Florida Department of Health's guidance would, if followed, harm transgender youth

Brittany S. Bruggeman and more than 300 others
·9 min read
4

We write as a group of more than 300 Florida health care professionals who care for transgender and gender diverse youth. We have one common goal: to provide the best quality, evidence-based, individualized and compassionate care for our patients.

Ultimately, we strive to empower each patient to achieve their optimal physical, mental, emotional and social health; and want each person to feel that they are accepted and valued for who they are.

The recent statement issued by the Florida Department of Health (DOH) entitled “Treatment of Gender Dysphoria for Children and Adolescents” misrepresents the weight of the evidence, does not allow for personalized patient and family-centered care, and would, if followed, lead to higher rates of youth depression and suicidality.

The Florida DOH guidance categorically recommends against social and medical gender transition for any patient under the age of 18. This directly contradicts existing guidelines from the American Academy of Pediatrics, the Endocrine Society, the American Academy of Child & Adolescent Psychiatry and the World Professional Association for Transgender Health. These national and international guidelines are the result of careful deliberation and examination of the evidence by experts including pediatricians, endocrinologists, psychologists and psychiatrists.

A demonstrator holds a sign in support of transgender youth.
A demonstrator holds a sign in support of transgender youth.

While we agree with the Florida DOH that guidance surrounding care of transgender youth “requires a full, diligent understanding of the scientific evidence,” they fail to follow their own recommendations. Specifically, the Florida DOH cites a selective and non-representative sample of small studies and reviews, editorials, opinion pieces and commentary to support several of their substantial claims.

When citing high-quality studies, they make conclusions that are not supported by the authors of the articles. And while they state that their guidance is consistent with recommendations from Sweden, Finland, the United Kingdom and France, in fact, none of these countries recommends against social gender transition, and all provide a path forward for patients in need of medical intervention. This stands in marked contrast to the categorical ban recommended by the Florida DOH.

Current national guidelines recommend developmentally appropriate, patient- and family-centered, and nuanced care that promotes children and adolescents’ self-worth. Evaluation and treatment includes thorough assessment by multidisciplinary teams including mental health professionals and medical providers and may include social or medical transition if indicated and desired by the patient and family.

Transgender youth face rates of depression that are 5-7 times higher and rates of suicidality that are 10-20 times higher than that of the cisgender population. Social gender transition and family support are linked to reduced rates of depression and suicidality in these youth. There is little cost and much to gain in supporting a child or adolescent to express themselves fully and honestly.

Professional guidelines do not recommend initiation of puberty-blocking medications prior to the onset of puberty, and their use has been linked to reduced rates of depression and suicidality. Similarly, guidelines recommend initiation of gender-affirming hormonal treatment only after multidisciplinary teams have confirmed the presence of gender dysphoria and the desire of the patient and parents to start treatment.

In addition, the patient must have the mental maturity to weight risks and benefits so as to provide informed consent alongside their guardians, which is present in most by age 16. Treatment is linked to improved body satisfaction and rates of depression. Genital surgeries are not recommended for patients under 18, and masculinizing chest surgeries only after patients meet strict criteria and can give truly informed consent alongside their guardians. In all cases, these decisions are made with great thoughtfulness and cannot be dealt with in a one-size-fits-all approach.

While we need research to further improve care for transgender and gender diverse youth, taking away social support and medical care is not the answer. We urge the professionals at the Florida DOH to reconsider its guidance in favor of a more individualized, patient- and family-centered, and compassionate approach.

