We write as a gaggle of greater than 300 Florida well being care professionals who look after transgender and gender various youth. We have now one frequent objective: to supply the highest quality, evidence-based, individualized and compassionate look after our sufferers. In the end, we attempt to empower every affected person to realize their optimum bodily, psychological, emotional and social well being, and we wish every individual to really feel that they’re accepted and valued for who they’re.

The latest assertion issued by the Florida Division of Well being entitled “Remedy of Gender Dysphoria for Kids and Adolescents” misrepresents the load of the proof, doesn’t permit for customized affected person and family-centered care, and would, if adopted, result in greater charges of youth melancholy and suicidality.

The Florida Division of Well being steering categorically recommends towards social and medical gender transition for any affected person underneath the age of 18. This immediately contradicts present pointers from the American Academy of Pediatrics, the Endocrine Society, the American Academy of Youngster and Adolescent Psychiatry and the World Skilled Affiliation for Transgender Well being. These nationwide and worldwide pointers are the results of cautious deliberation and examination of the proof by specialists together with pediatricians, endocrinologists, psychologists and psychiatrists.

Whereas we agree with the Florida Division of Well being that steering surrounding care of transgender youth “requires a full, diligent understanding of the scientific proof,” their assertion fails to comply with their very own suggestions. Particularly, the Florida Division of Well being cites a selective and non-representative pattern of small research and evaluations, editorials, opinion items and commentary to help a number of of their substantial claims. When citing high-quality research, they make conclusions that aren’t supported by the authors of the articles. And whereas they state that their steering is in step with suggestions from Sweden, Finland, the UK and France, actually, none of those nations recommends towards social gender transition, and all present a path ahead for sufferers in want of medical intervention. This stands in marked distinction to the explicit ban beneficial by the Florida Division of Well being.

Present nationwide pointers advocate developmentally applicable, patient- and family-centered, and nuanced care that promotes youngsters and adolescents’ self-worth. Analysis and remedy consists of thorough evaluation by multidisciplinary groups together with psychological well being professionals and medical suppliers and should embrace social or medical transition if indicated and desired by the affected person and household.

Transgender youth face charges of melancholy which might be 5 to 7 instances greater and charges of suicidality which might be 10 to twenty instances greater than that of the cisgender inhabitants. Social gender transition and household help are linked to diminished charges of melancholy and suicidality in these youth. There may be little value and far to realize in supporting a baby or adolescent to specific themselves totally and truthfully.

Skilled pointers don’t advocate initiation of puberty blocking drugs previous to the onset of puberty, and their use has been linked to diminished charges of melancholy and suicidality. Equally, pointers advocate initiation of gender-affirming hormonal remedy solely after multidisciplinary groups have confirmed the presence of gender dysphoria and the need of the affected person and oldsters to begin remedy.

As well as, the affected person should have the psychological maturity to weight dangers and advantages in order to supply knowledgeable consent alongside their guardians, which is current in most by age 16. Remedy is linked to improved physique satisfaction and charges of melancholy. Genital surgical procedures are usually not beneficial for sufferers underneath 18, and masculinizing chest surgical procedures solely after sufferers meet strict standards and may give really knowledgeable consent alongside their guardians. In all instances, these choices are made with nice thoughtfulness and can’t be handled in a one-size-fits-all method.

Whereas we want analysis to additional enhance look after transgender and gender various youth, taking away social help and medical care isn’t the reply. We urge the professionals on the Florida Division of Well being to rethink its steering in favor of a extra individualized, patient- and family-centered, and compassionate method.

Sincerely,

Brittany S. Bruggeman, MD, FAAP, Assistant Professor of Pediatric Endocrinology, College of Florida School of Drugs

Kristin Dayton, MD, Director, UF Youth Gender Program, Assistant Professor of Pediatric Endocrinology College of Florida School of Drugs

Alejandro Diaz, MD Chief, Division of Pediatric Endocrinology Nicklaus Kids’s Hospital

Jennifer Evans, PsyD, Licensed Medical Psychologist, UF Youth Gender Program

Michael J. Haller, MD, Professor and Chief of Pediatric Endocrinology, College of Florida School of Drugs

Mark L. Hudak, MD, Professor and Chair of Pediatrics, College of Florida School of Drugs-Jacksonville

Carol A. Mathews, MD Professor and Interim Chair of Psychiatry, College of Florida School of Drugs

Stephanie Ryan, MD, Affiliate Professor of Pediatrics, Assistant Dean Workplace of Variety and Well being Fairness, College of Florida School of Drugs

Michael Shapiro, MD, Affiliate Professor of Psychiatry, College of Florida School of Drugs

Desmond Schatz, MD, Professor and Interim Chair of Pediatrics, College of Florida School of Drugs

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 Ok. 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 Likelihood 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 Grey, LMFT

Sara Inexperienced, MSW

Linsey Grove, DrPH, MPH, CPH

Andrea D Guastello, PhD

Jennifer Guida, PhD, MPH

Colleen Ok. 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 Ok. 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

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-Fixed, 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 Clever, 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

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