Florida Medicaid: Puberty Blockers Not Proven Safe or Effective — Existing Studies ‘Questionable’ and ‘Incomplete’

Puberty Blockers, Teen Suicide
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There is “low or very low quality” evidence that so-called “puberty blocker” drugs protect the mental health of minors who want to live as members of the opposite sex, says a report released by Florida Medicaid.

Florida’s 45-page report rebuts claims by transgender and transgender-affirming groups that puberty blockers are a safe fix for children and teenagers who are unhappy with their male or female bodies.

These groups include the World Professional Association for Transgender Health (WPATH), the Endocrine Society , and the American Academy of Pediatrics (AAP), and they are being cited as experts by large hospitals, Democrats, and the Biden administration, which wants to deliver the drugs to troubled children.

The report concluded that puberty blockers, cross-sex hormones, and sex change surgeries for adults and minors go against Medicaid’s rule, which mandates that sex reassignment treatments, as a condition of coverage, must be “consistent with generally accepted professional medical standards (GAPMS) and not experimental or investigational.” The report was completed by Florida Medicaid and requested by the Secretary of the Agency for Health Care Administration (AHCA).

The report is significant because it could be used to inform the rule-making process for what types of treatments state health care agencies will be able to cover through programs like Medicaid. Florida State Surgeon General Joseph Ladapo already sent a letter to the Florida Board of Medicine citing the report’s findings and asking the board to establish “a standard of care for these complex and irreversible procedures.”

Key Findings about Puberty Blockers 

A section of the report entitled “Literature Review: Desistance of Gender Dysphoria and Puberty” investigates claims by clinical organizations that puberty blockers are an effective mental health treatment for minors with gender dysphoria. The report also addresses the lack of long-term research into the potential side effects of puberty blockers, which have not been approved by the Food and Drug Administration (FDA) to treat gender dysphoria.

Deciding Against Transitioning

Both WPATH and the Endocrine Society state that, in addition to being safe and fully reversible, puberty blockers can provide more time for adolescents to explore the gender in which the choose to live. The organizations also state that puberty blockers  can prevent the development of sex characteristics that are “difficult or impossible to reverse” if minors decide to later pursue sex reassignment.

The Florida Medicaid report contradicts those claims, stating that “some studies provide weak support for this treatment but leave too many questions as to its effectiveness and medical necessity, especially considering how many children decide against transitioning.

“In addition, puberty blockers halt development of primary and secondary sexual characteristics and deny opportunities for adolescents to adapt and become comfortable with their natal sex,” the report states. “Instead, puberty blockers can serve as a potential ‘gateway drug’ for cross-sex hormones by denying them the experience of physically maturing.”

The report cites a 2013 study of 127 minors, with the mean age of 15,  who were referred to a Dutch gender dysphoria clinic. Out of the cohort, 47 (37 percent — 23 of them boys and 24 of them girls) “continued experiencing the condition and applied for sex reassignment treatment.” The other 80 minors never returned to the clinic. The study noted that older adolescents were more likely to persist in transitioning, while younger minors “tended not to follow through.”

“While the study focuses on factors that contribute to the condition’s persistence or desistance, it raises the question as to whether puberty suppression is necessary when age plays such an important role regarding the decision to transition,” the report says.

‘Low Quality’ Research 

The report also rebuffed the claims by clinical organizations and media that these treatments have large swaths of quality research proving the effectiveness of puberty blockers as a mental health treatment. For example, an article published in Scientific American in May of 2022 claimed that “laws that ban gender-affirming treatment ignore the wealth of research demonstrating its benefits for trans people’s health.”

The Medicaid report counters that existing studies showing puberty blockers to be an effective treatment for minors with gender dysphoria are “low or very low quality.” The report states that these studies are characterized by small sample sizes, often lack control groups, involve self-assessments, and are conducted over short periods of time. The report even points to a recent acknowledgment from acting director of the National Institutes of Health (NIH) Lawrence Tabak that there are no long-term studies available evaluating the effects of puberty blockers when used for gender dysphoria.

The report further notes that the current body of research lacks randomized-controlled trials (RCT). The report calls RCTs the “gold standard” of medical studies because they use large sample sizes, have blind testing groups, and use objective controls.

“Because RCTs utilize large sample sizes, have blind testing groups (i.e., placebos), and use objective controls, they can offer concrete conclusions and shape the array of established treatments,” the report states. “In addition, RCTs require comparisons between cohort outcomes and ensure that participants are randomly assigned to each group. These measures further reduce the potential for bias and subjectivity.”

Potential Side Effects 

The report adds that “aside from questionable research” methods, information regarding the “full physical effects of puberty suppression is incomplete.”

The report cites a 2020 study in which 44 experts in neurodevelopment, gender development, and puberty/adolescence reach the conclusion that “the effects of pubertal suppression warrant further study.” More specifically, the experts raised questions as to whether suppressing natural hormones could stifle brain development in addition to sexual maturation.

“Because this question remains unanswered, it casts doubt on the veracity of organizations’ assertions that puberty suppression is ‘fully reversible,”‘ the report indicates.

The report also points to a 2019 literature review which found that while most side effects associated with puberty blockers “are mild,” clinicians have linked the drug (GnRHa) to “long-term conditions such as polycystic ovarian syndrome, obesity, hypertension, and reduced bone mineral density.”

“[T]he review raises questions about whether off-label use to treat a psychological condition is worth the risks,” the report reads, adding that “no long-term research has been completed on how puberty suppression affects bone growth.”

Bucking the Biden Administration

Overall, the Medicaid report concluded that “additional evidence is required to establish puberty suppression as a standard treatment for gender dysphoria.” It further states that sex reassignment surgeries, puberty blockers, and cross-sex hormone treatments for people with gender dysphoria are not proven as “safe or effective” treatments and are “experimental and investigational.”

The Florida Medicaid report is one of the latest pushback efforts from Florida Gov. Ron DeSantis against the Biden administration’s efforts to force the state to comply with radical leftist gender ideology. In April, the Florida Department of Health released guidance on how to treat gender dysphoria in children and adolescents in response to the Biden administration’s plea for what it calls “gender-affirming” care, making it clear that social gender transition, as well as sex reassignment surgery, “should not be a treatment option for children or adolescents.”

Katherine Hamilton is a political reporter for Breitbart News. You can follow her on Twitter.


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