TAMPA — While Florida considers banning hormone therapy and surgeries for transgender youth, the current political debate about treatment for gender dysphoria is already having a chilling effect on those seeking care.
A surgery scheduled for a St. Petersburg transgender boy at Tampa General Hospital was canceled in June after both the hospital and the unaffiliated surgeon expressed concerns about performing the procedure over fears of future sanctions, according to the boy’s mother. More patients are traveling out of state to get treatment, according to some surgeons. It’s also become tougher for plastic surgeons to find hospitals willing to allow them to use operating rooms, said Sidhbh Gallagher, a Miami plastic surgeon who specializes in surgery for people transitioning gender.
Nicklaus Children’s Hospital in Miami said on Sunday that it stopped accepting new patients to its gender program, and several pediatric clinics have either followed suit or have ceased prescribing puberty blockers and hormones for children, said Michael Haller, chief of pediatric endocrinology at the University of Florida.
“This is another example of politics interfering with the inviolability of the doctor-patient relationship,” Haller told the Tampa Bay Times in an email. “I expect to see additional situations in which patients are forced to seek care outside of our state.”
Gender dysphoria is defined as strong, persistent feelings of identifying with another gender and significant discomfort and distress with the one assigned at birth. It can lead to severe mental health problems. At least one in four kids diagnosed with gender dysphoria reports having attempted suicide, according to three studies cited by a peer-reviewed case report.
Sixteen studies listed by Psychology Today found that medical treatment for gender dysphoria led to better mental health outcomes for transgender youth. Denying children such treatment could increase the risk of suicide, transgender advocates warn.
Medical treatment for gender dysphoria is rare. Based on the number of people who seek treatment, less than 0.1% are diagnosed with gender dysphoria, according to the American Psychiatric Association.
It’s unclear how many children in Florida receive treatment for gender dysphoria. A report from the Agency for Health Care Administration shows Medicaid funding in 2021 paid for a dozen children to have surgery, 346, children to be treated with male hormones and 151 children to get female hormones.
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Standard treatment practices
Gov. Ron DeSantis’ administration is challenging psychiatric and medical standards for treating gender dysphoria that have been around for decades. The World Professional Association for Transgender Health first published guidelines in 1979. The Endocrine Society released its medical advice in 2009.
Recommended treatments known in the medical community as gender-affirming care include psychiatric help and counseling, and allowing children to socially identify and dress in the gender with which they identify.
In some cases, doctors prescribe puberty blockers and hormone therapy so that a child’s body aligns with their identity. Children ages 16 and older may be recommended for a mastectomy if they meet strict criteria and are able to give informed consent along with their parents. Genital surgery such as vaginoplasty is not recommended for children.
The standards have been endorsed by the American Academy of Pediatrics, the American Psychological Association, and the American Academy of Child and Adolescent Psychiatry and other national medical organizations.
But in the past year, more than a dozen Republican-controlled states have enacted legislation to restrict or ban treatment or surgeries for minors. It comes after years of litigation and lawmaking driven by conservatives about whether transgender girls can compete in women’s sports, limiting or banning discussions about sexual orientation and gender for some grade levels in schools, and which bathroom is appropriate for transgender people to use.
In April, the Florida Department of Health released new guidance against the use of treatments like puberty blockers and hormone therapy for children. It said social transition — the use of a different name, pronouns or style of dress — should not be a treatment option.
Florida Surgeon General Joseph Ladapo also requested the state’s medical board create rules that could restrict access to certain gender dysphoria treatments. Last week, a rule denying Medicaid coverage for treatments like puberty blockers and hormone therapies for all residents, regardless of age, went into effect.
“There clearly is a level of risk with these procedures, both the hormone therapy and hormone blockers for individuals who are in puberty, and for the surgical interventions,” Ladapo said during an Aug. 5 meeting of the state’s medical board.
Surgical treatments not common
The Youth Gender Program at the University of Florida currently follows about 50 children receiving puberty blockers, according to data supplied by the clinic. About 200 of its patients are receiving hormone therapy.
Less than 50 patients in the practice have had mastectomies, which are not performed on children under 16.
Johns Hopkins All Children’s Hospital in St. Petersburg treats children with gender dysphoria. In some cases, patients are prescribed hormones but the hospital does not perform gender-reassignment surgery, officials said.
