Nov 4, 2022 - Health

Politicians turn to medical boards to ban gender-affirming care

Illustration of a stethoscope with a "no" symbol on the bell/diaphragm.

Illustration: Allie Carl/Axios

Medical boards appointed by governors in some red states may be opening a new front in the ongoing political battle over government restrictions on gender-affirming care.

Driving the news: The Florida Board of Medicine today is set to ban puberty blockers, hormone therapy and surgeries for trans minors in the first such action of its kind.

  • Under a proposed rule, health providers that offer such care would risk disciplinary action, including potentially losing their medical licenses.
  • It's the latest move by Gov. Ron DeSantis' administration after Florida's health department released guidance in April telling health providers not to assist children and teens seeking gender transitions.
  • "The Florida medical board has been encouraged by state officials to ban youth access to gender-affirming care," said Lindsey Dawson, director of LGBTQ health policy at the Kaiser Family Foundation.

How it works: State medical boards are appointed bodies that regulate the practice of medicine in a state — including how telemedicine is offered or how opioids are prescribed. The bodies oversee the issuance and revocation of medical licenses, according to Lisa Robin, chief advocacy officer of the Federation of State Medical Boards.

The big picture: Red states have been looking beyond legislation to restrict gender-affirming care, most notably when Texas Gov. Greg Abbott in February issued a directive to investigate transitioning care for trans kids as child abuse, said Dale Melchert, a staff attorney at the Transgender Law Center.

  • "When they failed to pass legislation to limit health care for transgender Floridians, they turned to other avenues, namely executive action through regulatory process," Melchert added, noting past attempts by state lawmakers.

Reality check: Gender-affirming care is widely supported as appropriate and medically necessary by major health groups, including the American Medical Association and the American Academy of Pediatrics.

  • Over two-thirds of LGBTQ youth say debates over state laws that target transgender people have negatively impacted their mental health, according to a poll by the Trevor Project, which provides crisis intervention and suicide prevention services to LGBTQ youth.

Catch up fast: A committee of the Florida board last week voted to start drafting the proposed rule, after some members said that children and teens with gender dysphoria should be treated for mental health issues instead of receiving gender-affirming care.

  • One board member, Patrick Hunter, said that research on this type of care "is very conflicted, very low-quality," and suggested that more studies be done on its efficacy.
  • Nicholas Romanello, another member, said that patients should be presented with information on the "risks" of gender-affirming care.
  • Tiffany Di Pietro, member of Florida's Board of Osteopathic Medicine, said that trans children should see different health specialists to better determine what health care they should receive.

Between the lines: Elected officials tend to appoint board members that align with their agendas to gain "bureaucratic control of various government agencies," said Joshua Scacco, associate professor of political communication at the University of South Florida.

  • All members of the Florida medical board were appointed by DeSantis, who has said that he opposes gender-affirming care for minors.
    • His administration has brought in health professionals that are "going against the grain of established medical advice and opinion," Scacco added.

Zoom out: The board is setting a precedent that could extend to other forms of health care, said Cathryn Oakley, state legislative director and senior counsel at the Human Rights Campaign.

  • "There are lots of kids of medical care that politicians would love to be able to be in charge of," Oakley added. "This sets a terrible precedent for Florida and for other states to have doctors capitulate to political whims, rather than sticking to the science."
  • A state medical board could make decisions around reproductive health, drug prescription and public health.

State of play: Some states have managed to pass and enact laws to restrict health care access to transgender issues.

  • Arkansas in 2021 became the first state to make gender-affirming care illegal, but the ban is temporarily blocked and is being challenged.
  • Arizona enacted a law that prohibits gender-affirming surgeries from being offered to trans youth under 18. The ban takes effect in late March.
  • Alabama earlier this year enacted a law that makes providing gender-affirming care a felony. The law was temporarily blocked shortly after taking effect, and a lawsuit is ongoing.

What we're watching: Next year, experts expect more bans to be introduced in legislatures — and more administrative actions similar to Florida's.

Go deeper