FORT LAUDERDALE, Fla. -- Kai was 13 when his period arrived, crushing his spirit.
The middle schooler rushed home to shower and emerged from the bathroom distraught. Kai’s mother, Barbara, said she looked into his eyes and knew she needed to do something or her child, who identified as a male, would harm himself.
Within weeks, Kai began puberty-blocking hormones that stopped the periods.
“I really believe that saved his life,” Barbara said.
In Florida, recent state actions threaten medical and psychological care for transgender youth like Kai, say more than a dozen families of transgender youth and children. They say that years of gains would be erased if the state makes transition-related care difficult to get or pay for. In interviews with the South Florida Sun Sentinel, the families credit transition care and gender-affirming therapy with not only allowing their child to become the sex they feel they are but also with keeping their child alive.
These are the ways transgender youth treatment is under fire in Florida:
• Gov. Ron DeSantis’ administration moved forward Friday with a proposal that would deny Medicaid coverage for treatments such as puberty-blocking medication and hormone therapy for transgender people.
• Florida health officials are asking medical professionals to ignore federal guidance and stop assisting children and teens with gender transitions.
• Florida’s surgeon general is asking the Florida Board of Medicine to create policies that could ban or restrict transition-related care for transgender youth. The Board of Medicine regulates the state’s medical doctors.
• At least one state legislator wants to introduce legislation that would create a “felony child abuse” penalty for doctors who provide surgery or prescribe drugs that aid in the “gender assignment” of youth in Florida.
“This is scary and upsetting,” said Jennifer, a Weston mom of a 14-year-old daughter who was born male. The Sun Sentinel is not using some parents’ last names out of their concerns their children would be identified. “We as parents need to make these decisions with, and on behalf of, our children. The government should not tell us how to medically treat our children.
“I can assure you, I don’t know where my daughter would be mentally, physically and socially if she was denied treatment. It is real, the facts about kids who don’t get support are real.”
The mental and physical issues at play
The Trevor Project’s 2022 National Survey on LGBTQ Youth Mental Health found nearly 1 in 5 transgender and nonbinary youth had attempted suicide and two-thirds had experienced symptoms of depression.
Those are not statistics parents of trans youth take lightly, says Jeanette Jennings, the mother of 21-year-old Jazz, who transitioned in her own series on national television. Jennings says Florida health officials don’t realize what is at stake if they clamp down on care.
“This is not about politics, it’s about kids that need this life-or-death medical intervention,” Jennings said.
Some of Florida’s recent actions come in response to efforts at the federal level to bolster access to gender-affirming care and family counseling. President Biden signed an executive order on Wednesday aimed at protecting LGBTQ people and trans youth.
Florida health officials want trans youth to wait until they are 18 to change their names, wear clothes that match the sex they identify with, get therapy for gender dysphoria, block their hormones during puberty, or have any type of gender-changing surgery. This comes as a leading transgender health association has just lowered its recommended minimum age for starting gender transition treatment to 14, two years earlier than previous. However, the association does want parents to take their child’s emotional maturity into consideration and have a psychological evaluation.
Jeanette Jennings says the state’s move to ban gender transition health care until a child reaches 18 would cause harm.
Young people need puberty blockers to delay unwanted physical changes that don’t match their gender identity, she said. Providing those blockers pre-puberty can give a child more time to explore their options before deciding whether or how to transition. Denying the hormone blockers to minors, she said, makes it more difficult as an adult to reverse the physical changes puberty brings on.
“It’s a necessary step. These kids who identify as female don’t want beards and mustaches and Adam’s apples, and those who identify as male don’t want breasts and periods,” Jennings said.
Over the last five years, the number of youth who identify as transgender has doubled, according to the Williams Institute, a research center at the University of California, Los Angeles law school that produces reports on the LGBTQ populations in the United States. Researchers believe social media may be behind the increase by giving access to teenagers questioning their gender identities to gain information.
In Florida, more than 16,000 individuals ages 13 to 17 identify as transgender as of 2020, a larger share of the overall population than previously estimated, according to the Williams Institute, which used data from the CDC’s Youth Risk Behavior Surveillance System.
Dr. Michael Haller, professor and chief of pediatric endocrinology at the University of Florida, said transgender youth finally have social support and better access to medical care in Florida, including several transgender clinics throughout the state.
Any action to limit medical care, he said, would have harsh consequences, especially for young people mid-way through treatment. The state’s push to take away Medicaid funding, he said, could make the costly treatment suddenly financially out of reach.
“Imagine a 16-year-old transwoman who can’t get the blockers and now starts to have facial hair and testicular hair and a deep voice. I can’t imagine anything more unethical to do. It’s like having someone halfway through chemo and pulling the plug.”
Florida’s parents see repercussions
Jennifer, the Weston mom, said gender dysphoria — a mismatch between biological sex and gender identity — in a child is challenging for parents, families and friends to understand. She says state health officials can’t possibly understand the needs of these young people and the repercussions of restricting care.