“Johns Hopkins Medicine continues to support all children, including transgender youth who have high risks of depression, anxiety and suicide,” spokesperson Danielle Caci told the Times in an email. “We support the American Academy of Pediatrics statement that all children should have access to evidence-based gender-affirming care at developmentally appropriate ages in order to reduce gender dysphoria and improve mental health.”
In addition to not accepting new patients, Nicklaus Children’s Hospital in Miami recently removed the gender program page from its website. Hospital spokesperson Fuad Kiuhan said the changes were due to “a number of factors” but declined to elaborate.
Some hospitals are no longer publicizing medical treatment for transgender people after Boston Children’s Hospital was inundated with threats and harassed online over informational videos on YouTube, according to a USA Today report.
The St. Petersburg boy whose surgery was canceled was diagnosed with gender dysphoria when he was 11, according to his mother. The Times is not naming the mother nor the boy, who is 16, to protect his identity.
The boy had worn chest binders, a garment that flattens the chest, since seventh grade. The option of surgery was discussed between the boy, his parents, doctors and his psychiatrist for several years before he was approved for a double mastectomy. It was scheduled for June 6 at Tampa General Hospital with a plastic surgeon from the University of South Florida’s Plastic Surgery Department.
Three days before the operation, his mother was told by telephone that the surgery was being canceled. The day the procedure was supposed to take place, she attended a meeting at USF Health South Tampa Center for Advanced Healthcare on Davis Islands, emails provided to the Times show. Officials from both the plastic surgery department and Tampa General told the boy’s family they were concerned about reprisals from the state, the mother said.
The boy was “devastated,” his mother said.
The family traveled to Rush University Medical Center in Chicago in July where the surgery was performed. While the boy was recovering, the family stayed in a room provided by the hospital, for which they paid just under $1,000. They also spent around $1,300 on plane tickets. Their private insurance covered the surgery.
Tampa General officials declined to comment on the boy’s case, citing confidentiality concerns.
Tampa General Hospital “has no formal policy on performing gender-affirming surgeries,” spokesperson Jennifer McVan told the Times in an email. “Of course the hospital periodically performs these surgeries when medically necessary. The decision on performing the surgery is between the physician and the patient (and) their family, based on what is determined to be the most appropriate medical direction.”
The boy’s mother said the DeSantis administration is putting transgender children at risk.
“I don’t think there’s a willingness to understand the decisions made by trans youth and their families ... and the effect body dysphoria has on a daily basis and how ruinous it can be,” she said.
Requests for comment from the DeSantis administration were referred to Florida’s Agency for Health Care Administration. Officials there cited policy changes in Sweden, Finland and the UK to adopt stricter criteria for medical treatment of gender dysphoria in children.
“We have seen a dangerous trend in recent years of medical societies and associations in the United States, along with the federal government, mixing politics and medicine when it comes to the treatment of gender dysphoria,” said agency spokesperson Brock Juarez. “It is imperative that the medical community ensure their focus remains on the actual evidence.”
The boy’s surgery was performed by Loren Schechter, director of gender-affirmation surgery at Rush and a member of the executive committee of the World Professional Association for Transgender Health.
He said the hospital has recently treated about 20 patients from other states where transgender surgeries have been banned or restricted or have become more difficult to obtain. That includes several from Florida, he said.
“They’re prepared to undergo the procedure and then you get a phone call that the surgery is now canceled,” he said. “That’s quite traumatic.”
Joshua Safer, executive director at the Center for Transgender Medicine and Surgery at Mount Sinai Health System in New York, said he has been speaking with another Florida family who wants to travel to his clinic for treatment for their child because planned appointments were canceled by their medical provider.
Gallagher, the Miami plastic surgeon, has been performing gender-reassignment surgeries for eight years. She was recently contacted by the FBI after agents picked up online chatter about a plot to target her clinic, she said.
Though Gallagher can perform most operations in her clinic, some major surgeries where the patient may need to be admitted take place in a hospital operating room, she said, with hospitals sharing some of the proceeds of the surgery cost. About 95% of her patients are adults, she said.
In recent months, it’s become tougher to find a hospital that will allow gender-reassignment surgery, Gallagher said.
“Patients are scared. They’re upset,” she said. “These are powerful bodies that are targeting them.”