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Experts say FL’s informed consent forms for gender-affirming care are misleading, confusing

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Experts say FL’s informed consent forms for gender-affirming care are misleading, confusing

Dec 14, 2023 | 4:27 pm ET
By Jackie Llanos
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Experts say FL’s informed consent forms for gender-affirming care are misleading, confusing
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Two Florida medical oversight boards held a meeting about proposed rules for treating gender dysphoria for minors in the state on Feb. 10, 2023. Credit: Issac Morgan

The state requires transgender people seeking gender-affirming care to sign consent forms stating that the treatments they’d get are based on poor-quality research, may be ineffective, and that their risks may include the need for lifelong care.

Assertions, according to experts in transgender care, that are outright wrong.

During the second day of a federal trial over Florida’s restrictions on gender-affirming care, attorneys for transgender people and their parents challenging the state’s restrictions on that care argued that the forms impose an undue burden on transgender people.

Attorneys for the DeSantis administration, meanwhile, insisted the forms outline risks of common medical treatments for gender dysphoria.

Following Gov. Ron DeSantis’ approval of SB 254 in May, trans patients or their legal guardians must sign consent forms depending on the treatment they seek, whether hormone replacement therapy, puberty blockers, or surgery. The state Board of Medicine and the Board of Osteopathic Medicine created the forms.

The plaintiffs — including trans adults, trans minors, and their parents — want U.S. District Judge Robert Hinkle to declare that the law violates the Fourteenth Amendment and strike down both it and the rules restricting care for adults and banning it for children.

Representing the plaintiffs are GLBTQ Legal Advocates and Defenders, the Human Rights Campaign Foundation, the Lowenstein Sandler law firm, the National Center for Lesbian Rights, and Southern Legal Counsel.

Two parent plaintiffs and one trans adult plaintiff testified during the opening day of the trial on Wednesday in Tallahassee that the law is harming their wellbeing.

In September, Hinkle denied the adults’ a preliminary injunction to stop enforcement of the law. He wrote in his decision that the adult plaintiffs hadn’t established that they’d suffer unduly if the law continued to be enforced.

Outlining risks

The forms are not balanced in expressing the risks, benefits, and alternatives of treatments, said Kenneth Goodman, director of the University of Miami Institute for Bioethics and Health Policy.

“These forms are trying to discourage people from getting gender-affirming care,” Goodman said, adding that they have “no particularly good purpose unless one wants to reduce the availability of gender-affirming care.”

Informed consent forms are supposed to encourage conversation between the physician and the patient. However, the ones the boards crafted undermine that relationship, Goodman testified for the plaintiffs.

The attorneys representing the defendants, including the boards and Surgeon General Joseph Ladapo, emphasized that Goodman is neither a physician nor a care provider for transgender people.

The expert witnesses called by the plaintiffs took particular issue with one statement included in all the consent forms:

“Medical treatment of people with gender dysphoria is based on very limited, poor-quality research with only subtle improvements seen in some patient’s psychological functioning in some, but not all, research studies. This practice is purely speculative, and the possible psychological benefits may not outweigh the substantial risks of medical treatments and, in many cases, the need for lifelong medical treatments.”

Psychiatrist Dan Karasic, who specializes in treating transgender people, testified to the contrary that there has been substantial research on the benefits of gender-affirming care. He co-authored a version of the World Professional Association for Transgender Health guidelines.

Loren Schechter, director of gender affirmation surgery at Rush University, also deemed that statement inaccurate and said the list of risks in the consent form for surgical treatments, from facial reconstructive surgery to genital surgery, did not distinguish the risks for each one.

“It would confuse patients,” he said.

During cross-examination, the defense team questioned Karasic about the permanence of gender dysphoria, asking whether he had experience with people who stopped identifying as transgender.

“I’m not going to say detransitioners don’t exist,” Karasic said. “If someone detransitions, they deserve excellent health care, as well.”

In decades of treating transgender people, he has had patients who tried to subdue their identity but ultimately transitioned as older adults, he said.

Provider restrictions

The consent forms may not be the only problem with the restrictions. The plaintiffs’ attorneys also focused on how the law only allows physicians to provide gender-affirming care. Overnight, nurse practitioners who were able to prescribe hormones to patients with gender dysphoria couldn’t do so anymore, said Vernon Langford, president of the Florida Association of Nurse Practitioners.

“It is well known in the Florida Legislature that there is a shortage of physicians,” Langford said, explaining why restricting nurse practitioners’ scope of practice would make it more difficult for trans people to access care. Nurse practitioners can still prescribe hormone treatments, just not to treat gender dysphoria, Langford said.

Defense attorney Mohammad Jazil asked Langford how he could know the law restricted care if he didn’t know how many nurse practitioners treated gender dysphoria before the law became effective.

“Because if before it was one, now it’s zero,” Langford said.

The trial is scheduled to continue next week.