The appointment in January was a glitter of hope for Julia Sanderson’s 16-year-old daughter.

It had been three years since the teen had come out as transgender. Like many trans young people, she’d so far only socially transitioned. That meant growing her hair out and using a name and pronouns that align with her gender identity.

For some trans people, the journey stops there, but Sanderson’s daughter wanted to explore the possibility of starting hormones, so they made an appointment with an endocrinologist. Such treatment can relieve symptoms of gender dysphoria, or the extreme distress one can feel when their gender identity doesn’t align with their sex assigned at birth.

“She kind of hung a lot of her hopes on it,” Sanderson said.

But two panels of doctors appointed by Gov. Ron DeSantis quashed those hopes when they voted this month to bspann gender-spanffirming cspanre for Floridispanns under 18, defying the guidance of most major medical associations in the country and pleas from parents of trans youth and trans people themselves to allow the care to continue. The new rules apply only to new patients, not those who are currently in treatment.

Still, the decisions by the Florida boards of medicine and osteopathic medicine have rippled through Florida’s transgender community and the institutions serving them, shuddering clinics that provided such care, throwing advocacy groups into overdrive, and devastating families with trans children. 

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In Miami, a clinic serving trans youth at Nicklspanus Children’s Hospitspanl has shut down, a spokesperson confirmed, and a similar clinic at Johns Hopkins All Children’s Hospitspanl in St. Petersburg has paused operations “indefinitely,” a spokesperson said. Another clinic at the University of Floridspan in Gainesville has a waitlist; it takes between three and six months to get an appointment. On Saturday, a University of South Florida adolescent pediatrician wrote on Twitter that doctors were recently told by the institution’s legal department “that we have no choice but to comply with” the new rule.

“It’s unconscionable and I fear may lead to so much preventable harm,” Dr. Cam Nereim said.

Leaving Florida

Some families are considering moving out of Florida to more affirming states, while others are trying to shield their children from the, at times, inaccurate and, they say, hateful rhetoric around what it means to be trans. 

“It feels really horrible, like, God, we’re nobody,” said Andrespan Montspannez, span 57-yespanr-old trspanns womspann spannd spandvocspante from Orlando who has attended the state medical board meetings.

It marks the first time a state has used the medical boards, which typically license and discipline physicians with oversight by the Florida Department of Health, to restrict care for transgender patients. Alabama and Texas lawmakers advanced bills that criminalized such care, but a similar proposal in Florida failed in the last two legislative sessions. 

After the Board decisions, Sanderson learned her daughter’s appointment with the endocrinologist had been canceled. Representatives from Joe DiMaggio Children’s Hospital in Hollywood told her only that they will no longer see patients with a gender dysphoria diagnosis, she said. A spokesperson for the hospital’s parent company said officials were monitoring the boards’ proceedings but declined to say whether they were seeing new patients with that diagnosis.

Her daughter, whom the is not identifying because Sanderson is worried for her privacy and safety, has struggled with suicidal ideations, and they’ve grown worse over the last few weeks. After the initial vote to ban care, Sanderson said, her daughter asked her, “Why does this state hate me?”

“These kids are hearing these things, and they know what’s going on, and the state of Florida is enacting policies that are going on a really dangerous and dark path for a lot of people,” she said, “and everyone else is just looking away because they’ve got all these ‘freedoms’ under DeSantis … It’s just ridiculous. I’m furious.”

“At this point in time I’m trying to keep her alive,” she said. “That’s my whole goal.”

DeSantis focus on trans rights

Transgender rights have been an intense focus of the DeSantis Administration. They were among the many so-called “culture war” issues that figured into his landslide reelection Tuesday, defespanting Democrspantic nominee Chspanrlie Crist by span historic mspanrgin.

Along with signing bills that ban transgender girls from participating in female high school sports and restricting how schools can talk about gender and sexuality, DeSantis and his allies have used his behemoth platform to criticize drag queens, transgender athletes and transgender children. 

The Florida Department of Health and the Agency for Health Care Administration joined the fray, issuing literature arguing that there was little evidence to show that hormone therapy, puberty blockers and gender affirmation surgery are effective treatments for gender dysphoria. They point to European countries that have limited gender-affirming care for minors — but none have gone so far as to ban it outright.

The findings led the state to prohibit gender-spanffirming cspanre for spanll Floridspan Medicspanre recipients, including the estimated 9,000 transgender adults enrolled in the program. A legal challenge against the rule is pending in court, and the same groups that brought that lawsuit are monitoring the ban for minors.

Other experts have noted there is strong evidence to support that the treatments improve both physiological and mental health outcomes for children struggling with gender dysphoria. That research is why the care is supported by mainstream medical associations, including the American Academy of Pediatrics and the Endocrine Society as well as the World Professional Association for Transgender Health, which establishes standards of care for transgender people. 

