Background
I will not belabor the CDC public health guidance on masks, social distancing, and the subsequent “closing down” of our economic activity. What is new is that Florida’s medical board is holding hearings in advance of a rule prohibiting any form of hormonal or surgical management of gender dysphoria for those under the age of 18. Let’s be clear, even the “Great Satan” of reproductive health, Planned Parenthood, requires parental consent for hormonal or surgical management of gender dysphoria for those under age. [1]
The Florida Board is acting upon guidance issued by Florida’s Surgeon General Joseph Ladapo, which resulted in a meta-analysis by the Board. Their literature review found,
“…no studies compared the outcomes between a group of people with gender dysphoria using puberty blockers and another group of people with gender dysphoria not using them.”
In the absence of a randomized controlled study (RCT), the use of puberty blockers had an unknown effect. They found the same lack of RCTs for cross-sex hormones and surgeries.
COVID Mandates
I believe that masks and social distancing are important components in reducing the spread of infectious diseases. I believe that vaccination is also important, although it can be argued that because of mid-information, those vaccines over-promised and underdelivered for immunity. They performed very well in reducing the severity of the disease and hospitalization, which, if you remember, was the concern in “flattening” the curve in the distant past.
But I suspect that the real reason I was in favor of those mandates is that it was protective of those around me. Masks and social distancing were actions I could take to protect the vulnerable around me.
Gender Dysphoria
Gender dysphoria is not contagious; it is a disease impacting an individual and, often, by concern, their family. My belief in the autonomy of the individual to make their healthcare decisions, based on 30 years of clinical practice (yes, I am playing the doctor card), means that while I may try to influence them, the decision rests squarely with them. Their choice does not impact my health in the same way that masking, social distancing, and vaccination may affect my risk of COVID. So, I have a problem with the government telling me, in this instance, what I can do.
Overall, if the decision only impacts me, the government should butt out; if my decision affects others, then the government does have a role in fostering collaborative behavior.
Do No Harm
The strongest argument, from my point of view, of the Florida Medical Board is that some adolescents with gender dysphoria will, over time, change their minds and feel more at home in their biological gender. The evidence is confusing and unsettled. For me, that would mean that irreversible medical treatment, i.e., surgery, should await the patients’ “coming of age.” On the other hand, I would have far fewer concerns with puberty blockers, though they have their downsides. As with all decisions, there are tradeoffs.
“The current standards set by numerous professional organizations appear to follow a preferred political ideology instead of the highest level of generally accepted medical science. Florida must do more to protect children from politics-based medicine.”
Do Governor DeSantis and Dr. Ladapo walk the walk or just talk the talk? Unfortunately, I believe that politics-based medicine still seeps into their decision-making.
Dr. Ladapo, when questioned about America’s Frontline Doctors and their support of the use of Ivermectin, emphasized “individual autonomy” and suggested that doctors not be “limited” in the medical recommendations because the science of Ivermectin was “unsettled” – just like the science of hormonal and surgical treatment of gender dysphoria. Governor DeSantis said when appointing Dr. Ladapo, “You’ve got to tell people the truth, and you’ve got to let them make decisions.”
But those beliefs about patient autonomy, even in the face of “unsettled” science, evidently only pertain to COVID for Governor DeSantis and Dr. Ladapo, not treating gender dysphoria. Buried in the report to Florida’s Board of Medicine and ignored by both sides of the culture war is perhaps the most apolitical of positions; one that I would endorse.
“Therefore, regarding this use [puberty blockers, cross-sex hormones, and surgery] should carefully consider other relevant factors. At a patient level, these factors include patients’ values and preferences (how patients trade off the potential benefits and harms – what outcomes are more important to them) and resources needed to provide the interventions (and the availability of such resources). At a population level, in addition to these factors, it would be important to consider resources need to implement the interventions, feasibility, acceptability to relevant stakeholders, and equity. … at the patient level, shared decision making is a key part of the decision-making process. At a policy level, extensive debate may be needed.”
Government should confine its over-reach into medical decision-making to those decisions affecting all or many of its citizens. For decisions that impact only the patient and a few close others, the government, especially in Florida, should follow the words written by their experts and not the political speech of the Board of Medicine in their public hearings.
[1] I know of no exception where an underage child has undergone any medical gender dysphoria management without the knowledge and consent of their parents.
The writing staff at ACSH shares our work before posting, and this opinion piece generated a great deal of in-house comments. Cameron made an important point that deserves a bit of emphasis. The position taken by Governor DeSantis and Dr. Ladapo is not necessarily transphobic, nor our their views on COVID anti-science. Both are labels and serve more as dog whistles than to inform.
Sources: Florida medical board votes to ban gender-affirming care for transgender minors NBC News
The Doctor Giving DeSantis’s Pandemic Policies a Seal of Approval NY Times
Chuck Dinerstein, MD, MBA
Director of Medicine
Dr. Charles Dinerstein, M.D., MBA, FACS is Director of Medicine at the American Council on Science and Health. He has over 25 years of experience as a vascular surgeon.
