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Florida report on transgender care flawed, politically motivated, Yale experts say

A group of scientists, including four from Yale University, accuse Florida of making health policy based on pseudo science.
Jeanette Jennings, mother of transgender advocate Jazz Jennings, speaks in 2020 at a news conference in the Florida Capitol against a bill that would have made it a felony for doctors to provide minors with hormone therapy or to perform sex reassignment surgery. The bill did not pass but Florida's Agency for Health Care Administration is proposing a rule that would prevent the state’s Medicaid program from reimbursing providers for a series of therapies meant to treat gender dysphoria.
Jeanette Jennings, mother of transgender advocate Jazz Jennings, speaks in 2020 at a news conference in the Florida Capitol against a bill that would have made it a felony for doctors to provide minors with hormone therapy or to perform sex reassignment surgery. The bill did not pass but Florida's Agency for Health Care Administration is proposing a rule that would prevent the state’s Medicaid program from reimbursing providers for a series of therapies meant to treat gender dysphoria. [ SAMANTHA J. GROSS | Times/Herald ]
Published Jul. 14|Updated Jul. 14

A report from Florida’s Medicaid agency is anticipated to be the basis for a state rule banning the use of Medicaid to pay for hormonal therapies to treat transgender people diagnosed with gender dysphoria.

It concluded last month that puberty blockers and other hormones are “experimental and investigational.”

But a group of seven scientists and a Yale law professor are slamming the state report as unscientific, thoroughly flawed and politically motivated.

An analysis published by the group this week highlighted what it says are major deficiencies in the state’s 48-page report, which was released June 2 by Florida’s Agency for Health Care Administration. Among its findings:

  • The report ignored accepted scientific studies and consensus acknowledging gender dysphoria and the medical therapies effective in treating it.
  • Experts who helped write the report — some with ties to groups that oppose legal rights for the LGBTQ community — were chosen because of their bias.
  • If the state used the same criteria to evaluate other treatments, it would no longer, for example, allow Medicaid to pay for drugs that lower cholesterol.
  • The report cites sources that have no scientific merit, including a student blog and a letter to the editor.

The debate is more than academic. Experts have warned that denying treatment to those with gender dysphoria could have severe mental health consequences for those patients.

Anne Alstott, a professor at Yale Law School and one of the authors of the analysis, said Florida is using pseudo science to justify medical policy that fits a political agenda.

The state’s proposed rule would violate both the U.S. and state constitutions, in addition to Florida’s own rules that medical policy must be based on peer-reviewed science and accepted clinical guidelines, she said.

“The idea that you would take transgender people and take away their ability to access standard medical care is appalling,” she said. “It’s quite clear a medical policy that targets only medical care for transgender people is discrimination.”

Related: As DeSantis focuses on Florida transgender kids, here’s what you need to know

A spokesperson for the Agency for Health Care Administration said in an email Thursday that the state stands by its June paper.

“This is simply another example of the left-wing academia propaganda machine arrogantly demanding you follow their words and not the clear evidence-based science sitting right in front of you,” wrote Brock Juarez, the spokesperson. “The Yale ‘review’ is a hodgepodge of baseless claims using ‘expert opinions’ that lack any sort of real authority or scientific credibility.”

Juarez did not respond to specific allegations in the paper but linked back to research attached to the state report that purported to show that “the evidence showing benefits from hormone replacement therapies for gender dysphoria is very weak.”

The Yale report engages specifically with those exhibits, and argues they are not based on good science. It contends that its authors, which include James Cantor, a research scientist and clinical psychologist, and Quentin Van Meter, a pediatric endocrinologist and the president of the conservative American College of Pediatricians, are biased. It notes that the pair are or have been affiliated with groups that have taken stances against equal rights for transgender people.

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Cantor disputed that he is biased in an email Thursday.

“I am openly gay myself, with a long and public history of supporting transition,” Cantor wrote. “But because the science about transgender children shows different results than for transgender adults, my opinions about transgender children are different than for transgender adults.”

Cantor testified in favor of a law that blocks the use of puberty blockers and hormone therapies for children during a recent federal court case in Alabama. The judge wrote that he gave Cantor’s testimony “very little weight” as Cantor had never treated a transgender child under the age of 16 or diagnosed a child with gender dysphoria.

Van Meter’s American College of Pediatrics has been called a “fringe anti-LGBTQ hate group” by the Southern Poverty Law Center for, among other things, advocating for conversion therapy. In a 2017 blog post, the American College of Pediatrics wrote that the law center is “motivated by an anti-traditional Judeo-Christian animus” and asked news organizations “to stop using the Southern Poverty Law Center as a news source.”

Nathan Bruemmer, a transgender man and the LGBTQ consumer advocate at the Florida Department of Agriculture and Consumer Services, testified against the rule in a heated Tallahassee public hearing last week, saying the care was an important part of what he described as a happy, productive life.

”I am one of thousands, tens of thousands, of transgender Floridians here in our state who have had the privilege to have access to gender-affirming care,” Bruemmer said. “We are part of the fabric of this nation and of this great state, and we deserve the rights and benefits afforded to all.”

The day of the meeting, the Yale experts published their report calling the state’s analysis “highly deceptive” because it dismisses some medical studies as “low quality” without explaining that term is a technical one used by scientists to rank research. “Low quality” studies can still be used to craft clinical recommendations, according to a system researchers use to judge the quality of medical evidence called the GRADE system.

Researchers use such evidence to make recommendations often: doctors prescribe cholesterol-lowering drugs to millions of older Americans because of guidelines premised on observational studies, the analysis states.

The analysis also notes that clinical practice guidelines for the treatment of gender dysphoria, developed by the World Professional Association for Transgender Health, have been used for decades and confirmed as standard care by every relevant medical organization in the United States, including the American Academy of Pediatrics, the American Psychological Association and the Endocrine Society and the American Academy of Child and Adolescent Psychiatry.

The rule limiting access to hormonal therapies to Medicaid patients has yet to be finalized but the state seems likely to make it official. It’s unclear how many state Medicaid patients are treated with such therapies; the state has not responded to repeated requests for this data.

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