Florida
We 300 Florida health care professionals say the state gets transgender guidance wrong | Open letter
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.
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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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