Brittany S. Bruggeman, MD, FAAP, is an assistant professor of pediatric endocrinology at the University of Florida College of Medicine. Kristin Dayton, MD, is director of the UF Youth Gender Program and assistant professor of pediatric endocrinology at the UF College of Medicine. Alejandro Diaz, MD, is chief of the Division of Pediatric Endocrinology at Nicklaus Children’s Hospital. Jennifer Evans, PsyD, is a Licensed Clinical Psychologist in the UF Youth Gender Program. Michael J. Haller, MD., is a professor and chief of pediatric endocrinology at the UF College of Medicine. Mark L. Hudak, MD, is a professor and chair of pediatrics at the UF College of Medicine- Jacksonville. Carol A. Mathews, MD, is a professor and interim chair of psychiatry at the UF College of Medicine. Stephanie Ryan, MD, is an associate professor of pediatrics and an assistant dean in the Office of Diversity and Health Equity in the UF College of Medicine. Michael Shapiro, MD, is an associate professor of psychiatry at the UF College of Medicine. Desmond Schatz, MD, is a professor and interim chair of pediatrics at the UF College of Medicine

This piece was also co-signed by more than 300 others. They include:

Dennrik Abrahan, MD

Keisha Adams, MD, MPH

Randell Alexander, MD, PhD

Andrew Ali Hamm, LAC

Tarek Aly, MD, MPH

Emilie Ansay, LMHC, CST

Tatiana Aragon, MA

Maria T. Aranda, PhD

Jeremy M. Archer, MD, MS, FAAP

John S. Auerbach, PhD

Naomi Ardjomand-Kermani, MPH

Constance Aria, PhD

Natalia Ballesteros, MD

Ludmila Barbosa De Faria, MD

Jacob Barnes, DO

Christopher Bauchman, PsyD

Daniel Baughn, PhD

Brittney Benjamin, MD

Corrie Bharucha, MD

Nicole Paradise Black, MD, Med

Paola K. Blanco, MD

Stephen Bloomfield, EdD

Brittany Blue, MD

Joshua Broadman, MD, MS

Amy Brown, MD

Hannah Brown, MS

Kathleen S. Brown, PhD

Corrine Buchanan, LMHC

Regina Bussing, MD, MSHS

Genevieve Camp, LMHC

Adriana Cantville, DO

Carolyn G. Carter, MD, MS

Jennifer Carter, APRN

J. Brett Chafin, MD

Caroline Chance Earls, EdS, LMFT

Aracelys Chang, BS

Tess Chase, MD

Daniela Chiriboga Salazar, MD

Marianne Choy, MEd

Alex C. Clement, BA

Rachel M. Coleman, MD

Isaiah Cochran, MD, AAHIVS

Jennifer Cowart, MD, SFHM, FACP

Paige Crocus, MD

Jennifer Crofts, PsyD

Lisa Cronin, MD

Shanti Cruz, LCSW

Sophia Cruz-Perez, MSW, RCSWI

Madison Curry, RMHCI

Marco Danon, MD

Jeremy J. Darling, LMHC

Jorelle Degen, LMHC

Stacy De-Lin, MD

María Del Pilar Siman, LCSW

Samantha Deming-Berr, DO, MPH

Kanthi Dhaduvai, MD

Paola Dees, MD

Patrick Dominguez, MD

Seth Downing, BS

Martina Drawdy, MD

Kathleen Dully, MD

América El Sheikh, MEd

Heather D. Eslien, LMHC

Andrea Frazier, MD

Rebecca Frye, LCSW

