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DeSantis moves to ban transition care for transgender youths, Medicaid recipients

The Florida governor's administration asked a state medical board to ban the therapies for minors while seeking to block Medicaid payments for all transition-related care.
Key Speakers At Conservative Political Action Conference
Gov. Ron DeSantis speaks at the Conservative Political Action Conference in Orlando, Fla., on Feb. 24.Tristan Wheelock / Bloomberg via Getty Images file

Florida Gov. Ron DeSantis’ administration Thursday asked the state board regulating doctors to essentially ban transition-related care for transgender minors, according to a letter obtained by NBC News.

The state Health Department made the request hours after another state agency issued a 46-page report to justify banning Medicaid coverage for transgender people of any age who want puberty blockers, hormone therapies or gender-reassignment surgery.

The two-pronged effort, which ensures DeSantis can act quickly and without the need for 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 2024 White House contender.

Leading the charge for DeSantis: Florida Surgeon General Joseph Ladapo, who oversees the Health Department.

In April, Ladapo issued guidance recommending against transgender treatments for minors who feel their bodies and their gender identities are misaligned. It contradicted guidance issued by the U.S. Department of Health and Human Services under President Joe Biden, and transgender rights activists and 300 state health care professionals accused Florida of cherry-picking evidence and performing incomplete research.

In a partial answer to the criticisms, Florida's Agency for Health Care Administration issued its report Thursday questioning the science and safety of hormone therapies, puberty blockers and gender-reassignment surgery. Ladapo then asked the Florida Board of Medicine to “establish a standard of care” Thursday that could ultimately result in prohibiting doctors from prescribing the therapies for transgender youths. 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 extraordinarily weak,” Ladapo wrote in his letter.

“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,” he wrote. “Florida must do more to protect children from politics-based medicine.”

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

“It’s unconstitutional for the government to step in and deprive youth — and especially trans youth — of getting the necessary medical care they need,” said Gary Howell, a psychologist in Tampa who has transgender youth and adult patients.

“This interferes with the rights of parents,” Howell said, drawing attention to DeSantis’ crusade for parental rights when it comes to teaching kids about race, gender identity and sexual orientation in the classroom.

Howell said doctors aren’t just prescribing puberty blockers or hormones without adequate safeguards or without the informed consent of caring and involved parents. He said that operations for children — mainly mastectomies for transgender boys — are exceedingly rare and that they occur only after multiple evaluations.

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

But his administration has gone a step further, experts say, by also seeking to ban what’s called “social gender transition therapy” — prohibiting therapists from encouraging children to change their pronouns, hair and dress in accordance with their gender identities.

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

Republican candidates throughout the country have also unleashed a wave 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 such as Alabama and Arkansas have led the way in limiting hormone and puberty-blocking therapies for kids.

Florida seized the national spotlight during the Legislature’s winter lawmaking session when DeSantis signed legislation to inhibit classroom discussions of sexual orientation and gender identity. When Disney sided with LGBTQ activists and vowed to fight what it called the “Don’t Say Gay” legislation, DeSantis accused the company of a “woke” misrepresentation of the law and successfully pushed for additional legislation that could undo a special taxing district for Disney World in the Orlando area.

Asked in April whether he would sign a ban on transition-related care for transgender children, DeSantis said he would.

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

But DeSantis wasn’t waiting on the Legislature. By the time of his interview, DeSantis’ surgeon general had already issued his guidance and the Agency for Health Care Administration was already combing over studies and research for the report it issued Thursday.

By having Ladapo ask the Florida Board of Medicine to take executive action, DeSantis’ administration essentially bypasses the Legislature and speeds the process of enacting a ban on transition-related care. 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 guidance in opposition to the DeSantis administration’s posture on transition-related care, including the American Academy of Pediatrics, the Endocrine Society, the American Academy of Child and Adolescent Psychiatry and the World Professional Association for Transgender Health

It’s not the first time DeSantis and Ladapo have faced off against the experts when it comes to children and medical therapy.

In March, Ladapo recommended 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 cherry-picked data, similar to an accusation other physicians and health care experts leveled a month later over the Health Department’s guidance concerning transgender youth.

A major difference between the DeSantis administration and the experts: whether the pharmaceutical treatments are reversible. The latter says they are, and the former says they’re not and that the evidence isn’t there.

“While clinical organizations like the AAP endorse the above treatments, none of those organizations relies on high quality evidence,” the AHCA Medicaid report says, swiping at the experts. “Their eminence in the medical community alone does not validate their views in the absence of quality, supporting evidence. To the contrary, the evidence shows that the above treatments pose irreversible consequences, exacerbate or fail to alleviate existing mental health conditions, and cause infertility or sterility.”

But those critical of DeSantis' moves say the state fails to appreciate that transgender kids are struggling and that denying them puberty blockers and hormones is dangerous to their psychological well-being.

“I was a teenager. I wanted to transition. I didn’t have access to that 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 is under the governor’s office.

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