“Their blood is on your hands,” the crowd chanted as the Florida Board of Medicine announced it will only hear one last public comment regarding their ruling to ban gender-affirming care to minors.
It’s been a long time coming. In June, the Board revoked medicaid coverage of gender-affirming care. More recently, on Oct. 28th, the Board is moving forward “to draft a rule to prohibit such therapies as puberty blockers, cross hormonal therapies and surgeries to treat gender-affirming care for gender dysphoria to anyone under the chronological age of eighteen.”
This decision has been met with uproar from the trans community and their allies—some even going as far to call this a deliberate genocide on trans youth.
To help inform their ultimate decision, the Board heard from a panel of experts on gender-affirming care. All of these experts came in with a polarizing viewpoint, either being notably anti or pro-trans.
Notable anti-trans pediatric endocrinologist Michael K. Laidlaw MD was one of the few experts to show up in person. Laidlaw is a board-certified physician in Rocklin, California specializing in diabetes and metabolism. Laidlaw presented a PowerPoint to the Board and public detailing why he believed gender-affirming care for minors is ill-advised.
He explained that his experience with gender dysphoria is having “a patient who is a detransitioner.”
Laidlaw’s arguments ultimately highlighted the main precedents that the board used to justify their ruling.
“Gender Dysphoria is a distress that arises from an incongruence between that identity and the physical body, leading to impairment,” Laidlaw explained at the meeting. “I think it’s important to note that studies have shown that desistance or growing out of this condition of children by adulthood is very high, some 50 to 98%. And these are studies done primarily on 12 years old and younger.”
Laidlaw cites a “desistance rate” of 50-98%, an incredibly wide margin for a presumably researched percentage. This statistic comes from Laidlaw’s own published study in 2019, which has been criticized by the medical community for misrepresenting how the resistance or persistence of gender dysphoria functions.
The current standard for early childhood gender dysphoria treatment practices, based on the “watchful waiting” Dutch approach, typically includes beginning puberty blockers as early as 12 and re-evaluating as time goes on (usually until age 16) to determine if there has been persistence in the condition.
“On what basis can we find the gender identity?” Laidlaw asked the Board. “To be certain that these children will not desist by adulthood? Can we use imaging of the brain or blood tests? Genetic testing? Are there other biomarkers to ensure that we are correct?”
“There is no such thing,” he continued. “Starting with basic[s], just go back a bit to basic biology, there are two human sexes: male and female.”
When questioned by members of the Board, Laidlaw admitted that the studies he cited are “to my knowledge all, well, they’re adults. For the most part.”
“There is no such long term study for children,” Laidlaw continued. “But one would predict based on what’s happening to adults it would be similar for children or worse.”
One would think a study involving children would be necessary for determining whether gender-affirming treatment on children is medically okay or not. Or at the very least, specific case studies involving minors. It is worth re-emphsizingthat Laidlaw does not treat gender dysphoria in his practice.
Dr. Meredithe McNamara was another expert called to present to the board. McNamara is a Board-certified Adolescent Medicine Physician and pediatrician with both a degree in medicine and a Master’s degree of Science and Clinical Research from Emory University. She is also an assistant professor at the Yale School of Medicine.
“I provide clinical care for youth aged 12 to 25, which includes transgender and gender expansive youth,” McNamara explained. “I join you from Connecticut to address health policy matters in Florida because misinformation about gender-affirming care poses a threat to the well-being of youth everywhere, and the use of misinformation to set legal standards will degrade medical authority.”
McNamara was asked by the Board how likely children who experience gender dysphoria would grow out of the condition, and how medical experts are to tell.
“I think one of the prevailing themes of all of our testimonies today is that it’s highly individualized,” McNamara responded. “These children and their families meet with therapists with experts on gender dysphoria, a range of options to help this child live authentically and comfortably are offered. For pre-pubertal children, though, this does not include medications of any kind, and I really want to state that clearly that is stated emphatically in clinical practice guidelines from World Professional Association for Transgender Health (WPATH) and The Endocrine Society.”
The Board also asked McNamara why there has been an increase in cases of gender dysphoria in recent years.
McNamara asserts that “we’re not seeing much larger numbers,” and instead that “that has been blown out of proportion and discourse. But if you look at the absolute numbers, it’s not exponential by any means.”
“We live in a more forgiving and nurturing environment than we did 20 years ago for gender expansive identities,” she explained. “I believe that there are trans and nonbinary role models. There are people that are trailblazing and showing young people that it’s safe to be who they are. That’s my simplest answer.”
McNamara’s testimony included citations of multiple reviewed medical studies that asserted the case for gender-affirming care. She explained that the current standard of medical care today typically does not include giving hormones to young children. Instead, gender-affirming care consists of a long, thoughtful process that is tailored to individual needs, rather than a standard set of care that is given to every patient.
Board members also questioned McNamara on her referral of patients for gender-affirming surgery such as Mastectomy (top surgery), Phalloplasty and Gynoplasty (bottom surgery).
She explained that she’s “never referred a patient for bottom surgery” and that one has not been performed “under the age of legal majority in my institution.”
Following testimonies, DeSantis-appointed Board member Nicholas Romanello proposed a motion.
“I believe that based upon the testimony that we heard this morning and the materials in the portal, that the risk of puberty suppressing therapies, cross hormonal therapy and surgery, those risks outweigh the possible benefits,” he asserted. “There is a lack of consistent, reliable, scientific peer reviewed evidence concerning the efficacy and safety of such treatment.”