“Our daughter transitioned at 9, which is very young. I tried everything in my power to figure out an alternate path. I did not want to allow her to socially transition. I fought it and that’s the reality of the situation,” she said. “We now realize she was born in the wrong body in every way possible. And if you met her, you would agree.”
Parents of trans youth tell a similar account as Jennifer’s: that the care the state wants to limit saves lives, even if it has some risks.
Jennifer says had she not taken her then-son to the endocrinologist at 9 and put her on puberty blockers, her now confident and happy daughter could have taken a different road. “I don’t know if she would be here.”
“My child will die,” said Leslie, a Fort Lauderdale parent whose 12-year-old child is going through the type of gender-affirming mental health therapy state health officials advise against. Her son, who believes his true identity is female, has already expressed thoughts of suicide.
Families say denying Medicaid coverage for treatments such as puberty-blocking medication and hormone therapy for transgender people will make treatment impossible. “Would you deny a child coverage for cancer?” Amanda Husband, of Gainesville, wants to know.
Husband says her 20-year-old son is a thriving graphic designer and fully transitioned. The most difficult piece to navigate, she says, has been paying for the care. She has spent many hours navigating insurance, ordering medications from Canada and researching Medicaid reimbursement.
“My son is a success story because we were blessed to have the opportunity to get what he needed.”
Deanna Muniz, of West Palm Beach, said her son just turned 18 and had a hysterectomy.
But because he was on hormone blockers that prevented his breasts from growing, he did not have to have invasive top surgery.
“Early intervention helps children get mentally and physically stable in their bodies. There are people who will never understand that and they don’t have to understand. Just respect that is a condition that is real.”
Florida’s surgeon general leads the charge
Florida Surgeon General Joseph Ladapo, who oversees the Health Department, is leading Florida’s effort to restrict transition care. Ladapo has been aligned with Gov. Ron DeSantis in his opposition to coronavirus mandates for vaccines and masks and more recently his opposition to vaccines for young children.
In April, Ladapo issued guidance to health professionals via email recommending they withhold transgender treatments for minors. This includes social gender transitioning — acknowledging that a young person is trans, using their correct pronouns and name, and supporting their desire to live publicly as the gender of their experience rather than their sex assigned at birth.
In its guidance, Florida’s health department said evidence on hormonal treatment is “low quality” and noted other evidence that claims 80% of those seeking clinical care will lose their desire to identify with the non-birth sex.
Demetrius Williams, licensed mental health counselor with Thrive Counseling in Tampa, said he will not follow the guidance. “In my opinion, it is flawed,” he said.
“To not provide counseling to trans youth leads to an increase in depression and suicidal thoughts and behavior,” Williams said.
Williams helps adolescents and their families identify baby steps toward transitioning — changing a name or hairstyle and using gender-neutral pronouns. “I help them figure out what works for them and plan for how to deal with the highs and lows of that experience.”
Williams says waiting for a minor to become 18 to get help is cruel — and has consequences. “They will act out because it’s very painful to not be able to live as their true selves.”
Ladapo also has asked the Florida Board of Medicine to establish a standard of care for transition-related treatments such as gender-affirming surgery, hormone therapy and puberty blockers. That could ultimately result in prohibiting doctors from prescribing the therapies for transgender youths.
Doctors disagree with Ladapo
Doctors at UF Health’s Youth Gender Program say no one from the state has reached out to experts to help shape the new guidance.
Haller at UF said while there is a need for more data on medical treatment and risks, “the state is relying on evidence from people who don’t manage these kids.”
“If followed,” he said, “their recommendations would worsen the overall health and well-being of children in Florida.”
Dr. Ann Grooms, who works with college students on gender dysphoria at UF Health, says the reality is the opposite of what Ladapo asserts. She provides gender transitioning care to college students in Gainesville who consistently tell her they wish they had treatment sooner. Grooms said the benefits of early medical treatment outweigh the risks and don’t necessarily lock a child into permanently transitioning.
“When these children are at or near puberty they have tremendous anxiety. Puberty blockers put everything on hold as they age and become more developmentally sound and express themselves better. Some will end up being heterosexual, some gay, some non-binary and some will end up transgender. But without that support, some will end up taking their lives.”
Distraught families will fight back
Across the state, families of transgender youth are banning together, brainstorming ways to fight back against Florida’s actions.
“If the state is going to limit access to care, we need to help teens find a way to get it,” said Jaye, 20, who has had the surgical procedures to transition after early gender-affirming care.
Ashley Mayfaire, director of operations at Transsocial in Miami, said her organization is creating support networks for families of trans youth who fear their providers who accept Medicaid will stop treating them.
“Not everyone has the ability to relocate out of state so we have to look at community organizing,” she said. “Encouraging people to get out and vote is one method of harm reduction. We are also looking at workarounds for medical care. Telemedicine has some flexibility. There may be out-of-state providers who are able to treat Florida’s trans youth.”
Mario DePedro said his organization, SunServe of Fort Lauderdale, offers therapy and life coaching for trans youth as well as support groups. Those services will continue regardless of state actions, he said. “For youth to be able to meet other youth who feel the same way makes a big difference. It is dangerous and damaging to the lives of these young people to limit care in any way.”
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