After an unprecedented vote by the state's medical board, Florida has effectively banned medications and surgery for new adolescents.

Florida is the first state to restrict gender-affirming care for adolescents through the actions of its Board of Medicine. The Republican-controlled State Legislature twice declined to take up a bill aimed at limiting such treatment.

The board voted 6-3 on Friday to adopt a new standard of care that forbids doctors to prescribe puberty blockers and hormones until a patient is 18 years old. There will be exceptions for children who are already receiving treatment.

On Friday, the Florida Board of Osteopathic Medicine voted to restrict care for new patients and allow an exception for children in clinical studies. Doctors who don't follow the rules could lose their licenses.

There is a pressing need for additional, high-quality clinical research according to the chair of the board.

The decision followed months of heated discussion, including a tense and at times bitterly divided public meeting in Florida last week featuring testimony from doctors, parents of trans children and adults who have come to regret their transitions

Four days before the conclusion of the governor's race in the state and as conservatives have adopted gender-related medical care for adolescents as a key issue on the national political stage, it was announced. Mr. DeSantis said in a recent debate that such treatments would not be permitted in Florida. Before the medical board decided to craft the new standard, they received calls from the state surgeon general urging them to do so.

Thousands of low-income adults and children were affected by Florida's decision to bar Medicaid coverage of gender-affirming care.

puberty blockers, which stall development, often followed by testosterone or estradiol to bring about secondary sex characteristics, is one of the treatments for adolescents. A small but increasing number of adolescents are having their breasts removed. Parents are required to approve all treatments.

The American Academy of Pediatrics is one of the major medical groups in the United States. Small studies show that medical interventions can help adolescents who suffer from depression and anxiety.

There is a lack of data on the long-term outcomes of adolescents who seek such treatments. At the public meeting last week, board members talked about changes in Europe, where some countries have recently limited which adolescents can receive puberty blockers.

The US has taken an all-or-nothing approach. Laws have been passed in Arkansas and Alabama that make it illegal for doctors to provide gender related care to children. The governor of Texas ordered the state's child welfare agency to investigate the parents of children who are trans. Civil rights groups are challenging these actions in the courts.

ImageMr. DeSantis nominated Dr. Joseph Ladapo as surgeon general in September 2021.
Mr. DeSantis nominated Dr. Joseph Ladapo as surgeon general in September 2021.Credit...Chris O'Meara/Associated Press
Mr. DeSantis nominated Dr. Joseph Ladapo as surgeon general in September 2021.

The medical board in Florida is overseen by the Department of Health. The board is mostly responsible for licensing and disciplining doctors.

Over the past decade, eight members of Florida's board have donated a combined total of nearly $100,000 to Mr. Four members have given more than one million dollars.

Questions about the role of a politically appointed body in controlling complex and highly personal medical decisions were raised after the board voted on Friday. Opioid abuse and procedures like Brazilian butt lifts that have resulted in patient deaths in Florida are some of the grave threats the board focuses on. The state had not received any patient complaints about gender-affirming care according to a lawyer for the health department.

At the meeting, Dr. McNamara said that she felt that this was misuse of their power.

He nominated Dr. Ladapo to be the surgeon general in September 2021. The two men took scientific uncertainty and used it to justify aggressive policies out of the mainstream medical orthodoxy.

Legislation that would have made it a first- degree felony to prescribe puberty blockers and hormones was introduced by a Republican lawmaker in Florida. The bill did not make it to the House of Representatives in either year.

In April of this year, Dr. Ladapo sent a letter to physicians in Florida, telling them not to prescribe gender-affirming drugs or surgeries for minor children. Medicaid coverage of gender-related treatments for patients of all ages was lost due to the memo.

In June, Dr. Ladapo asked the state's medical board to consider a ban, arguing that evidence for gender-affirming care in adolescents was "extraordinarily weak" and that it had a "high risk for long-term, irreversible harms."

On the eve of the board's vote on its own rule, Dr. Ladapo called the board members to check in, according to one member who requested anonymity because he was concerned about his privacy. He said that the board wouldn't investigate physicians at the request of the surgeon general. A new standard of care was voted on by the board.

There was no reason for the surgeon general to reach out to the board members.

The deputy chief of staff of the department said in an email that it was shocking for the surgeon general to communicate with members of any board. She said that Dr. Ladapo contacted members of the state Board of Osteopathic Medicine to check on their safety after receiving death threats.

The medical board didn't like the idea of banning the care. According to two people familiar with his decision, the vice chair of the board stepped down because he was disappointed by the board's actions on this issue.

At the meeting last Friday, with an audience of 200 people, the board heard testimony from doctors who treat trans adolescents, as well as from two critics who don't specialize in such care.

Dr. Dayton is the head of the youth gender program at the University of Florida. After two other clinics in Florida stopped accepting new patients, the only other option was Dr. Dayton's clinic.

Patients who received access to gender-affirming hormone therapy reported reduced suicidal ideation and increased satisfaction with their lives.

She wanted the board to consider that some patients didn't receive medical interventions. There is no one-size-fits-all model for healthcare.

The youth gender program in that country has been led by Dr. Riittakerttu Kaltiala since 2011.

She said that most of her patients were assigned female at birth and began to experience distress about their gender identity later in adolescence. Many of her patients were not helped by the treatments. In 2020, Finns began limiting puberty blocking and hormonal treatments for minor children, only to adolescents with clear diagnoses of gender dysphoria and expanding the availability of talk therapy.

The board was told by Dr. Kaltiala that the evidence was not good.

ImageChloe Cole spoke at a news conference on Capitol Hill in September.
Chloe Cole spoke at a news conference on Capitol Hill in September.Credit...Drew Angerer/Getty Images
Chloe Cole spoke at a news conference on Capitol Hill in September.

Nine people who had reversed their gender transitions were invited to speak first at the meeting. Many people said their transitions had happened during periods of psychological distress.

The 18-year-old who testified in favor of the state's Medicaid ban developed more mental health issues as a result. She had surgery to remove her breasts when she was 15. She realized that her transition was a mistake after a year.

Parents talked about how gender-related medical support had improved their children's lives. A mother described the path of her child. She doesn't want to go through puberty as a male.

She said that they don't make these decisions lightly. The families should make these decisions, not the state or the board.

Jude Speegle said he had known for a long time that he was a trans person. He said he tried to kill himself multiple times because he thought it was wrong to be who he was.

The same change to the standard of care was going to be voted on by both boards on Friday. The research exemption was hit by the medical board. There will be two standards for medical and osteopathic doctors in the state.

Anna Eskamani is a democrat from Orange County. The board of medicine is not what she expects the legislature to be.

After a 21-day public comment period, the new standards will be implemented. There are no clinical trials for children in Florida.

She gave reporting.