Andrew Galligan, MD

Matthew Garber, MD

Suman Ghosh, MD

Elizabeth Gill, PhD

Margaret Ginestra, LAc

Zac Gohsman, MD

An Goldbauer, PhD

Jessica Goldberg, LCSW

Jeffrey Goldhagen, MD

Cristina M. Gonzalez, LMHC, CRC, NCC

Rafael Gosalbez, MD

Michael Gravenstein, MD

Emily Gray, LMFT

Sara Green, MSW

Linsey Grove, DrPH, MPH, CPH

Andrea D Guastello, PhD

Jennifer Guida, PhD, MPH

Colleen K. Gutman, MD

Cassandra Hafner, DO

Allison Haller, MD

Anna Halliday, LMHC

Julie Hallanger Johnson, MD

Anyaliese D. Hancock-Smith, PhD

Scott Harvey, PsyD

Debra Hatfield, MEd, LMHC

Eugene R. Hershorin, MD

Carolyn K. Holland, MD, MEd, FACEP, FAAP

Elizabeth Hornbeck, MD

Michael Horseman, MD

Gary Howell, PsyD

Rubab Islam, MD

Laura Jacobsen, MD, FAAP

Crystal Jacovino, DO

Stephani Jahn, PhD

Jennifer Jain, MD

Ryan James, PhD

Jaime Jasser-Stone, PhD, LMHC

Sadaf Jeelani, MD

Keri Johnson, PhD, LMHC

Ronda Jordan, PsyD

Lauren Juyia, DO, FACOG

Sheba Katz, PhD, LP, LSP, NCSP

Marc D. Kepner, PsyD

Vinita Kiluk, MD

Jordanne King, MD

Stephanie Kirkconnell, MD

Vicki Knox, MSW, RCSWI

Natalie Koskela-Staples, BA

Jameson Kuang, MD

Bhumi Kumar, DO

Monica Kypreos, LMFT

Donna LaBarge, PhD

Anatalia Labilloy, MD, PhD, MPH

Sasha Larson, EdS, Med

Orlyn Claire Lavilla, MD

Amanda Lawson-Ross, PhD

Katherine Lee, MD, MSPH

Anne Lenz, MD

Carol Lewis, PhD, MPH

Sigal Levy, PhD

John Ligon, MD

Carol M. Lilly, MD

Pamela Lindor, MD

Adam Lloyd, SLP

Lynne Loewenthal, LMT

Anna Lowell, DO, MPH

Soniely Lugo-Ruiz, MD, FAAP

Quinn Lundquist, MPH

Sunni S. Lutton, PhD, LMHC

Faryal Mallick, MD

Rebecca Manganello, DO

Tamara L Martin, PhD

Zophia Martinez, DO

Rosana Marzullo-Dove, PsyD

Jennifer Martin, PhD, CGP

Babetta Mathai, PhD

Paul Maxfield, PhD

Shannon McClenathan, APRN

Sarah McConnell, PhD

Bri Anne McKeon, MD

Patricia McKey APRN

Ezekiel McLeskey, EdS

Veronica Medina, PsyD

Victoria Menzies, PhD, RN, FAAN

Elvira Mercado, MD

Dan Merkan, MA

Tanya Mickler, PhD

Jacob Miller, DO

Jennifer Miller, MD

Laurie Mintz, PhD

Gloria Monasmith, LCSW

Erin Moorman, MS

Melanie Murillo, BS

Martina Murphy, MD

Melinda Murphy, MD, FAAP

Brittany Nazario, CPhT

Anjali Nirmalani-Gandhy, MD

Michelle Nall, MPH, ANP-BC

Ryan Nall, MD

Ronica H. Nanda, MD

Daniel Nassau, MD

Rita Nathawad, MD

Heather Nations MPAS, PA-C

Myrna R. Neims, PhD, LMHC

Melanie Nelson, PhD

Kelly A. Nenezian, LMHC

Cameron D. Nereim, MD

Laurel Nesbit, EdS, LMHC

Josef Neu, MD

Kim Nguyen, MD

Lana Nguyen, MD

Patrick Nobles, DNP, APRN, FNP-BC, CNL

Don Novak, MD

Maureen Novak, MD, FAAP

Robin Nuzum, LCSW, LMFT

Charlotte A O’Leary, MD, FACP

Tina O'Shea, MD

Misti Oxford-Pickeral, MAc, AP, DiplAc (NCCAOM)

