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 we 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 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 Department of Health 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 and 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.
While we agree with the Florida Department of Health that guidance surrounding care of transgender youth “requires a full, diligent understanding of the scientific evidence,” their statement fails to follow their own recommendations. Specifically, the Florida Department of Health 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 Department of Health.
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 to 7 times higher and rates of suicidality that are 10 to 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.
Spend your days with Hayes
Subscribe to our free Stephinitely newsletter
You’re all signed up!
Want more of our free, weekly newsletters in your inbox? Let’s get started.
Explore all your optionsProfessional 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 Department of Health to reconsider its guidance in favor of a more individualized, patient- and family-centered, and compassionate approach.
Sincerely,
Brittany S. Bruggeman, MD, FAAP, Assistant Professor of Pediatric Endocrinology, University of Florida College of Medicine
Kristin Dayton, MD, Director, UF Youth Gender Program, Assistant Professor of Pediatric Endocrinology University of Florida College of Medicine
Alejandro Diaz, MD Chief, Division of Pediatric Endocrinology Nicklaus Children’s Hospital
Jennifer Evans, PsyD, Licensed Clinical Psychologist, UF Youth Gender Program
Michael J. Haller, MD, Professor and Chief of Pediatric Endocrinology, University of Florida College of Medicine
Mark L. Hudak, MD, Professor and Chair of Pediatrics, University of Florida College of Medicine-Jacksonville
Carol A. Mathews, MD Professor and Interim Chair of Psychiatry, University of Florida College of Medicine
Stephanie Ryan, MD, Associate Professor of Pediatrics, Assistant Dean Office of Diversity and Health Equity, University of Florida College of Medicine
Michael Shapiro, MD, Associate Professor of Psychiatry, University of Florida College of Medicine
Desmond Schatz, MD, Professor and Interim Chair of Pediatrics, University of Florida College of Medicine
Co-signed by:
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
Nicole Fanarjian, MD Franklin H. Foote, PhD
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