Florida Targets Gender-Affirming Care for Trans Youth & Medicaid Users

Officials in Florida Gov. Ron DeSantis' administration took steps this week to prohibit doctors from providing medical care to transgender youth. The governor's name also appears on a new state report asserting Medicaid should not cover gender-affirming surgery for patients of any age.

Florida Surgeon General Joseph Ladapo requested the state Board of Medicine prohibit gender-affirming surgery for minors -- which is a rare practice -- along with certain other gender-affirming treatments. His recommendation directly contradicts guidance from the Biden administration.

"The Agency for Health Care Administration has conducted a full review to determine if these treatments are 'consistent with generally accepted professional medical standards and not experimental or investigational,'" Ladapo wrote. "The Agency's review included an overview of systematic reviews on puberty blockers, cross-sex hormones, surgeries, or a combination of interventions."

He acknowledges the American Academy of Pediatrics and other organizations support gender-affirming health care but challenged their positions. "The scientific evidence supporting these complex medical interventions is extraordinarily weak," Ladapo wrote.

He encouraged Florida medical board to "establish a standard of care for these complex and irreversible procedures.

"The current standards set by numerous professional organizations appear to follow a preferred political ideology instead of the highest level of generally accepted medical science. Florida must do more to protect children from politics-based medicine," he wrote. "Otherwise, children and adolescents in our state will continue to face a substantial risk of long-term harm."

That, of course, is a different assessment than that of professional organizations dedicated to the health of children.

"It is critically important for every child to have access to quality, comprehensive and evidence-based care -- transgender and gender-diverse youth are no exception," said Dr. Lee Savio Beers, The American Academy of Pediatrics' immediate past president, in a release earlier this year. "As pediatricians, we will continue to speak up and advocate for our patients. We also want transgender and gender-diverse youth to know that not only do we care for them, we care about them, we value them and we will do all we can to ensure they have access to the care they need and deserve."

This isn't the first time Ladapo has stood in conflict with widely held medical consensus. Before being appointed to his current post by DeSantis, he gained national attention as part of a group of physicians questioning medical response to the COVID-19 pandemic.

The letter from Ladapo wasn't the only push against medical treatment for transgender Floridians issued by the DeSantis administration this week. A report from Gov. DeSantis' office the same day calls for Florida Medicaid to refuse coverage of such surgeries for any patients.

"Available medical literature provides insufficient evidence that sex reassignment through medical intervention is a safe and effective treatment for gender dysphoria," the report reads. "Studies presenting the benefits to mental health, including those claiming that the services prevent suicide, are either low or very low quality and rely on unreliable methods such as surveys and retrospective analyses, both of which are cross-sectional and highly biased."

The report claims there is insufficient evidence to support the efficacy or safety of the surgery while citing five expert assessments that gender dysphoria should be treated as a mental health disorder.

Approximately 9,000 trans Floridians would be affected, according to the Human Rights Campaign.

"In a year when Florida officials have already unleashed repeated, mean-spirited attacks on the LGBTQ+ community, this latest move by the DeSantis administration to deny best practice, age-appropriate, medically-necessary health care to transgender people is simply one more purely partisan attack on LGBTQ Floridians -- timed to coincide with the start of Pride Month," Cathryn Oakley, the Human Rights Campaign's state legislative director and senior counsel, said in a release. "Gender-affirming care is lifesaving -- that, unlike the material in this report, is a fact -- and this medical care is neither experimental, nor new. It is supported by the overwhelming majority of medical associations, representing more than 1.3 million doctors in the United States. This controversy is entirely contrived for partisan political purposes, but will cause very real harm to the thousands of folks impacted."

Of note, these attacks on transgender Floridians came the same day DeSantis vetoed funding for housing for LGBTQ+ youth. It's the second year DeSantis killed funding for the Zebra Coalition, which provides services specifically to LGBTQ+ children and young adults, ages 13 to 24.