Florida’s targeted healthcare guide for trans youth is an error-riddled mess

The department of health’s new guidelines linked to several sources that directly contradicted their own claims

In an April 20 press release on “Treatment of Gender Dysphoria for Children and Adolescents,” the Florida Department of Health made recommendations that no one under 18 should be treated with puberty blockers or hormone replacement therapy (HRT). They even went so as to say people under 18 should not socially transition—a non-medical aspect of transitioning that can involve things like changing one’s name, pronouns, attire or hairstyle.

The DOH’s guidance against gender-affirming care for trans youth, though non-binding, is part of a national and local wave of anti-LGBTQ2S+ policy, which includes Florida’s “Don’t Say Gay” bill, and state representative Randy Fine’s proposal to criminalize medical treatment for trans youth. The DOH’s positions place the state of Florida in firm opposition to major medical and professional organizations, which have consistently advocated for supporting and affirming trans youth as appropriate via the options of social transition in childhood and possible treatment with puberty blockers in adolescence. 

A closer look at the DOH’s sources reveal some unusual choices. Critics have pointed out, for example, that the DOH also contradicts several of the sources they cited in their own press release—including many sources that clearly emphasize the importance of supporting trans children in their gender and that state that medical interventions should be available to some youth. Another source the department links to is a brief piece taking the alarming view that trans people should be subjected to conversion therapy.

Here, Xtra breaks down several instances where the DOH cited pseudo-scientific sources, cherry-picked quotes and misinterpreted or misrepresented the content of multiple legitimate scientific sources they cited.

The DOH says their positions are in line with those of Medicare, Sweden, Finland, England and France. They aren’t.

The DOH claims that their recommendations are “consistent with the federal Centers for Medicare and Medicaid Services age requirement for surgical and non-surgical treatment” and “in line with the guidance, reviews, and recommendations from Sweden, Finland, the United Kingdom, and France.” The documents they reference say otherwise. A Medicare coverage decision states their policy of only covering gender-affirming HRT from age 18, in cases where people display “persistent, well-documented gender dysphoria,” something which frequently occurs before reaching legal adulthood. The Medicare decision says nothing about puberty blockers for trans youth, or about social transition for trans kids.

Another linked document from Sweden’s National Board of Health and Welfare includes guidelines that require trans youth to have “lived socially in accordance with their gender identity since the onset of puberty-inhibiting treatment” before they’re given gender-affirming HRT. The Finnish recommendations describe use of puberty blockers and HRT for trans kids at or before age 16, while the interim report from an ongoing review of trans youth care by NHS England outlines how to obtain informed consent for puberty blockers and recommends “expanding the number of providers” and “reducing waiting times for specialist care” for evaluating trans and gender-questioning youth. Linked from the DOH’s own press release, France’s National Academy of Medicine recommends: “In the event of a persistent desire for transition, a careful decision about medical treatment with hormone blockers or hormones of the opposite sex.” The DOH guidance wouldn’t allow a careful decision about a haircut before the age of majority.

 

The DOH said kids shouldn’t socially transition, or access puberty blockers or hormone therapy. The studies they cite said youth should have options.

The Department of Health says “Social gender transition should not be a treatment option for children or adolescents,” but the study they referenced simply found that a healthy environment and support from family and peers were more important to the well-being of gender-dysphoric children than whether they had currently socially transitioned. Its authors state that because the children at their gender clinic were largely supported (and had their genders affirmed) by their parents, “these findings might not apply to a more diverse sample of transgender children who are not supported in their gender identity or expression by parents or clinicians.” Nothing about this argues that trans children should neither be supported in their gender nor be allowed to transition socially.

The DOH also cited a review that stated: “hormonal treatments for trans adolescents can achieve their intended physical effects, but evidence regarding their psychosocial and cognitive impact is generally lacking.” However, this review article also found that for trans adolescents, puberty blockers were “associated with significant improvements in global functioning, depression and overall behavioural and/or emotional problems‍”—a conclusion left out of the DOH’s press release.

In support of their blanket recommendation that “anyone under 18 should not be prescribed puberty blockers or hormone therapy,” the department links to a study that found trans youth on puberty blockers reported improved relationships with their family and peers and wished to continue transitioning. Another study allegedly supporting the DOH actually looked at a group of later-transitioning adolescents and young adults, who all transitioned too late for treatment with puberty blockers and largely didn’t start hormone therapy until after turning 18. The authors suggested this delay is why these youth didn’t show an even greater benefit from transitioning, and, unlike the DOH, at no point do they argue that both puberty blockers and hormone therapy should be off-limits before 18.

The DOH says “systematic reviews” do not support giving trans youth gender-affirming care. In reality, the “review” they reference is a short summary from a conservative Christian medical journal.

The Department of Health declares that “systematic reviews” of gender-affirming care for youth “show a trend of low-quality evidence, small sample sizes and medium to high risk of bias.” To back up this claim, they link to one four-page summary article that doesn’t include any of the standard techniques of a systematic review. This article appears in an issue of The Linacre Quarterly, a journal of the Catholic Medical Association. The journal has included pieces promoting pseudo-scientific arguments such as claims that gay and lesbian parents are harmful to their children, and that IUDs cause abortions.

In a broad criticism of gender-affirming care for all ages, not only trans youth, the article cites a publication from 1984 as “showing patients who benefited from” “psychological approaches to mitigate dysphoria, with or without desistance as a desired goal.” Such approaches would fall under the definition of conversion therapy, considered by the United Nations to be “degrading, inhuman and cruel in its very essence.” Moreover, the authors of the 1984 paper later explained they actually found that “evidence for complete and long-term reversal of cross-gender identity by means of psychotherapy was not convincing.”

Why these guidelines matter

Anti-trans guidelines and laws affect both professionals and patients. In Texas, for example, orders to investigate families of trans youth have placed social workers’ ethical obligations at odds with government policy. Professionals in Florida now face a similar dilemma: healthcare providers and other professionals must choose between following the department’s recommendations or following the recommendations contained in the sources the DOH itself links to.

Even guidelines that are non-binding, unevenly enforced or possibly unconstitutional can create an atmosphere of perceived legal threat—and have a chilling effect that can deter healthcare providers from continuing to offer the care that trans youth need. Guidelines like these can also dissuade practitioners from pursuing careers in transgender medicine. Multiple clinics for trans kids in Texas have already closed and stopped providing gender-affirming care in order to avoid potential legal liability. Parents of trans kids in Florida do not want to see the same thing happen in their state. Whether or not this guidance is a prelude to further attacks, it has already caused harm to trans youth in Florida.

Zinnia Jones is an Orlando-based science writer and trans advocate. Her work has been featured in the Huffington Post and Autostraddle.

Keep Reading

What you need need to know about gender-affirming care for youth

What sort of healthcare is available? Do parents have any say? Is the healthcare safe and effective?

Could this week’s Supreme Court abortion pill case affect gender-affirming care?

OPINION: The Comstock Act, a 150-year-old federal obscenity law, has advocates on edge

Raising the bar: How an Edmonton gym is making exercise accessible

Run by queer and trans professionals, Action Potential Fitness was created with LGBTQ2S+ clients in mind
The Ohio state legislature building with a blue star with stars and stripes behind it.

Ohio’s trans healthcare ban sets dangerous precedent ahead of 2024 election

ANALYSIS: Ohio has set a new precedent for using gubernatorial powers to indirectly outlaw transition—other states may follow