*Correction appended.

The Florida Department of Health on Wednesday advised health care professionals against performing certain gender-affirming care treatments or helping trans minors navigate socially transitioning. Those nonenforceable guidelines break with recent guidance from the U.S. Department of Health and Human Services.

Even if the guidelines are not legally binding, they are significant: Experts told The 19th that singling out socially transitioning rather than just medically transitioning pushes Florida’s efforts to restrict gender-affirming care beyond many other states’. 

The guidelines were laid out in a news release from Gov. Ron DeSantis and Florida state Surgeon General Joseph Ladapo. In addition to the guidance surrounding social transitioning, they specifically recommended against offering hormone therapies and puberty blockers — both recommended by the foremost medical associations on trans health and backed by the American Medical Association — or gender-affirming surgeries, which are not recommended or typically administered for patients under 18.

Kellan Baker, executive director and chief learning officer of D.C.-based LGBTQ+ health care provider Whitman-Walker Institute, said the guidelines against social transitioning — using a new name, new pronouns, or changing outfits or hairstyles to better match gender expression or identity — are ultimately advising physicians to misgender trans youth and deny their identity when working with their families. 

Social transitioning is often a key step for young trans people experiencing gender dysphoria, Baker said. The World Professional Association for Transgender Health recommends that families work with mental health professionals on how to best navigate a social transition for their child. Clinics like the University of Florida Health Youth Gender Program offer services to support trans youth’s medical and social transitions. 

“It’s listening to the young person and doing what they need to feel safe and supported,” Baker said. Asking trans youth to be closeted when they wish to socially transition could greatly hurt their mental health and lead to kids feeling like they need to hide who they are, he said. 

Brandon Wolf, press secretary for Equality Florida, said over text that the guidelines singling out social transitions are “a dangerous escalation” beyond what other states have attempted via anti-trans legislation. 

“DeSantis has asserted that government not only knows better than parents and doctors what care to provide to children, but that government knows better than parents what clothes their kids should wear, what name they should be given, and what pronouns they should be referred to with,” he said. 

Jeremy Redfern, press secretary for the Florida Department of Health, said in an email that the department’s guidelines are not enforced by the state. The guidelines are intended to inform health care practitioners, patients and families, he said. 

Florida’s health agency cites a peer-reviewed 2020 analysis of German children with gender dysphoria as evidence for its recommendation against allowing transgender youth to socially transition. The study found that peer and family support should be provided instead of encouraging a trans child to socially transition, since the authors could not prove a direct link between socially transitioning and improved mental health. By contrast, pediatricians who work with trans youth say the reversible and affirming practice helps lessen depression and anxiety.  

Liz Jaques, who lives in Orange Park, Florida, is helping her 13-year-old son, AJ, socially transition alongside his medical transition. She sees it as a very important part of supporting him. 

“How can you support the child and then tell them, when we leave the house, you have to look this way or dress this way and use this name?” she said. 

Jaques is worried about whether her son’s pediatrician will follow the new guidelines against providing hormones and puberty blockers, potentially denying her son care he is currently receiving. She’s also worried about what the guidelines could mean for his mental health. 

Anthony Michael Kreis, who teaches constitutional law and employment discrimination at the Georgia State University College of Law, said though the guidelines are unenforceable, they do signal a hostility toward trans children that might lay the groundwork for further action by the state — similar to Texas’ attorney general issuing a directive that gender-affirming care is child abuse. (There is now an ongoing legal battle over that directive.) 

“I think it’s important to know that nothing has really changed in the last few hours, but it might signal something much more dangerous, creeping ahead,” he said. “The focus on social-based trans care is something we really haven’t seen any state target,” he said. 

Sam Ames, director of advocacy and government affairs at LGBTQ+ suicide prevention organization the Trevor Project, said in a news release that Florida Health is ignoring evidence in their 2021 peer-reviewed study that found receiving gender-affirming care is linked to lower odds of depression and attempting suicide for minors. 

“Gender-affirming care can save lives,” they said. 

Redfern, with the Florida Department of Health, said that the agency had no comment when asked for the agency’s response to LGBTQ+ and civil rights organizations condemning the guidelines as harmful to trans youth.  

In announcing its guidelines Wednesday, Florida’s health department framed its position on gender-affirming care as opposing the Biden administration. 

Last month, the federal HHS Office for Civil Rights released a statement saying that parents who believe their child has been denied gender-affirming health care should file a complaint with the office — and that health care providers who believe they are being unlawfully restricted from providing that care on the basis of a patient’s gender identity should also file a complaint.  

When asked for comment on the Florida health department’s newly released guidelines, an HHS spokesperson pointed to a statement Wednesday by Sarah Lovenheim, HHS assistant secretary for public affairs. 

“For anyone who needs to hear this, we’ve said it before: We are committed to protecting young Americans who are targeted because of their sexual orientation or gender identity, and supporting their parents, caretakers and families,” Lovenheim said. 

Correction: An earlier version of this article misstated Liz Jaques' last name. We regret the error.