Florida Department of Health Guidelines for Treatment of Gender Dysphoria in Children and Adolescents

Miscellaneous and Personal Stuff I Must Share
1

As I work for a doctor, I get these emails. I’m not sure whether this is good policy based on science or if it’s political, but it sure was announced at an opportune time. Right on the heels of the Don’t Say Gay bill law, the state emails all of the health providers and says transgender children and adolescents will probably change their mind - you shouldn’t be prescribing any transition treatments.

I also noticed they say they are “clarifying” an HHS fact sheet, but actually present something 180° in the other direction.

If anything counts as a mundane pointless stuff I must share, this is one of them.

The actual email,

https://content.govdelivery.com/accounts/FLDOH/bulletins/3143d4c

Due to the lack of conclusive evidence, and the potential for long-term, irreversible effects, the Department’s guidelines are as follows:

These guidelines do not apply to procedures or treatments for children or adolescents born with a genetically or biochemically verifiable disorder of sex development (DSD). These disorders include, but are not limited to, 46, XX DSD; 46, XY DSD; sex chromosome DSDs; XX or XY sex reversal; and ovotesticular disorder.

(AFAIK these guidelines have no legal force - providers are free to disregard them as they see fit.)

~Max

2

Why include that last bullet point if the entire state government is being hijacked to do the exact opposite?

3

A provider gets paid for the consult even if they won’t provide treatment.

I guess though, if a patient presents with anxiety due to gender dysphoria maybe a provider following these guidelines would treat the symptom (that is, CBT/talk therapy - again, provider gets paid) rather than the underlying cause, if the belief is that the gender dysphoria will go away on its own.

~Max

4

What’s the actual purpose of this mailing? I can’t believe it’s to “inform” doctors, who are certainly already aware of the HHS fact sheet and don’t need the “clarification.” Is this supposed to lay the legal groundwork for something? Or intimidate docs?

(For the record, I don’t see this as either mundane or pointless.) Thanks for posting.

5

This is the channel the Department uses to tell us when flu vaccines are available, on state COVID-19 policy updates, when there’s an outbreak of some disease (such as the recent worldwide hepatitis in children, or Ebola in DRC) and what the DoH is doing about it, etc. Also for when there are changes in state law affecting providers, and as in this case, changes in Department of Health policy or guidelines.

~Max

6

Let’s actually look at this scientifically, without paying attention to the political aspect.

The first two are stupid. The whole point of puberty blockers is to delay the need for medical transition while maintaining the benefits of early intervention. Those who transition before puberty have much better outcomes.

Social transition is a less intensive treatment, one with no known side effects (as long as one discounts bigotry). It’s also something entirely within the child’s right under freedom of speech. It is the government taking a side in a cultural debate, rather than anything about medical science.

The third one is entirely correct. It is generally not a good idea to perform the surgical options on adolescents. However, the fourth one is only partially correct: hormones and hormone blockers are entirely reversible, and the likelihood of harm is quite low. This is, in fact, the reason for using puberty blockers, since they just block hormones temporarily. Lumping one with the other artificially inflates hormones.

The fifth one is correct, but is also just boilerplate and would apply to literally everyone. And, as mentioned, a lot of scientifically valid tolls to accomplish the firth option have been taken off the table.

So, I can at most say that it gets 1.5/5 correct, or 30%. That’s well into a massively failing grade. And that’s without actually clicking on the links or checking to see whether their purported studies are legitimate.

Now, allowing politics back in, why would a medical organization be this willing to deny the actual science and specifically group different concepts in misleading ways? This is 100% a culture war thing, with a veneer of scientific validity being thrown on as a cover.

Any doctor worth their salt will only at most follow this as much as the law actually requires. They should be more up on the science than this, and spot the politics being used as a substitute.

7

Good list but a nitpick. Hormones are only partially reverseable. For example, vocal deepening amoungst FtM is not reverseable.

So-called “concern trolls” should be all over puberty blockers. This delays the onset of puberty, and if it is “just a phase” maybe the pre-pubescent kid in question will “outgrow” it. (Pretty fanciful at least in the case of my son, who thankfully doesn’t live in bigot central Florida), and can get the gender affirming care he needs here.

8

This is just old-Confederacy hate mongering.

“If you can convince the lowest white man he’s better than the best colored man, he won’t notice you’re picking his pocket. Hell, give him somebody to look down on, and he’ll empty his pockets for you.” -LBJ, campaigning against Goldwater

“You want to know what this was really all about? The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people. You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.” -John Ehrlichman, Assistant to the President for Domestic Affairs under Nixon

“I believe in States’ Rights” -Ronald Reagan

Transgender kids aren’t organized as a voting block and don’t have enough money to fuel political campaigns, so they’re getting used as Willie Horton figures.

