Republican leaders, medical groups try to sway federal court considering transgender treatment

TALLAHASSEE — Republican attorneys general from across the country and major medical organizations are trying to help sway a federal appeals court as it considers Florida restrictions on treatments for transgender people.

Briefs filed Friday at the 11th U.S. Circuit Court of Appeals offer clashing views of treatments such as puberty blockers and hormone therapy, particularly for adolescents with gender dysphoria.

The state this summer went to the Atlanta-based appeals court in two cases after U.S. District Judge Robert Hinkle ruled against a prohibition on Medicaid coverage for such treatments and blocked rules preventing minors from receiving the treatments.

Republican attorneys general from 18 states signed on to a friend-of-the-court brief Friday urging the appeals court to overturn Hinkle’s ruling in the Medicaid case. They argued that a Florida Agency for Health Care Administration decision to block Medicaid coverage for the treatments should receive “due deference” and disputed arguments from many medical organizations supporting the use of puberty blockers and hormone therapy.

“As with other institutions, American medical organizations have become increasingly ‘performative,’ treated by their leaders as platforms for advancing the current moment’s cause célèbre,” the attorneys general brief said. “Add to this a replication crisis in scientific literature and the ability of researchers to use statistics to make findings appear significant when they are not, and it is no wonder that medical organizations find it easier to just go with the zeitgeist. Science is hard, and there is no reward in the current climate for any organization that questions the safety and efficacy of using sterilizing gender-transition procedures on children.”

But 23 medical organizations, such as the American Academy of Pediatrics, the American Medical Association and the Endocrine Society, filed a brief Friday in the case about rules for minors and said that denying “such evidence-based medical care to adolescents who meet the requisite medical criteria puts them at risk of significant harm.”

“The widely accepted view of the professional medical community is that gender-affirming care is the appropriate treatment for gender dysphoria and that, for some adolescents, gender-affirming medical interventions are necessary,” the medical organizations’ brief said. “This care greatly reduces the negative physical and mental health consequences that result when gender dysphoria is untreated.”

With Gov. Ron DeSantis making the issue a priority, Florida regulators and lawmakers in 2022 and this year approved restrictions on treatments for people with gender dysphoria. The moves came amid politically charged debates across the country about transgender issues, with GOP-controlled states passing similar restrictions.

The issue centers on treatments for gender dysphoria, which the federal government defines clinically as “significant distress that a person may feel when sex or gender assigned at birth is not the same as their identity.”

The Florida Agency for Health Care Administration last year adopted a rule banning Medicaid reimbursements to health-care providers for treatments such as puberty blockers and hormone therapy. The agency, which runs most of the Medicaid program, based its decision on a report that concluded such treatments were “experimental” and “not medically necessary,” and thus did not meet the threshold for Medicaid coverage. The report was by researchers who oppose the treatments.

The state Board of Medicine and the Board of Osteopathic Medicine also approved rules blocking puberty blockers and hormone therapy for minors. DeSantis and the Legislature this spring effectively enshrined those rules in law.

Hinkle, however, ruled against the restrictions in two decisions in June. In the case about blocking treatments for minors, for example, the judge said the “statute and the rules were an exercise in politics, not good medicine.”

“The statute and rules at issue were motivated in substantial part by the plainly illegitimate purposes of disapproving transgender status and discouraging individuals from pursuing their honest gender identities,” Hinkle wrote. “This was purposeful discrimination against transgenders.”

But the state and the Republican attorneys general dispute the positions of the major medical organizations that say the treatments are proven and needed. Also on Friday, the American College of Pediatricians, which says on its website that it is “leading the charge against the harms of transgender interventions on minors,” filed a brief supporting the state in the Medicaid case.

The attorneys general brief was led by Alabama Attorney General Steve Marshall, Arkansas Attorney General Tim Griffin and Tennessee Attorney General Jonathan Skrmetti and joined by the chief legal officers in Georgia, Montana, Idaho, Nebraska, Indiana, South Carolina, Iowa, Texas, Kansas, Utah, Kentucky, Virginia, Mississippi, West Virginia and Missouri.