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  • Non-binding guidance released by the Florida Department of Health recommends against gender-affirming care for transgender youth, including “social gender transition.”
  • The guidance goes against recommendations from the American Academy of Pediatrics and the American Medical Association.
  • Gender-affirming care can be as simple as a new haircut or clothes for younger children.

The Florida Department of Health released guidance last week that seeks to bar gender-affirming care for transgender youth in the state, including “social gender transition.”

The guidance, which is a non-binding and not a rule or regulation, was issued in a statement by Gov. Ron DeSantis and State Surgeon General Dr. Joseph A. Ladapo.

It recommends against medical transition for children under 18 — including puberty blockers and hormone therapy — and social gender transition. The latter can include wearing gender-affirming hairstyles or clothing.

The state’s guidance also says gender reassignment surgery “should not be a treatment option for children or adolescents.”

Experts say surgical procedures are typically used for adults.

In the news release, DeSantis and Ladapo cite a “lack of conclusive evidence [for gender-affirming care for youth], and the potential for long-term, irreversible effects.”

However, Dr. Joshua Safer, a professor of medicine at the Mount Sinai Center for Transgender Medicine and Surgery and the Icahn School of Medicine at Mount Sinai in New York City, said medical care options offered to transgender and nonbinary youth are reversible.

In addition, “when young children experience feelings that their gender identity does not match the sex recorded at birth,” he said, “the first course of action is to support the child in exploring their gender identity and to provide practical mental health support, as needed.”

The Florida guidance was released in response to a fact sheet on gender-affirming care published last month by the U.S. Department of Health and Human Services (HHS).

The HHS fact sheet states that gender-affirming care for transgender and nonbinary youth is “crucial to overall health and well-being as it allows the child or adolescent to focus on social transitions and can increase their confidence while navigating the healthcare system.”

The American Medical Association, American Academy of Pediatrics, American Psychological Association and other medical associations support youth’s access to gender-affirming care.

“The Endocrine Society objects to the Florida Department of Health’s bulletin on gender-affirming care for transgender and gender-diverse youth,” the society said last week in a statement.

“Transgender and gender-diverse youth need access to evidence-based care that is supported by major international medical groups. … Medical evidence, not politics, should inform treatment decisions,” the statement said.

The society added that the Florida Department of Health’s release cited only a handful of studies. In contrast, the society’s own Clinical Practice Guideline relies on a comprehensive review of the scientific evidence — more than 260 studies.

The Florida Department of Health’s guidance comes as Republicans in Alabama, Texas, and other states seek to bar gender-affirming medical care for transgender and nonbinary youth. In Missouri, legislators are also considering a bill that would extend a ban on gender-affirming care to those 25 years or younger.

“Across the country and in Florida, lawmakers have enacted sweeping attacks on transgender people — particularly transgender youth,” the ACLU of Florida said last week in a statement.

“Just a few weeks ago, the governor signed a bill into law that would erase LGBTQ+ issues, families, and youth from classroom discussions,” the statement continued. “Now, the Florida Department of Health is attempting to demonize life-saving, critical, medically-necessary healthcare for transgender youth. It is simply despicable and wrong.”

Some research — including a study in JAMA Network Open and the Journal of Adolescent Health — has found that youth who have access to gender-affirming care have a lower risk of depression, thoughts of suicide, and suicide attempts.

Other research supports these mental health benefits of gender-affirming care.

“Anti-transgender laws — like the one that criminalizes gender-affirming medical care in Alabama — are already taking a toll on the mental health and well-being of transgender and nonbinary youth,” said Jonah DeChants, PhD, a research scientist at The Trevor Project and a co-author on the JAH paper.

In addition, he pointed to a March survey from The Trevor Project, which showed strong support among Americans for access to gender-affirming care.

“A majority of U.S. adults believe that transgender youth should have access to gender-affirming medical care recommended by their doctors and supported by their parents,” he said. “and that lawmakers should not contradict the recommendation of doctors and major medical associations.”