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 move that puts Florida at odds with existing treatment standards that have been endorsed by the American Academy of Pediatrics, the American Psychological Association and the 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 boards.
After the ban takes effect, doctors in the state who continue to prescribe puberty blockers, hormone therapy or surgeries to treat gender dysphoria among new patients younger than 18 could lose their licenses.
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.
The condition is rare. Based on the number of people who seek treatment, less than 0.1% of the population are diagnosed with gender dysphoria, according to the American Psychiatric Association.
The medical boards’ decision has raised a raft of questions for parents and health care providers about what happens next. Here’s what we know:
What happens now?
The medical boards will publish their rules in the Florida Administrative Register, a daily publication that provides information on proposed regulations. After that, residents will have 21 days to request a public hearing on the planned restrictions.
If a hearing is held, LGBTQ advocates could argue against the regulations or suggest changes. Based on that feedback, board members could tweak the rules or keep them as is, said Ed Tellechea, the Board of Medicine’s longtime attorney.
When will the ban take effect?
That remains unclear, though it could be early next year.
“Realistically,” Tellechea said last week, “once rule language is published, we’re talking about anywhere between 60 to 90 days before it becomes effective.”
As of Friday morning, the boards hadn’t published their rules in the Florida Administrative Register.
Will there be exceptions to the ban?
The ban doesn’t apply to children already being prescribed puberty blockers or those on hormone therapy. They are grandfathered in, though it’s unclear if the clinics treating them will continue to do so.
The Board of Osteopathic Medicine will also let osteopathic physicians prescribe puberty blockers and hormone therapy to new patients under the age of 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 a university committee that reviews whether research is ethical.
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The Board of Medicine rejected the same carve-out for medical doctors, who vastly outnumber osteopathic physicians in Florida.
What options are there for children with gender dysphoria?
In short, the options are limited. Even before the medical boards’ recent votes, some hospitals and gender 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 treatment and plastic surgery. Now, it plans to operate “wholly in line with the decisions and guidance of the Florida Board of Medicine,” a spokesperson said. USF Health refused to say whether it would continue treating existing patients and whether it’s accepting new ones.
That leaves the University of Florida’s Youth Gender Program as the only pediatric multidisciplinary academic center open to new referrals in the state, according to Michael Haller, a 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 capacity to provide care to all of those in need,” he said in an email.
Until the ban is in effect, doctors will still be able to provide care to gender-diverse youth per American Academy of Pediatrics-endorsed guidelines, Haller said.
“If the Board’s approved rule becomes active, adolescents with gender dysphoria will be forced to seek care outside of Florida until legal action is successful in overturning the Board of Medicine’s decision,” Haller said.
Will the restrictions be challenged in court?
Most likely, yes.
“Unquestionably there will be legal challenges,” said Simone Chriss, director of the Transgender Rights Initiative at Southern Legal Counsel, a Gainesville-based nonprofit law firm, during a recent news conference. The firm and several groups are suing the state over a rule that bans Medicaid coverage of gender dysphoria treatments.
“We are actively litigating the Medicaid ban,” Chriss said, “and we will fight this one as well. ... These things cannot stand. These folks know that it’s unconstitutional.”
The Florida Department of Health, which urged the boards to ban the treatments, did not respond to a request for comment.