“I would propose a rule that would prohibit such therapies,” Romanello suggested, creating the language that would eventually become the ultimate ruling.
The motion was seconded. However, voting would not continue until after deliberation and public comment.
During the deliberation portion, the Board discussed several options for the rule, including exceptions. The Board drew on the comorbidity between autism and gender dysphoria, stating that psychotherapy should be a standard of gender-affirming care.
Romanello proposed an “enhanced consent process” which would require at least four doctors of different specialities in order for any form of hormone replacement therapy (HRT) to be prescribed.
“My rule would be a prospective rule to take effect, I would look to [the] Board Counsel to help on a prospective start date,” Romanello said. “For those patients [currently in care] I would propose that we continue that care, but that we, to ensure the safety and to ensure an educated and well-informed patient, that we enhance the consent process for those sorts of therapies.”
As a response, Chair of the Florida Board of Osteopathic Medicine Dr. Sandra Schwemmer raised the idea of creating a state “registry” of transgender children, “that could monitor and give data back to the Board.” This was met with boo’s from the crowd.
The public comment section included nine people who had previously transitioned but later detransitioned, five pro-trans advocates and seven testimonies from people for the ruling.
Jude Spiegel, a transgender person and a parent of two children, was the only trans person allowed to speak.
“I’ve known I was transgender since I was very young,” Spiegel said. “I suffered from suicidal ideation from the age of 10 to 26 and attempted suicide multiple times, thinking it was wrong to be who I was. Let these decisions remain between parents, children and their doctors. If rules must be adopted, then please adopt the WPATH standards of care.”
Another testimony was from a medical professional and assistant professor with the University of South Florida (USF) Taneja College of Pharmacy, Dr. Kevin Astle.
“This discussion today, the fact that we’re having this, is impairing progress,” Astle claimed. “You have the right to choose whether or not you want to provide gender-affirming care in your practice. You have that choice in that decision. You have the choice and decision whether you should pursue gender-affirming care yourself or for your children. Your actions today are going to take that right away from Floridians all across the state.”
Astle explained that the Board of Medicine would be violating their role with the ruling: “You’re here to allow for safe practice, not to dictate what is medical care and what is not. When you graduated from medical school, you took an oath to do no harm. These decisions today will completely violate that oath.”
The Board announced that they would only be taking one more public comment, and referred additional public comments to be sent to an email address. This was met with audience member Sarah Parker, from Women’s Voices of Southwest Florida (WVSWF), starting to chant, “their blood is on your hands.” Many other advocates joined the shouts. Chair of the Board, Dr. Zachariah Zachariah responded, “That’s okay.”
Parker explained to the Catalyst that WVSWF has used this chant before in relation to abortion rights protests.
“They knew the suicide rates would go up,” Parker said about the Medical Board’s Decision.
As the meeting minutes state, “A Motion was made, seconded and approved with two votes in opposition to prohibit such therapies as puberty blockers, cross hormonal therapies and surgeries to treat gender-affirming care for gender dysphoria to anyone under the chronological age of eighteen. These are prohibited unless being done within the auspices of an Institutional Review Board (IRB) approved university-affiliated clinical trial. The rule will be a prospective rule. The rule will apply exclusively to minors with gender dysphoria.”
On Friday, Nov. 4, Florida Board of Medicine and Board of Osteopathic Medicine voted 6-3 to formalize the language—the rule is now in a 21-day comment period where any opponents can make challenges to the decision, which they have made clear they plan to do.
The rule will effectively, as the current language states, force any children currently undergoing gender-affirming care to immediately stop once the rule is in place, essentially forcing detransition.
The most recent meeting had dozens of people, primarily advocates, packed into the conference room. After the last meeting cut off public comment, audience members came prepared with signage—forcing the board to see their pleas.
Parker and her colleague, Vice President and Founder of WVSWF Kate Danehy-Samitz, described the meeting as “enraging” and “motivating.”
Danehy-Samitz said that it’s hypocrisy “for Gov. DeSantis, to sit here and say that forcing vaccinations on people is unconstitutional. That he’s going to fight for every Floridian’s right to choose what they do with their body, and in the same breath, ban abortion and gender-affirming care for minors.”
“A lot of people say they don’t do politics, but politics are always going to do you,” Parker explained.
“It’s motivating in the sense of, putting our feet to the fire, it’s holding us [activists] accountable,” Parker continued, referring to the meeting. “It doesn’t matter if it’s not happening specifically to us. It’s happening to everyone around us, and Women’s Voices really believes that our community comes first.”
At the Nov. 4 meeting, Parker was lucky enough to be allowed to speak. She used her time to highlight the thousands of dollars that the Florida Board of Medicine members have contributed to DeSantis’ reelection campaign.
“They should have given more space to people that are trans,” Parker said. “If we had been able to find other people to speak, it would not have been us.”
Parker and Danehy-Samitz explained that in the future, they will continue to hold the government, including the Board of Medicine, accountable for their actions.
Shortly after the meeting, The Endocrine Society released their own statement asking the Florida Medical Board to reverse their decision and to “allow physicians to provide evidence-based care and protect the lives of minors.”
Families across the state are beginning to make their plans to protect their trans-children in preparation for the ban to go into effect.