Florida medical boards approve trans care rules

TALLAHASSEE - Florida medical boards on Friday approved rules related to providing treatments such as puberty blockers and hormone-replacement therapy to transgender children and adults, carrying out part of a new law championed by Gov. Ron DeSantis.

The rules include "informed consent" forms containing language that says gender-affirming care "is purely speculative, and the possible psychological benefits may not outweigh the substantial risks of medical treatments and, in many cases, the need for lifelong medical treatments."

The forms also say that "medical treatment of people with gender dysphoria is based on very limited, poor-quality research with only subtle improvements seen in some patient's psychological functioning in some, but not all, research studies."

The advisories in the forms run counter to what most experts say about gender-affirming care and research supporting it — that treatment is medically safe, effective and can be life-saving.

The language is "inflammatory, unnecessary and not even true," Yale University School of Medicine professor Meredithe McNamara told The News Service of Florida in a phone interview Thursday.

"It is not abnormal for youth, minors, to undergo informed-consent processes with their parents that are guided by forms that are similar in structure to the ones Florida has. But when it comes to adults, that's not standard practice whatsoever. And what we're finally seeing is what we feared for a long time, which is that bans on care for youth have made legal interference into totally undisputed care for adults more acceptable and more palatable," McNamara, who specializes in adolescent medicine, added.

Numerous speakers at a joint meeting Friday of the state Board of Medicine and the state Board of Osteopathic Medicine opposed the rules and forms, which include a laundry list of dangers associated with puberty blockers and hormone-replacement therapy.

"What you're proposing is not an informed consent. You're going far further, essentially trying to create a new standard of care, when one already exists," physician Michael Haller, a professor and chief of endocrinology at the University of Florida, told members of the boards. "The ongoing emphasis on the idea that there's low-grade, low-quality evidence for gender affirming care is extremely problematic."

Doing nothing to treat children diagnosed with gender dysphoria can have harmful effects, Haller said.

"This is a conversation that physicians have with their patients all day every day. And so to try to put this specific language in the consent form is, again, entirely disingenuous. And you all know that, and it's shameful. The bias that's being represented by medical organizations," Haller said, before being interrupted by Board of Medicine Chairman Scot Ackerman.

"I take offense to your comments. Don't tell us what we know, and don't call us shameful," Ackerman, a Jacksonville-based oncologist, said.

Board of Medicine member Hector Vila, a Tampa physician, offered an explanation for the use of the term "poor-quality" studies.

"It's not like an adjective. It's not like we're who proscribe it. That is very standard medical terminology that describes the absence of the highest quality of studies that exist, and that's prospective, randomized, controlled studies that have large numbers of patients and follow those patients over an adequate period of time to provide good predictive value," Vila said. "That would be good studies. So this is just a medical term, and all of us doctors are used to using it for quality studies. … It just means that they don't meet the standard of what we in medicine refer to as high-quality studies."

The approval of the rules and the forms helped carry out a new law, signed by DeSantis on May 17, that banned physicians from using puberty blockers or hormone-replacement therapy for children diagnosed with gender dysphoria, which the federal government defines clinically as "significant distress that a person may feel when sex or gender assigned at birth is not the same as their identity."

The law included an exception that allows children currently receiving puberty blockers or hormone therapy to continue the treatment and required the state medical boards to establish standards of care for such children.

In addition, the law required the boards, which regulate physicians, to create informed-consent forms for transgender patients seeking gender-affirming care. 

Adults, children and parents of kids who receive puberty blockers or hormone therapy must sign the forms.

Doctors who violate the law could be stripped of their licenses and face felony charges.

Steven Rocha was among speakers during Friday's meeting who disputed that gender-affirming care is speculative.

Trans people "have been taking hormones for decades, and to say that only subtle improvements were seen in patients' mental health would be laughable if it weren't so dangerous," Rocha, a trans man who is policy director for the LGBTQ youth-advocacy group PRISM Florida. "That kind of thinking is what gets critical health care ripped away from those who need it most. Gender-affirming care helped me, and I'm nowhere near alone."

Florida is among a number of Republican-led states that have approved measures to curb or prohibit gender-affirming care for transgender children and adults. DeSantis, who is running for president, has made the issue one of his priorities.

"We cannot speak something into existence that doesn't exist. We cannot change our sex," Rep. Ralph Massullo, a Lecanto Republican who is a dermatologist, said in May before the House gave final approval to the bill (SB 254) that included requiring the rules and forms.

"And for those children that this bill addresses, they cannot change their sex, and they need to learn that fact."

Restrictions approved by DeSantis and the GOP-controlled Legislature, however, have not fared well in federal court.

U.S. District Judge Robert Hinkle this month blocked Florida's ban on the use of puberty blockers and hormone therapy to treat children diagnosed with gender dysphoria, calling the prohibition "an exercise in politics, not good medicine."

"The statute and rules at issue were motivated in substantial part by the plainly illegitimate purposes of disapproving transgender status and discouraging individuals from pursuing their honest gender identities. This was purposeful discrimination against transgenders," Hinkle wrote.

The judge on June 22 also blocked a state ban of Medicaid coverage for transgender children and adults, saying the effort was "invidious discrimination." The state is appealing both decisions.