“I’d never consider myself an activist in that sense,” says Dr. Michael Haller, a medical school professor and head of paediatric endocrinology at the University of Florida. “But I’m sure as hell going to stand up for my patients.”
Although his primary specialisation is type 1 diabetes, Haller has treated transgender children, and oversees other paediatric endocrinologists who specialise in their care. And those patients’ well-being is currently at risk, given how prominent Florida Republicans, especially Governor Ron DeSantis, are targeting trans rights. The result is that experts of conscience, such as Haller, have become vocal opponents of the politicisation of patient care for authoritarian ends.
Trans people are now the primary target for political persecution in the Sunshine State (and many other Republican-controlled states), just as November’s midterm elections loom. This is a development that Haller views with concern. He describes DeSantis as “willing to use whatever tools he needs to maintain power, even if it means trying to utilise policies that are not in the best interests of people he represents”.
DeSantis is widely viewed as a leading contender for the Republican Party’s 2024 presidential candidate, should that candidate be anyone other than Donald Trump.
For Floridians and other Americans concerned about the rights and welfare of marginalised people, that’s a worrying prospect.
Attacks on Trans Minors
Last September, DeSantis appointed Joseph Ladapo Florida’s surgeon general – the operational head of the state’s department of health. Ladapo has also been given a professorship at the University of Florida in what Haller, who has expressed concern over Ladapo’s lack of public health experience, describes as “a political process well outside the norms” of typical university hiring.
Ladapo has proved willing to use his office to pursue DeSantis’s anti-trans agenda, adopting the arguments of fringe groups and what Haller calls “cherry-picked” data to provide a fig leaf of cover to push for a sharp departure from both the US and international medical consensus regarding best practices for the treatment of transgender minors.
In April, Ladapo sent a memo to the state’s medical professionals claiming a “lack of conclusive evidence” for the benefits of gender-affirming care and advising that “social gender transition should not be a treatment option for children or adolescents.” It also read in part, “Anyone under 18 should not be prescribed puberty blockers or hormone therapy.”
In response, the Florida branch of the American Civil Liberties Union (ACLU) put out a statement saying: “This non-binding guidance is in direct opposition to advice from every major medical organisation in the country.” The statement added that “the Florida Department of Health is attempting to demonise life-saving, critical, medically necessary healthcare for transgender youth. It is simply despicable and wrong.”
According to The Washington Post, Jack Turban, chief fellow in child and adolescent psychiatry at Stanford University School of Medicine, called Ladapo’s memo a “shocking” example of misinformation, observing, “There are false statements on nearly every line of this document.”
Brandon Wolf, press secretary for LGBTQI advocacy organisation Equality Florida, said Ladapo’s policy proposal is one of the most extreme in the country. “The surgeon general is asserting that the state government should dictate what haircuts and clothes kids receive.”
Haller says the memo has already had a chilling effect, with some Florida doctors halting their treatment of trans minors.
Ladapo’s guidelines for the ‘care’ of trans minors remain non-binding for now, but physicians, parents of trans kids and LGBTQI activists and advocates are concerned that this may change following a meeting of the Florida Board of Medicine, which oversees the licensing of medical practitioners in the state, set to take place in Fort Lauderdale today.
Transgender Floridians and their allies have been sounding the alarm about the session, calling it an attempt at a “backdoor” ban on gender-affirming care in Florida. Should this prove to be the case, DeSantis will have pulled off an end run around the state legislature similar to how Texas Governor Greg Abbott exploited his power over the state bureaucracy to redefine supportive parenting of trans children as “child abuse”.
The meeting’s agenda includes a “discussion” of a 2 June letter from the state surgeon general to the board regarding gender dysphoria in children and adolescents. The Florida Department of Health has also petitioned the board to ban gender-affirming care for anyone under the age of 18, and to discourage adults considering medical transition.
This isn’t the first time DeSantis has abused state bureaucracy in pursuit of far-Right social policy goals. For example, the agency that administers Medicaid in Florida – taking its cues from the governor and the surgeon general – has already moved to ban coverage of gender-affirming care, not just for trans minors, but for all trans patients.
While this would mainly affect poorer Floridians (Medicaid is government-provided health insurance for low-income Americans), private insurers in the state might decide to follow suit and drop their coverage of gender-affirming care.
Haller spoke at a public meeting in Tallahassee on 8 July, where the state pushed its plan to defund gender-affirming care. Calling the government’s move “well organised”, Haller described the meeting as “a political showpiece”, noting that it featured far more speakers who favoured the government’s plan, including many “faux-experts”, than those who opposed it.