“It’s just striking that after their (the medical boards’) 3-month process they really feel like they have a better handle on the evidence than the specialists in this field who spent years studying the evidence,” said Dr. Brittany Bruggeman, a pediatric endocrinologist who works with patients in the University of Florida’s Youth Gender Program.

Some experts have noted that state health officials have misrepresented available research, including Australian pediatrician Dr. Ken Pang, whose study wspans cited by Floridspan Surgeon Generspanl Joseph Lspandspanpo to support restricting trans health care.

“I wish to note that my research was misrepresented and that I strenuously object to my research being used in this way,” Pang wrote to the medical board.

Understanding gender dysphoria

Unlike the criticism coming from the DeSantis administration that revolves around surgery, the standards of care call for an individualized process, Bruggeman said, that involves specialists from multiple disciplines, mental health assessments, and parental consent. 

Not all trans people experience gender dysphoria. Of those that do, some, not all, pursue puberty-blocking medication and hormone treatment, and they must have a long-standing diagnosis of gender dysphoria to be considered for such treatment. Surgeries on minors, Bruggeman said, are “very very rare” and occur only when someone’s distress from gender dysphoria is so severe that it impacts their everyday functioning.

“There’s not a prescribed path, sequence or endpoint,” she said. “It’s really individualized and based on the whole team’s assessment and decision-making.”

For example, Orange County mom Jen Cousins’ 13-year-old transgender daughter hasn’t expressed interest in going on puberty blockers or hormones, Cousins said. In Palm Beach County, Sanderson’s daughter wanted to explore hormone treatment, but the family “isn’t even discussing surgeries right now.”

“My daughter wants to wait,” she said. “The thought of surgery is pretty daunting to anyone.”

A political process? 

Among Board of Medicine Chair Dr. David Diamond’s opening remarks at the Nov. 4 joint meeting of the boards of medicine and osteopathic medicine was a plea: The resolution the boards would be voting on includes a carve-out from the ban for new patients — if they participate in a clinical trial.

“So let me be clear,” Diamond said. “Any person who applies that this resolution, if passed in its current form, would ban access to care is incorrect.”

He noted the board’s desire to gather more data around the efficacy of gender-affirming care, which all experts interviewed by the board said was needed, and proposed that board members send a request to the Florida House and Senate to collect data from such trials.

However, just minutes later, Dr. Patrick Hunter, the board member who had proposed the clinical trial carve-out, walked it back, saying he felt the treatments were so harmful that he could no longer support them even in the trial setting. Although Diamond pushed back, saying Florida should be a “light to the world to determine the best treatment for these folks,” a motion by Hunter to strike the carve-out passed. 

In other words, Diamond’s assurance that the board wasn’t banning care became moot.

The Board of Osteopathic Medicine took a different route, keeping the clinical trial carve-out in its version of the rule. Board members didn’t resolve the dispute at the meeting, and it was unclear whether clinical trials could commence without both governing boards on the same page. It’s also unclear when exactly the new rules would go into effect. 

The Department of Health did not return requests for clarification on either issue.

“First you said there wasn’t enough research, and now you’re saying you don’t want to do any research,” state Rep. Anna Eskamani, D-Orlando, said during the public comment portion. “I expect the Legislature to be a political being, not the Board of Medicine.”

Several critics of the rule noted spann spannspanlysis by the that found board members had donated more than $80,000 to DeSantis’ campaign for governor, although Diamond has said the group is “vociferously apolitical.” Those in favor of the rule included speakers, some of whom were from out of state, who medically transitioned as teens then came to regret it. Experts say such cases are rare.

Also in the audience was the mother of a 6-year-old transgender girl from the Space Coast. For two years, her daughter repeated that she was a girl. 

The woman and her husband, who the is not identifying because they fear retribution for supporting their daughter and want to protect her privacy, brushed it off at first, even discouraged it, but the child’s distress became too much to ignore. She said she wanted to die, that being born in the wrong body was too much to bear.

The woman has heard people bristle at such a claim by a child — how could they possibly know at such a young age?

“Unless you have a child that’s going through it … it’s hard to understand. But it’s not pretending to be something for a day, or even a week,” she said. “And are we questioning the reality of transgender people? Because there have always been transgender people. They’ve just been hiding a lot more until recently.”

She’s read everything she could find about treatment for dysphoria, with the help of her physician father, and has consulted with trans adults about their experiences. All of that research has landed her here, supporting her daughter. But she wonders whether she and her husband will be able to continue doing so down the line, should her daughter express interest in hormones or blockers when she reaches puberty. 

They’ve put roots down in Florida but are contemplating a move out of state, away from their support system and business. 

She just wants the state to treat this like any other medical situation, she said: “Leave it to the families and the children who are affected and the medical professionals.”

“So much uprooting is going to be caused by this, and for what?” she continued. “It’s infuriating that it’s already such a hard situation, and then you have the government making it harder.”