FIRST ON THE DAILY SIGNAL — A large number of pro-transgender medical interest groups have supported a legal challenge to Florida’s rule barring use of Medicaid funds to pay for controversial transgender medical interventions, after most of the same organizations fought in court to hide documents that Florida says are relevant to the case.

The American Academy of Pediatrics, the World Professional Association for Transgender Health, and the Endocrine Society, along with 20 other health care advocacy groups, signed an amicus brief late last month opposing Florida’s rule.

The 23 organizations seek “to ensure that all individuals, including those with gender dysphoria, receive the optimal medical and mental healthcare they need and deserve. [The groups] represent thousands of healthcare providers who have specific expertise with the issues raised in this brief,” reads the brief, a copy of which was provided exclusively to The Daily Signal.

Florida’s Agency for Health Care Administration in August declared that Medicaid would not cover “puberty blockers,” cross-sex hormones, “sex reassignment” surgeries, or other procedures that alter primary or secondary sex characteristics. LGBT and health activist groups led by Lambda Legal represent four young people who say they identify as transgender and filed a lawsuit in September aiming to block Florida’s rule.

As part of their lawsuit, the LGBT groups asked the court to block the rule temporarily while it considers the case. In denying that temporary injunction, the court ruled in October that the case centers on whether Florida’s determination that transgender interventions are “experimental” is “reasonable.”

The Debate Over Transgender Medical Interventions

Lambda Legal repeatedly cites AAP, WPATH, the Endocrine Society, and other medical groups in supporting its claim that describing transgender interventions as “experimental” is in fact not reasonable.

Yet numerous doctors, including former members and leaders of these groups, have testified against the “gender-affirming care” guidelines.

Dr. Stephen B. Levine, a psychiatrist and early proponent of transgender medical interventions, spent decades with the organization that became the World Professional Association for Transgender Health. Recently, however, Levine has harshly criticized the group as “dominated by politics and ideology,” and condemned WPATH’s standards of care as “not an impartial or evidence-based document.”

Dr. Julia Mason, a member of the American Academy of Pediatrics, warned that “AAP has stifled debate on how best to treat youth in distress over their bodies, shut down efforts by critics to present better scientific approaches… and put its thumb on the scale… in favor of shoddy but politically correct research.”

Shielded From Scrutiny

Amid this larger Medicaid case, the Florida agency subpoenaed AAP, WPATH, the Endocrine Society, and the other organizations cited by Lambda Legal. The Agency for Health Care Administration requested documents related to their standards of care, what studies they examined to support “gender-affirming care,” any considerations of side effects and risks from these interventions, and communications with membership about these matters, among other things.

In a motion opposing the subpoena, the medical interest groups acknowledge that “there is no dispute that the WPATH and Endocrine Society guidelines are relevant to this case,” but they claim to have offered a compromise with AHCA, which the Florida agency refused.

After some negotiation in which the medical interest groups offered publicly available documents to the Agency for Health Care Administration, the groups went to court trying to quash the subpoenas. They argued that they should not be forced to hand over documents, in part because they are not direct parties to the case.

Yet not only are these groups the medical authorities by which Lambda Legal aims to torpedo the Florida rule, but most of the groups themselves filed the amicus brief April 28 that highlights their interest in the case.

“Casting themselves in the underlying case as the standard bearers of the prevailing scientific view regarding gender dysphoria treatment — and used as such by [Lambda Legal] — the non-parties now seek to shield their perspective from any scrutiny,” the Agency for Health Care Administration writes in a Jan. 20 reply to the motion to quash the subpoenas.

“The non-parties refuse to answer whether their perspective is the result of careful study and debate among their memberships or the result of a handful of people dictating a result, as a past president of the American Academy of Pediatrics suggested,” AHCA’s response adds.

An Ongoing Legal Battle

The legal battle over the subpoenas is ongoing. A source familiar with the litigation told The Daily Signal that the night before depositions were to begin, the medical interest groups filed a stay with the U.S. Court of Appeals for the District of Columbia Circuit, and the court has yet to rule on the motion. A trial on the subpoenas is expected to begin soon.

Even amid this battle, most of the groups fighting the subpoenas filed the amicus brief.

The groups write that “the widely accepted recommendation of the medical community, including that of the respected professional organizations participating here as amici, is that the standard of care for treating gender dysphoria is ‘gender-affirming care.’” The groups condemn “efforts to change the individual’s gender identity to match their assigned sex at birth” as being “known to be ineffective and harmful.”

Dismissing Evidence of Detransitioners

The brief aims to dismiss the evidence of detransitioners — individuals such as Walt Heyer, Ted Halley, and Billy Burleigh, men who formerly identified as women and who had their bodies chemically and surgically altered only to regret those interventions later in life. The three men also wrote a brief supporting the Florida rule.

These detransitioners, in supporting AHCA’s Medicaid rule, argue that their own “personal experiences with gender dysphoria, gender transition surgery and medical treatments, and de-transition to embrace their biological sex” belie LGBT activists’ claims about a “supposed scientific consensus” on these interventions. The three men say their gender dysphoria was the result of childhood trauma, and that once they resolved that trauma, the dysphoria went away.

The AAP/WPATH brief, however, claims that “the most common reported factors that contribute to a person’s choice to detransition” are “pressure from parents and discrimination,” suggesting that Heyer, Halley, and Burleigh are mistaken about their own motivations for detransitioning.

“The non-parties’ views regarding the medical community’s supposed prevailing accepted standard of care for the treatment of gender dysphoria are the linchpin of [Lambda Legal’s] case against the [Medicaid] Rule,” the Agency for Health Care Administration argues in its reply brief from January. “The only way for AHCA to discern whether the non-parties’ views in fact represent the established medical consensus regarding gender dysphoria treatment — and for AHCA to adequately defend the [Medicaid] Rule — is for the non-parties to comply with their respective subpoenas and disclose the narrow range of testimony and documents sought by AHCA.”

“There is simply no reasonable basis for them to complain about having to explain the very gender dysphoria guidelines they themselves have sought to inject into the underlying case,” the Florida agency’s brief states.

Multiple organizations facing subpoenas also signed onto the amicus brief opposing Florida’s Medicaid rule, including the American Academy of Pediatrics, the American Academy of Child & Adolescent Psychiatry, the American Academy of Family Physicians, the American Academy of Nursing, the American College of Obstetricians and Gynecologists, the American College of Physicians, the American Medical Association, the American Psychiatric Association, the Association of American Medical Colleges, the Endocrine Society, the National Association of Pediatric Nurse Practitioners, the Societies for Pediatric Urology, the Society for Adolescent Health and Medicine, the Society for Pediatric Research, the Society of Pediatric Nurses, and the World Professional Association for Transgender Health.

The North Central Florida Council of Child & Adolescent Psychiatry faces subpoenas but did not join the amicus brief.

Some organizations that don’t face subpoenas joined WPATH and others on the amicus brief, including the American Association of Physicians for Human Rights, Health Professionals Advancing LGBTQ+ Equality, the American College of Osteopathic Pediatricians, the Association of Medical School Pediatric Department Chairs, the Florida Chapter of the AAP, and the Pediatric Endocrine Society.

Tyler O’Neil is managing editor of The Daily Signal and the author of Making Hate Pay: The Corruption of the Southern Poverty Law Center.

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