The Sarasota Herald-Tribune called the meeting “raucous and rowdy”. The sessions on gender-affirming care at the upcoming board of medicine meeting may well be the same.
And it’s not just trans healthcare that’s under attack in Florida.
Ron DeSantis: Worse Than Trump
Last week, the state commissioner of education, Manny Diaz Jr., issued a memo to education professionals to reject the Biden administration’s recently issued guidelines on non-discrimination for transgender students.
The memo states that the department of education “will not stand idly by as federal agencies attempt to impose a sexual ideology on Florida schools that risk the health, safety, and welfare of Florida students”.
Of course, there is nothing inherently ‘sexual’ about being transgender, and there is no evidence of any inherent ‘risk’ in allowing trans students to access the bathrooms and locker rooms that match their gender identity.
Haller describes DeSantis as “unfortunately, quite clever” at deftly manoeuvring within state politics and the bureaucracy he oversees, identifying means to persecute scapegoated communities in order to “stir a base that is scared of anything perceived as ‘other’”.
Jaime Jara, a high-school teacher of American history and mother of three children, one of whom is a ten-year-old transgender girl, agrees. “I thought Trump was bad,” she says. “But for me, DeSantis is even worse, because he’s smarter and more calculating. So it’s terrifying.”
The Florida Board of Medicine has 15 members, appointed by the governor as vacancies arise. Most were appointed by Republican governors, with four appointed by DeSantis. A simple majority is all it will take to begin the process of imposing the ban on gender-affirming care for minors that the DeSantis administration is seeking.
This appears to be the most likely outcome – though Haller thinks the worst might be avoided. The 12 physicians on the board are supposed to speak in their professional capacity as doctors, not politicians – and Haller thinks there’s some chance, however small, that the majority could have enough integrity to declare that setting the standard of care for a field in which most of them have no experience, and in contravention to the consensus of that field, falls outside the board’s purview.
If they do toe the governor’s line, however, they will not make an instant decision but will set up a committee to determine the standard of care at a later date. Banning puberty blockers and hormones, at least for minors, is highly likely.
“We’re Being Persecuted”
Should that occur, Jara says her family will leave the state. When people ask if they plan to move, Jara insists: “Let’s call it what it is. It’s not moving, it’s fleeing. We’re being persecuted.”
And if DeSantis becomes president? In that case, Jara says her family will find a way to leave not just Florida, but the United States itself.
Protecting her children is her highest priority as a parent. According to Jara, her daughter, Dempsey, has shown persistent gender non-conformity since she was 18 months old and at the age of five insisted, “I’m a girl in my heart and my brain.”
Although Jara receives hate mail and is often accused of somehow ‘making’ Dempsey trans, she says that no one ever pressured her child. In fact, Dempsey would throw tantrums when forced to wear boy’s clothing in public, and became increasingly withdrawn as a result.
Once she was allowed to socially transition, however, Dempsey thrived, including at school. Because some of her classmates remembered her using different pronouns and dressing differently in kindergarten, Jara decided to work with the school (and an outside organisation) to provide an age-appropriate, educational workshop for the class with a puppet show explaining what it means to be transgender.
“Nothing sexual at all, because it has nothing do with sex,” Jara explains, frustrated that so many people regard the topic as inherently sexual. Such workshops are now illegal under Florida’s recently passed ‘don’t say gay’ law.
Dempsey doesn’t need puberty blockers just yet, but she will fairly soon, which means a lot is riding on the board of medicine’s decision – for her, her family and similar families across Florida.
Jara and her husband moved to Florida 17 years ago from New York, for its affordability and its weather. “We still love Florida,” she tells me. But the increasingly hostile, anti-trans political climate is becoming intolerable. “The fallout is bad, it’s very real, it’s affecting families.”
Brandon Wolf from Equality Florida confirmed that “Florida has grown increasingly more hostile toward our community.” He places much of the blame on DeSantis: “We are being targeted by a governor desperate to be president someday and willing to traffic in all manners of hate and bigotry to get there.”
Equality Florida is part of a broad coalition working to push back against anti-trans policy initiatives. This includes gathering public comments urging the board of medicine not to adopt the anti-trans standard of so-called “care” proposed by the state’s health department.
This much is certain. Whatever happens on Friday, the vicious Republican attacks on transgender Floridians are not likely to stop any time soon.