Florida rules on transgender treatments draw a court challenge

Protestors march against a bill restricting transgender girls from sports teams in Pierre, South Dakota on Thursday, March 11. (Toby Brusseau/AP Images for Human Rights Campaign)

By Dara Kam ©2023 The News Service of Florida

TALLAHASSEE — Four families filed a federal lawsuit Thursday challenging rules adopted by Florida medical boards that prohibit doctors from providing gender-affirming treatment such as puberty blockers and hormone therapy to transgender children, arguing the rules intrude on “parents’ fundamental right to direct the upbringing of their adolescent children.

The lawsuit alleged the rules unconstitutionally “violate the rights of parents to make medical decisions to ensure the health and wellbeing of their adolescent children” and are discriminatory.

Gov. Ron DeSantis’ administration filed a petition last summer asking the medical boards to adopt the rules, arguing that gender-affirming care is experimental and not backed by rigorous research. The Florida Board of Medicine’s rule went into effect on March 16 and the Florida Board of Osteopathic Medicine’s rule will go into effect Tuesday.

“The transgender medical bans do nothing to protect the health or well-being of minors. To the contrary, the transgender medical bans undermine the health and well-being of transgender minors by denying them essential medical care,” lawyers for the plaintiffs argued in the 26-page complaint filed in the federal Northern District of Florida.

Under the rules, children diagnosed with gender dysphoria will be allowed to continue taking the drugs if they were receiving the treatments when the regulations took effect. But trans children who hadn’t begun taking the drugs are ineligible. The federal government clinically defines gender dysphoria as “significant distress that a person may feel when sex or gender assigned at birth is not the same as their identity,”

Attorneys from a number of LGBTQ advocacy groups filed the lawsuit on behalf of parents identified as Jane Doe, Brenda Boe, Carla Coe and Fiona Foe and their children, Susan Doe, Bennett Boe, Christina Coe and Freya Foe. The families, who are using pseudonyms to protect the children’s privacy, live in Alachua, Duval, Orange and St. Johns counties, and the children range in age from 9 to 14. The named defendants are Surgeon General Joseph Ladapo and the 12 members of the medical boards.

Florida is among a number of Republican-led states enacting policies targeting transgender youths and adults. DeSantis, widely seen as a top contender in the 2024 Republican presidential race, has made the issue one of his top priorities, frequently calling gender-affirming care “child mutilation.”

The lawsuit also alleged that the rules violate equal-protection rights by banning “essential medical treatments” for the adolescent plaintiffs “because they are transgender.” Under the rules, hormone therapy and puberty blockers remain available to children diagnosed with conditions other than gender dysphoria.

The challenge said the treatment restrictions contradict research supporting care for children diagnosed with gender dysphoria, who have higher rates of depression and suicidal ideation.

“The transgender medical bans ignore the established medical and scientific consensus that these treatments are medically necessary, safe, and effective for the treatment of gender dysphoria,” the lawsuit said. “The defendants have no compelling justification for preventing parents from ensuring their adolescent children can receive essential medical care. The transgender medical bans do not advance any legitimate interest, much less a compelling one.”

According to the lawsuit, the rules will have a negative effect on the young plaintiffs by interrupting various phases of transitioning. As an example, Susan Doe, 11, has been “living fully as a girl” since kindergarten but has not started taking medical treatment because she hasn’t reached puberty.

The Does, who moved to Florida when Susan Doe’s father was stationed in the state, said military doctors who worked with their family “understand the importance of providing … evidence-based, individualized care” to their daughter.

“We’re proud to serve our country, but we are being treated differently than other military families because of a decision by politicians in the state where we are stationed. We have no choice but to fight this ban to protect our daughter’s physical and mental health,” Jane Doe said in a news release Thursday.

Lawyers for the plaintiffs said they intend to seek a preliminary injunction to block health officials from enforcing the rules while the litigation proceeds.

“We are fighting for families, and we will not give up. They can keep erecting barriers, and we’re going to keep challenging them and dismantling them,” plaintiffs’ lawyer Simone Chriss, director of the Transgender Rights Initiative at Southern Legal Counsel, told The News Service of Florida after the lawsuit was filed.

The families also are represented by GLBTQ Legal Advocates & Defenders, the National Center for Lesbian Rights and the Human Rights Campaign.

Thursday’s challenge follows another federal lawsuit seeking to reverse action taken by DeSantis’ administration to restrict medical treatment for trans children and adults. A group of plaintiffs are challenging a state Agency for Health Care Administration rule banning Medicaid from reimbursing providers for treatment of transgender patients of all ages.

Also on Thursday, a Senate committee gave initial approval to a measure that would enshrine in state law the medical boards’ transgender treatment bans for children. The measure (SB 254) also would prohibit telehealth appointments for transgender adults and make it so that only doctors — not nurse practitioners — could write prescriptions for adults’ hormone-replacement treatments.

Sen. Victor Torres, an Orlando Democrat who said his granddaughter is trans, urged other members of the Senate Fiscal Policy Committee to oppose the bill.

“I hear this and I wonder, why are we doing this again? Why are we going after children? When you see a child grow … and develop and you support that child. You give that love to that child 100 percent. And does my love change because the child is transgender? Not one bit. It goes more. Why? Because you want to show support. You want to encourage a child, what they dream of, what they want to do,” Torres said.

But bill sponsor Clay Yarborough, R-Jacksonville, said the measure is intended to protect children and parents.

“Every single person was created with extraordinary, incredible value and has a unique purpose, and this has been true about you since before you were born and you can’t change it,” Yarborough said.

The committee voted 13-6 along party lines to approve the measure. A House committee on Wednesday advanced a more far-reaching measure (HB 1421) that would, among other things, ban health-insurance companies from covering gender-reassignment surgeries for adults.

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