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DeSantis takes action to ban transitional care for transgender youth and Medicaid recipients

The administration of Florida Governor Ron DeSantis on Thursday asked the state board regulating physicians to essentially ban transition-related care for transgender minors, according to a letter obtained by NBC News.

The state’s health department made the request hours after another state agency released a 46-page report justifying the ban on Medicaid coverage for transgender people of any age who want medical treatment. puberty blockers, hormone therapies or sex reassignment surgery.

The two-pronged effort, which ensures DeSantis can act quickly and without needing legislative approval, drew instant opposition from activists and medical professionals. They have increasingly clashed with DeSantis, a Republican, as he seeks re-election and builds a national brand as a culture warrior and potential candidate for the White House in 2024.

Leading DeSantis is Florida Surgeon General Joseph Ladapo, who oversees the health department.

In April, Ladapo issued guidelines advising against transgender treatment for minors who feel their body and gender identity are misaligned. It contradicted guidelines issued by the US Department of Health and Human Services under President Joe Biden, and transgender rights activists and 300 state medical professionals accused Florida of selecting evidence and perform incomplete searches.

In a partial response to the criticism, the Florida Agency for Health Care Administration released its report on Thursday questioning the science and safety of hormone therapies, puberty blockers and sex assignment surgery. Ladapo then asked the Florida Board of Medicine on Thursday to “establish a standard of care” that could ultimately result in doctors being banned from prescribing the therapies to transgender youth. The process could take months and it’s unclear how many people it could affect.

“While some professional organizations, such as the American Academy of Pediatrics and the Endocrine Society, recommend these treatments for ‘gender-affirming’ care, the scientific evidence supporting these complex medical interventions is extremely weak,” Ladapo wrote in his letter.

“Current standards set by many professional organizations appear to follow a preferred political ideology instead of the highest level of generally accepted medical science,” he wrote. “Florida must do more to protect children from politics-based medicine.”

But a host of other medical professionals, their organizations and activists have accused Ladapo and DeSantis of endangering the well-being of children who are already at increased risk of suicide.

“It is unconstitutional for the government to step in and deny young people — and especially trans youth — the necessary medical care they need,” said Gary Howell, a psychologist in Tampa who has transgender youth. and adult patients.

“It interferes with parental rights,” Howell said, drawing attention to DeSantis’ crusade for parental rights when it comes to teaching children about race, gender identity and orientation. sex in class.

Howell said doctors don’t just prescribe puberty blockers or hormones without adequate safeguards or informed consent from caring and involved parents. He said operations for children – mainly mastectomies for transgender boys – are extremely rare and only happen after multiple assessments.

The DeSantis administration notes that Sweden and Finland, which were among the first countries to engage in prescribing a wide range of transition-related care for transgender children, have now dramatically reduced their use.

But his administration went further, experts say, by also seeking to ban what is called “social gender transition therapy” – prohibiting therapists from encouraging children to change their pronouns, hair and clothes. based on their gender identity.

Republican-led states have focused on transgender issues since Biden took office in 2021 and recommitted the federal government to expanding and protecting the rights of transgender people. Biden appointed the first transgender assistant secretary of health and human services, Dr. Rachel Levine, whose office released a fact sheet promoting gender-affirming care, which Ladapo’s office criticized.

Republican candidates across the country have also sparked a flurry of transgender-related political ads this year.

Florida was one of the first states to ban transgender women and girls from participating in women’s sports, but states like Alabama and Arkansas have led the way by limiting hormone treatments and blocking puberty to the children.

Florida took center stage nationally during the winter legislative session of the Legislative Assembly when DeSantis signed legislation to prevent classroom discussions of sexual orientation and gender identity. When Disney sided with LGBTQ activists and pledged to fight what he called “Don’t Say Gay” legislation, DeSantis accused the company of a “woke” misrepresentation of the law and successfully lobbied for additional legislation that could override a special tax district for Disney World in the Orlando area.

When asked in April if he would sign a transition care ban for transgender children, DeSantis said he would.

“There’s a concerted effort in society to push these kids to do some type of medical intervention,” he told conservative podcaster Lisa Boothe.

But DeSantis wasn’t waiting for the Legislature. At the time of his interview, DeSantis’ surgeon general had already released his guidelines, and the Agency for Healthcare Administration was already combing through studies and research for the report it released. Thursday.

By asking Ladapo to ask the Florida Board of Medicine for executive action, the DeSantis administration is essentially bypassing the legislature and speeding up the process of enacting a transition care ban. The Florida Board of Medicine has a 12-member board of physicians who are technically independent of the state but are appointed by the governor and confirmed by the state Senate.

Most professional medical associations oppose or have councils opposing the DeSantis administration’s position on transition care, including the American Academy of Pediatrics, Endocrine Society, American Academy of Child and Adolescent Psychiatry and the World Professional Association for Transgender Health.

This isn’t the first time DeSantis and Ladapo have clashed with the experts on children and medical therapy.

In March, Ladapo advised against Covid vaccines for children, citing a host of studies. But some of the researchers told the Tampa Bay Times that he misrepresented their work and handpicked data, as an accusation that other doctors and health care experts leveled a month later on the advice of the department. of Health concerning young transgender people.

A major difference between the DeSantis administration and the experts: whether pharmaceutical treatments are reversible. The latter says they are, and the former says they are not and the proof is not there.

“While clinical organizations like the AAP endorse the above treatments, none of these organizations are backed by high-quality evidence,” the AHCA Medicaid report says, sweeping the experts. “Their eminence in the medical community alone does not validate their view in the absence of quality supporting evidence. On the contrary, the evidence shows that the above treatments lead to irreversible consequences, exacerbate or do not fail to alleviate existing mental health problems and result in infertility or sterility.

But those who criticize DeSantis’ decisions say the state fails to understand that transgender children are struggling and that denying them puberty blockers and hormones is dangerous to their psychological well-being.

“I was a teenager. I wanted to make the transition. I did not have access to this care. And it almost killed me,” said Ashley Brundage, a transgender activist who is the founder and president of Empowering Differences and sits on the national board of directors of GLAAD, formerly the Gay & Lesbian Alliance Against Defamation.

Brundage pointed out that she is supposed to receive a Spirit of the Community award from the Florida Commission on the Status of Women, which reports to the governor’s office.

“How about that for irony?” Brundage asked with a laugh. “Are they going to revoke my award?”

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