Gender-affirming health care makes up a fraction of the caseloads in medical facilities run by Florida’s public universities, according to records that Gov. Ron DeSantis’ budget office ordered the schools to turn over in January.
The order has been a topic of high interest across the state, inspiring student protests and frequent remarks by the governor.
“You’re talking about publicly funded institutions,” DeSantis said at a Jan. 31 news conference in Bradenton, laying out his rationale for the request. “Those are not things that I think are appropriate use of your tax dollars.”
According to his spokesperson, Jeremy Redfern, “radical gender ideology has supplanted academics at many institutions of higher education,” and the goal is to “get our colleges and universities refocused on education and truth.”
DeSantis has framed the issue in stark terms, referring to gender-affirming treatments as mutilation in his State of the State address last week and arguing that minors seeking gender transition would do better to wait.
“Most of it resolves itself by the time they become adults,” he said in Bradenton, “but the way to deal with that is to provide whatever counseling is needed, not to hack off their body parts.”
As the governor and Republican legislators make gender issues a priority, the numbers reported by Florida universities represent a small part of their overall caseloads, and the medical considerations around them are more complex than often portrayed in the political arena.
Nine of the state’s 12 public universities gave the Tampa Bay Times copies of what they submitted to DeSantis’ budget writers. They had been told to provide records from 2018 through 2022, with detailed counts of gender-related procedures; “encounters” with people seeking sex reassignment; and patients diagnosed with gender dysphoria.
The University of South Florida provided records dating only to 2019, citing a change in its data system.
Over the last three years, USF reported 698 cases that include the medical code for gender dysphoria, but the university said that number “fails to capture the complexity of clinical care environments.”
For example, USF explained, a patient being treated for depression could have gender dysphoria listed in their medical records as a “contributing condition” that came up during previous care.
Regarding instances where sex reassignment was sought, the university reported 48 “encounters” over the three years, noting that the number includes repeat visits by the same patient.
During that period, USF treated about 3 million patients overall, according to university estimates.
The University of Florida reported 1,914 patients whose medical files included the code for gender dysphoria over the last four years. Of those, 633 were younger than 18 and 751 were diagnosed prior to their first encounter at UF Health.
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The numbers were from UF’s medical facilities in Gainesville and Jacksonville, which together saw about 12 million patients over the four years, according to university estimates.
Caseload numbers were smaller at the other state universities that provided records.
The University of West Florida in Pensacola, Florida Polytechnic University in Lakeland and Florida International University in Miami said they had no encounters with the types of treatment DeSantis’ office asked about.
The University of North Florida in Jacksonville reported three individuals seeking sex reassignment treatment, two of whom were referred off campus and one who was prescribed hormones.
Florida Atlantic University, based in Boca Raton, reported 54 encounters over four years with individuals seeking sex reassignment treatment and seven people who were diagnosed under the code for gender dysphoria. The school offers health care through its student health services and primary care for the public through it’s college of medicine.
“The majority of visits for trans and gender expansive patients will be for typical health issues,” FAU said in documents submitted as a part of its response to the governor’s budget office. The university listed sore throats, immunizations and coughs as examples. It said all clinical staff are expected to make every effort to offer patients “basic comfort,” such as using preferred names and pronouns, and changing records accordingly.
The University of Central Florida in Orlando offers care outside it’s student health services through UCF Health. The school reported that it does not “initiate treatment for sex reassignment or provide initial evaluation for sex reassignment treatment.”
While UCF saw 84 patients over the last four years with gender dysphoria, officials there noted the diagnosis could have been part of a patient’s medical history and not necessarily the reason for the treatment at hand. Four of those patients were prescribed “maintenance medication” based on their previous care, the university said.
UCF Health sees just over 40,000 patients a year, while its student health service sees about 43,000.
In addition, some schools submitted data on specific treatments requested by the governor’s budget office, which wanted to know patients’ age ranges.
USF said it prescribed puberty blockers eight times over three years for patients ranging from 12 to 18 years old, but some of those were repeat visits by the same people.
It also prescribed hormones 333 times, including 180 times for contraceptives. While the patients involved had sought sex-reassignment treatment at some point, the university said the prescriptions involved “a broad set of medications used to treat a variety of conditions in both male and female patients … for a plethora of hormonal imbalances.”
The conditions they addressed included acne, abnormal uterine bleeding, menopause, mood and sleep problems, anemia and bone thinning, among others.
Fifty-five individuals underwent mastectomies at USF over the three years, the youngest a 16-year-old who was treated for a birth defect. And 36 people, ages 19 to 46, underwent hysterectomies.
The university said it treated 20 people, ages 20 to 74, who underwent an orchiectomy, a surgical procedure in which one or more testicles are removed. The procedure is used to treat testicular cancer, as well as breast and prostate cancer in men. It is also available for transgender women as they transition.
The governor’s budget office wanted detailed data on several other procedures involving surgery on genitalia, but USF said it had no cases to report.
The University of Florida reported 41 such surgeries over the four years.
It also said 90 patients received prescriptions for puberty blockers, including 74 who were younger than 18.
Among the 712 patients who received hormones, 159 were under 18.
The university reported that 25 people seeking treatment related to gender identity underwent mastectomies while 18 underwent breast augmentations. All were older than 18, UF said.
Students at USF and across the state have protested the governor’s records request, asking their universities not to comply. They argue that the small numbers could lead to privacy violations. They also contended that many transgender individuals never seek the treatments the governor inquired about because of how cost prohibitive they are.
State Rep. Anna Eskamani, D-Orlando, who has been critical of DeSantis’ higher education efforts, said she saw the request as an attempt to intimidate transgender individuals from seeking care on campuses, creating a “borderline registry of trans people.”
She called it “incredibly offensive and invasive” and said she expected to see students begin to seek care at medical facilities not associated with public universities.
USF spokesperson Althea Johnson said, “the university did not provide information that identifies an individual patient or violates patient privacy laws.”
The university’s response also included a 2017 study from the Endocrine Society, which has determined clinical standards of care for treating transgender individuals.
The organization has condemned the Florida Board of Medicine’s recent decision to ban gender-affirming care for transgender and gender-diverse teenagers, calling it “blatantly discriminatory” and against well-established medical evidence.
It added that the treatments recommended for adolescents are reversible, and take a “conservative approach that gives teenagers and their families more time to explore their options.”
“Medical evidence, not politics, should inform treatment decisions,” the organization said.
Divya Kumar covers higher education for the Tampa Bay Times, in partnership with Open Campus.