A new report out from Florida Medicaid finds that “puberty suppression, cross-sex hormones, and surgical procedures” used to treat gender dysphoria “do not conform” to generally accepted professional medical standards, which is a condition of coverage. The announcement, which emphasizes the dangers for minors but applies to Florida Medicaid in general, comes on the heels of Florida Surgeon General Joseph Ladapo’s guidance rejecting such damaging procedures in April.
“As a condition of coverage, sex reassignment treatment must be ‘consistent with generally accepted professional medical standards (GAPMS) and not experimental or investigational,’” as determined by the deputy secretary for Medicaid, explains today’s report, an advance copy of which was provided to The Federalist.
“Available medical literature provides insufficient evidence that sex reassignment through medical intervention is a safe and effective treatment for gender dysphoria,” the report concludes. Accompanying the document are multiple analyses by medical experts highlighting the concerns and dangers of cross-sex hormones and mutilative genital surgeries, particularly in children.
The report also concludes that “the available evidence demonstrates that these treatments cause irreversible physical changes and side effects that can affect long-term health.” It goes on to list the irreversible or potentially irreversible effects of cross-sex hormones, including facial and body hair growth, male pattern baldness, a deepening voice, and an enlarged clitoris for females taking male hormones, and breast growth, infertility, and sexual dysfunction for males taking female hormones. The irreversible effects of surgical interventions, such as elective mastectomies or genital amputations, are obviously far higher.
“[T]reatments that pose irreversible effects should not be utilized to address what is still categorized as a mental health issue,” the authors note, adding that “until 2013, the APA considered having gender identity issues a mental disorder by itself,” and citing studies that indicate “individuals with gender dysphoria have high rates of anxiety and depressive disorders with results ranging as high as 70% having a mental health diagnosis.”
“Following a review of available literature, clinical guidelines, and coverage by other insurers and nations, Florida Medicaid has determined that the research supporting sex reassignment treatment is insufficient to demonstrate efficacy and safety,” the report concludes (all emphasis mine). “Considering the weak evidence supporting the use of puberty suppression, cross-sex hormones, and surgical procedures when compared to the stronger research demonstrating the permanent effects they cause, these treatments do not conform to GAPMS and are experimental and investigational.”
The report signals that these procedures, many effects of which are irreversible, could be refused coverage by Florida Medicaid.
Eight other states — Arizona, Nebraska, Texas, Missouri, Arkansas, Ohio, Tennessee, and Georgia — already exclude puberty blockers, cross-sex hormones, and surgical interventions from state Medicaid coverage. In Europe, the United Kingdom’s National Health Service commissioned a study that “indicates that additional research and systematic changes are necessary to ensure the safe treatment of gender dysphoric youths,” as the Florida report notes. NHS also updated its online guidance from a full endorsement of “fully reversible” hormone suppressors to acknowledge that “Little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria.”
