New rules approved by the Florida Board of Medicine and the Florida Board of Osteopathic Medicine last week will ban medical treatment for transgender children with gender dysphoria.
It’s a decision that puts Florida at odds with existing treatment standards endorsed by the American Academy of Pediatrics, American Psychological Association, and American Academy of Child and Adolescent Psychiatry, among other medical organizations.
While some Republican-controlled state legislatures have enacted bans through legislation, Florida is the first to do so through its medical commissions.
After the ban takes effect, doctors in the state who continue to prescribe puberty blockers, hormone therapy or surgeries to treat gender dysphoria in new patients under 18 could lose their license.
Gender dysphoria is defined as a strong and persistent sense of identification with another sex and significant discomfort and distress with that assigned at birth. This can lead to serious mental health issues.
Condition is rare. Based on the number of people who seek treatment, less than 0.1% of the population is diagnosed with gender dysphoria, according to the American Psychiatric Association.
The medical advice’s decision raised a series of questions for parents and healthcare providers about what happens next. Here’s what we know:
What happens now?
Medical boards will publish their rules in the Florida Administrative Register, a daily publication that provides information about proposed regulations. After that, residents will have 21 days to request a public hearing into the planned restrictions.
If a hearing takes place, LGBTQ advocates could oppose the regulations or suggest changes. Based on that feedback, board members could change the rules or keep them as they are, said longtime medical board attorney Ed Tellechea.
When will the ban take effect?
That remains uncertain, although it could be early next year.
“In reality,” Tellechea said last week, “once the rules language is released, we’re talking about 60 to 90 days before it becomes effective.”
As of Friday morning, the councils had not published their rules in Florida’s administrative registry.
Will there be exceptions to the ban?
The ban does not apply to children who have already been prescribed puberty blockers or those on hormone therapy. They are grandfathered, although it is unclear whether the clinics treating them will continue to do so.
The Board of Osteopathic Medicine will also allow osteopathic physicians to prescribe puberty blockers and hormone therapy to new patients under age 18 who enroll in clinical trials at Florida medical schools. That’s as long as those studies have been approved by an institutional review board, which is an academic committee that reviews whether the research is ethical.
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The Board of Medicine rejected the same exclusion for physicians, who vastly outnumber osteopathic physicians in Florida.
What are the options for children with gender dysphoria?
In short, the options are limited. Even before recent medical board votes, some gender hospitals and clinics had stopped accepting new patients, including the gender program at Nicklaus Children’s Hospital in Miami.
USF Health at the University of South Florida previously provided hormone therapy and plastic surgery. Now, it plans to operate “entirely in accordance with the decisions and guidelines of the Florida Board of Medicine,” a spokesperson said. USF Health declined to say whether it would continue to treat existing patients and whether it was accepting new ones.
According to Michael Haller, professor and chief of pediatric endocrinology at the University of Florida, who said he was not speaking on behalf of the University.
As a result, the Gainesville clinic has seen an influx of patients that has “exceeded its ability to provide care to everyone in need,” he said in an email.
Until the ban takes effect, doctors will still be able to provide care to young people of various genders according to guidelines approved by the American Academy of Pediatrics, Haller said.
“If the Board-approved rule becomes active, teens with gender dysphoria will be forced to seek treatment outside of Florida until a successful lawsuit overturns the Medical Board’s decision,” Haller said.
Will the restrictions be challenged in court?
“There will undoubtedly be legal challenges,” Simone Chriss, director of the Transgender Rights Initiative at Southern Legal Counsel, a Gainesville-based nonprofit law firm, said at a recent press conference. The company and several groups are suing the state over a rule barring Medicaid coverage for gender dysphoria treatments.
“We’re actively advocating a ban on Medicaid,” Chriss said, “and we’ll fight this one as well. … These things can’t stand. These people know it’s unconstitutional.”
The Florida Department of Health, which has urged councils to ban the treatments, did not respond to a request for comment.