I wish all the trans talent and potential currently in the old Confederacy could come up here where I live, where they’d be most welcome as neighbors, colleagues, and friends.

9

They are guidelines, but if they were posted here on the SD, a quick followup reply would be

‘Cite?’

Where did they get their information from to draw up those guidelines?

I would say that altering children in an irreversible way does seem to cross a line for me, and maybe would require some form of at least partial legal emancipation, as as don’t believe the law allows a child to be legally able to decide.

10

Parents make irreversible decisions on behalf of their children all the time.

11

As I strive to be stereotypically Jewish, I’m a strong advocate of Jewish foreskin-having babies losing their foreskins on the eighth day of life. I suppose if you want to invest in plastic surgery this might be reversible. You could always endure the discomfort of a Tug Ahoy. But mostly, circumcision is “altering children in an irreversible way”

There is some outcry against foreskin snipping. But considering the number of Jewish and Muslim penises in the US, it’s nowhere near the outrage over trans kids.

12

But note, as BigT pointed out above, that it’s already generally agreed that irreversible gender-reassignment surgeries should not be performed on children. E.g.:

The notion that transgender minor children are routinely getting irreversible genital surgeries, or that mainstream trans rights supporters and medical professionals want transgender minor children to get irreversible genital surgeries, is just a made-up story by anti-trans activists who want to discredit other kinds of gender-affirming medical care.

But yeah, if all the conservatives are so outraged about “altering children in an irreversible way”, then they need to take a harder look at routine infant circumcision. If we agree that irreversible surgery on children’s genitals shouldn’t be performed for transgender-identity reasons, then there’s no really logical justification for permitting it for religious-dogma reasons.

13

You are aware of the appallingly high rates of suicide among trans youth. More so when they have no access to gender affirming care.

Just an ancedote. I lived with 3 years of my son “joking” about suicide. Getting calls from school on a regular basis that they were legally obligated to inform me that my son at school was uttering self harm and suicidal comments throughout the school day. He started testosterone injections at 16. Within a week the suicidal ideation completely stopped. In fact, he started saying “Dad, drive carefully now that I have the will to live.”

Which is the greater harm. Your sensibilities in denying gender affirming care, or my son’s life? Please think about it.

14

I’m open to discussion on the advisability of surgery and hormones for minors, but seriously, why aren’t we putting all our kids on puberty blockers? IIRC, at least as recently as the Victorian era, it was common for girls not to get their periods until age 16 or so. That’s a clock I could get behind turning back.

15

I’m glad that you son is a much happier person than he used to be. While I have some concerns for the kinds of treatment children receive (for all kinds of things not gender issues in particular), I am not a medical professional and am not qualified to tell you or anyone else what’s best for their child. Experiences like yours are a big reason why I wish places like Florida would refrain from interfering with treatment that will improve the quality of life for a transgender kid and possibly save their life.

16

This. Most of the decisions parents make are arguably irreversible.

What will my child’s milk-tongue be? Will they learn any other languages before puberty?

In what sort of neighborhood and social setting will they grow up?

Will i vaccinate them or potentially expose them to those diseases?

What kind of food will i feed them?

How much exercise will my children get?

Will they learn to code when they are young?

Will they be exposed to music when they are young? What kinds? Will they have access to instruments?

Those (and many others) are irreversible decisions. There are no star gymnasts who are dust exposed to the sport in their teens. What children learn and practice and eat in early childhood shape their abilities and options for life, in many ways.

17

Where are you on the childhood dental care debate?

18

Thank you China_Guy and hoping and praying your son continues to do well and love life.

In this post I was thinking more along the lines of the child’s ability to make a lifelong decision for themselves, though my post may have suggested it was the parents imposing the decision. This is why I stated that some sort of at least partial emancipation may be beneficial in a legal sense. Such a decision, I feel, needs to have the child’s ownership taken at an adult level. This is opposed to a parent’s decision to allow it on behalf of the child, which may come back to haunt the future parent / adult child relationship.

19

I’d say that. It’s putting them on notice that while doing any of these things might not be actually illegal right now, there’s a good chance that might change. That’s certainly what a lot of the GOP would like to do, after all.

And there’s a pretty good chance that they’ll make it retroactively illegal, legal principles be damned.

It also sets up a possible malpractice suit. Get some Republican parent to sue the doctor because they “ruined their child”. The parent can point to this, saying, “The government told them it was wrong, and they did it anyways!”

20

The citations are presented as inline hyperlinks. I won’t vouch for their applicability to the guidelines drawn from them, though.

~Max