Paige Partridge, MD

Amanda Pasciucco, LMFT, CST

Alyx Paul, MD

Anet Pargas, MD

Chandni Patel, DO

Perry Peace, PhD, LMHC

Eboni Peoples, MS

Mildred J. Perea-Bonet, MD

Judith Pezley, RN

Alisa Pierce-Kee, MD

Rebecca Plant, MD

Ethan G. Polsky, MD

Molly Posa, MD

Sujatha Prabhakaran, MD

Elizabeth Pratt, LMHC

Ana Puig, PhD, MA

Mariam Rahmani, MD, FAPA, DFAACAP

Aditi Ramcharitar, MMS, PA-C

Jennifer Rammel, MD, MPH

Rachel B. Rapkin, MD, MPH

Sonja A. Rasmussen, MD, MS

Leslie C. Ravago, MD

Laurie Reisman, LCSW

Natalie Rella, MPH, CPH

Cheyenne Reynolds, BS

Juan Ricardo, MD

Aijay Richards, MSN, APRN, PMHNP

Lynne M. Rigney Barolet PhD LMFT

Peggy Rios, PhD

Brittany Rivers, LMHC

Scott Rivkees, MD

Theresa Rodriguez, EdS, LMFT

Arlan L. Rosenbloom, MD

Cameron Rosenthal, MD

Monika Rosier, PhD

Celeste Rousseau, BS, MS-4

J. Lauren Ruoss, MD

Michelle Ryan, MEd

Tara Vinyette Saco, MD

Nikki Saltzburg, PhD

William Samek, PhD

Karen Samuels, PhD

Janine Sanchez, MD

Raoul Sanchez, MD

Carly Sanford, BA

Beatriz Sankey MD, MPH, FAAP

LInda S. Scharf, PhD

Robyn Schickler, MD

Lauren Schmidt, MD

I. David Schwartz, MD

Jason Scimeme, MD

Mona Shah, MD, MPH

Dorothy Shulman, MD

Sara M Shunkwiler, MD

Sarah Sidhu, MD

Heather J Simpson, LCSW

Manuela Sinisterra, BA

Dana Siperstein, MD

Michelle Slapion-Foote, PhD

Anne-Marie Slinger-Constant, MD

Marina Smerling, LMFT

Amanda G. Smith, MD

Jaclyne Smith, LCSW

Tara Snyder, PharmD

Sakina Sojar, MD

Louise Spierre, MD

Antoinette C. Spoto-Cannons, MD

Nancy E. Staats, MD

Peter S. Staats, MD

Carolyn Stalvey, MD

Angela Starkweather, PhD, RN

Herb Steier, PhD LMFT

Mori Stern, MD

Nichole Stetten, PhD, MPH, CPH

Ezra Stone, LCSW

Jennifer Stuart, PhD

Natalie Stuntz, MD

Sandra Suchomski, MD

Sandra Sullivan, MD

Lindsey Telg, MOT, OTR/L

Kelly Thibert, DO, MPH

Lindsay Thompson, MD

Alexandria Timmer, MD

Ashley Tirado-Martinez, PsyD

Megan Toufexis, DO

Pamela Trapane, MD

Krista Puente Trefz, PsyD

Paige J. Trojanowski, MA

Julia R. Varnes, PhD, MPH

Gerardo Vazquez Garcia, MD

Susie Vought, LMT

Neha Vyas, MD

Abby Wagner, MD

Tamara Walden, MA, PhD

Amy Weiss, MD, MPH

Jamie S. Weiss, PhD, LMFT

Robert L. Wernick, PhD

Erika Wert, MD

Sara E. Wetter, MA

Rachel Whynott, MD, FACOG

Lucas Wiegand, MD

Richard Wilde, MD, FAAP

Susan Wilde, BSN, RN, CPN

Jessica Williams, LMHC

R. Stan Williams, MD

Gwennaelle A. Wilson, MD

Salym Winter, LCSW

William E. Winter, MD

Alea Wise, LMHC, RPT, NCC

Lisa Wolcott, LCSW

Taylor Wolmer, DO

Kate Wrench, LMHC, MEd/EdS

JD Wright, PhD

Nancy Wright, MD

Patricia Xirau-Probert, PhD

Eunhui Yoon, PhD, NCC, NCYC

Elisa Zenni, MD

For a full list of co-signees, visit https://bit.ly/transgenderyouthcolumn.

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This article originally appeared on The Gainesville Sun: Health care professionals: Florida DOH guidance harms transgender youth