research and fierce legal challenges that expose the misuse of science.We must stop questioning the sacred decisions made in pediatricians’ offices and instead, question the processes by which such bans are manufactured. Until these bans are dismantled and disinformation is cast out of health policy, no one is safe from its harms.