After five hours of tense testimony and protests, the Florida Board of Medicine voted Friday to start drafting a rule that would bar all minors in the state from receiving puberty blockers, hormone therapy or surgeries as treatment for gender dysphoria.

Florida’s medical board is the first in the country to pursue such a rule, but Florida is among a wave of states where officials have attempted to restrict gender-affirming medical care for transgender minors.

By the end of Friday’s five-hour meeting, protesters began yelling “Shame!” at the board members, and some of them staged a “die-in” in the lobby of the Orlando International Airport, where the meeting was held.

The vote is the latest update in a months-long effort led by Gov. Ron DeSantis’ administration to restrict transition-related care for people under 18. 

The effort to restrict such care began in April, when DeSantis and Florida Surgeon General Joseph Ladapo issued nonbinding guidancethrough the Florida Health Department that sought to bar both “social gender transition” and gender-affirming medical care for minors. 

The guidance drew backlash from LGBTQ advocates and medical experts. Accredited medical groups — including the American Medical Association, the American Academy of Pediatrics and the American Psychological Association — have supported gender-affirming care for transgender youths. 

Despite that support, Florida’s Agency for Health Care Administration issued a report in June that “found that several services for the treatment of gender dysphoria — i.e., sex reassignment surgery, cross-sex hormones and puberty blockers — are not consistent with widely accepted professional medical standards and are experimental and investigational with the potential for harmful long-term affects.”

Just hours after the report’s release, Ladapo sent a letter to the Board of Medicine and asked it to establish a standard of care “for these complex and irreversible procedures.” 

The board held its first meeting on the issue in August, and on Friday it officially voted to draft a ban on certain gender-affirming therapies for minors. The meeting began with expert testimony in favor of and against such care.

Dr. Michael Laidlaw, an endocrinologist in Rockland, California, cited often-criticized research that found 50% to 90% of children whose gender identity isn’t consistent with their assigned sex at birth grow out of the condition by adulthood. 

“The basic problem with this treatment as I see it is: ‘What happens when you force a square peg into a round hole?’” he said. “You end up injuring or destroying the peg in the process.”

However, Dr. Meredithe McNamara, an assistant professor of pediatrics at Yale School of Medicine who treats transgender people between the ages of 10 and 25, told the board that the research Laidlaw cited and the June report issued by the Florida Agency for Health Care Administration are methodologically flawed. 

“Neither of the authors of the state’s review is a subject matter expert,” McNamara said. “One individual is a dentist. The other is a post-doctoral fellow in biostatistics. At a bare minimum, the systematic review should be conducted by those who are qualified to assess the literature. I wouldn’t trust a dermatologist review of the literature on a neurosurgical procedure, for instance.”

After expert testimony, the board began the public comment period, which was scheduled to last two hours, according to multiple attendees. 

The first nine attendees who spoke were in favor of restricting gender-affirming care for minors. Eight of them said they have detransitioned, or come to identify with their assigned sex at birth after having previously identified as trans. Only one of the eight had received gender-affirming medical care as a minor.

Chloe Cole, who described herself as an 18-year-old detransitioned female from California, said she began transitioning at 12 and received a double mastectomy at 15. At 16, she said, she realized she regretted her transition. 

“All the talk about mental health, self perception, pronouns and ideology leads me to the question, why is a mental health epidemic not being addressed with mental health treatment to get at the root causes for why female adolescents like me want to reject their bodies?” Cole said.

The board also heard from the parents of transgender youths. Hope McClay, who has a 9-year-old trans daughter, said that she used to have to force her daughter to get short haircuts before she came out as trans. 

“At one point she came up to me, at about three-and-a-half years old, and begged me, crying, and said, ‘Please, don’t make me be this way anymore. This is not who I am. I want to die,’” McClay said. 

She said she and her family have consulted with medical professionals on medical care for their daughter, and they have found that allowing her to go through male puberty would be “psychologically damaging.”

“So we do not make these decisions lightly, but these are the decisions that should be made by the families, not by the state, and not by a board,” McClay said.

Jude Spiegel, the only transgender person to testify at Friday’s meeting, read the names of 17 trans teens who died by suicide “over living in a world that refused to acknowledge or accept them.”

With about 45 minutes left in the public comment period, board member Dr. Zachariah P. Zachariah said only one more person would be allowed to testify. The crowd protested, and he offered to provide an email where they could share their testimonies. 

At one point, an audience member yelled that trans youths would suffer if the board voted to bar care: “The blood is on your hands!” To which Zachariah responded, “That’s OK.”

Emile Fox, a trans nonbinary person from Orlando who uses “they” and “he” pronouns, said they signed up to testify and weren’t able to, which frustrated them after the first eight people who testified were all in favor of restricting care, but none of them were from Florida.

“What was so appalling to me is how obviously staged this all was,” Fox said, adding that the board members didn’t appear to know that much about gender-affirming therapies. “They’ve been fed a narrative, and they ate it up.”

A spokesperson for the board said the committee “heard from subject matter experts and allowed for members of the public to speak on the issue at today’s workshop.” 

“The content of public comment is not ‘stacked’ by Boards,” the spokesperson said in an email Saturday. “Any members of the public who were unable to provide comment can submit written comment via email to BOMpubliccomment@flhealth.gov within 24 hours of the conclusion of the workshop. These comments will be included in the rulemaking record and reviewed just as all other public comments.”

After the public comment period, the board attempted to come up with a rough draft of a rule. Initially, members considered making trans youths who were already receiving gender-affirming medical care exempt from the ban if they underwent an informed consent process, but they decided to cut that proposal. 

Then, in a rushed exchange that attendees described as confusing, Zachariah pushed for a vote even as some board members asked for the proposal to be read aloud once more. He then said the motion was passed without saying what the final tally was. 

Florida Rep. Anna Eskamani, a Democrat whose district includes parts of Orlando, said that there would be another meeting on Nov. 4 at the Holiday Inn, Disney Springs, to discuss the drafted rule, and then there would be a 28-day approval process that would include additional time for public comments. 

She believes the timing of the rulemaking process — just ahead of the election — is intentional.

“It’s so clearly intentionally designed to create a news cycle that further polarizes and politicizes gender-affirming care to distract from the affordable housing crisis, to distract from the impact of Hurricane Ian and property insurance rates,” she said. “We have some actual real problems to solve, big health disparities that we need to address and yet, instead of talking about those real-life concerns, trans issues are going to be front and center, and that’s truly designed to continue to divide us.”