Missouri physician: ‘Gender-affirming therapy’ goes against bedrock standards for care
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It just doesn’t add up.
Medical professionals who prescribe puberty hormone blockers, cross-sex hormones and irreversible surgeries to treat gender dysphoria are not providing proper healthcare.
“Cognitive Behavioral Therapy — CBT — the gold standard when it comes to treating the majority of people with mental health disorders, recommends an approach that is the complete, polar opposite of gender-affirming therapy,” said Dr. Sarah Florence, a board-certified family medicine physician who serves in the St. Louis area.
“Anyone who knows how to apply CBT would never affirm gender dysphoria,” she said. “It’s not good care. It’s not scientific.”
Dr. Florence, a member of Incarnate Word Parish in Chesterfield, was a featured speaker at the MidWest March for Life in Jefferson City this past April.
She is a strong supporter of Amendment 3 (diojeffcity.org/amendment3), which will be set before Missouri voters on Nov. 3.
If passed by a simple majority, Amendment 3 would restore safeguards and regulations on abortion that were removed or weakened by the narrow passage of an abortion-friendly amendment to the state’s Constitution in 2024.
Amendment 3 would also place in the state Constitution a prohibition for sex-change surgeries, cross-sex hormones and puberty blockers for children.
Proper standards
A Missouri native, Dr. Florence attended college at Rockhurst University, went to medical school at Kansas City University, and completed her residency at Ascension Via Christi Hospitals in Wichita, Kansas.
For two years after residency, she provided outpatient family and obstetrical care in rural Iowa.
She treats men, women and children, with particular experience in women’s health, including reproductive care and menopausal hormonal therapy.
She noted that although she is not a psychiatrist, professionals in every facet of medicine study CBT in medical school, because mental and physical health are closely related.
She’s amazed that psychiatrists throughout the country aren’t standing up to proclaim that gender therapy does not measure up to the proper standard of care.
“Because affirming the confusion just further exacerbates the confusion and the delusion,” she said.
“And although it might bring temporary relief, you’re not getting to the center of the problem,” she stated. “The person will never be at complete peace and healing, because you’re just delving deeper and deeper into this delusion.”
She pointed out that here in the United States, “we are increasingly using an immediate affirmation model, where a child’s feelings are accepted as fact, and medical intervention follows quickly.”
But the practice of medicine is built on evidence, not feelings.
That’s not to say that people with gender dysphoria aren’t suffering or aren’t in need of compassionate care.
“It’s extremely difficult to live with gender dysphoria and the whole array of related problems,” said Dr. Florence. “And it’s important for everyone in the pro-life movement and the medical community to lean into love while providing an honest, scientific approach to this. Because true love is not dishonest.”
She emphasized that true, evidence-based medicine requires systematic reviews.
“And each of the approximately half-dozen systematic reviews that claim to support the use of puberty-blockers, cross-sex hormones and bodily mutilation in transgender-identifying children are rated low or very-low quality,” she said.
Risks to children’s health
Dr. Florence previously worked in obstetrics and gynecology.
“I have cared for women through crisis pregnancies and managed miscarriages and obstetric emergencies,” she said. “I have supported mothers in their most vulnerable moments. I care deeply about the health and safety of women and the protection of Missouri children.”
She has treated many women experiencing side effects of menopause or perimenopause.
“In those phases, our estrogen and progesterone levels plummet,” she said, referring to the female hormones that play an important role in women’s health throughout their childbearing years.”
With those hormonal drops, which are significant, come some problems.
“We often replace progesterone and estrogen for perimenopause and as late as the first decade of menopause,” said Dr. Florence, “to help reduce the risk of stroke or heart attack, along with osteoporosis, fractures, underlying anxiety and depression, and issues pertaining to skin and the eyes and with libido and urinary function.”
The benefits of hormone replacement therapy have been widely demonstrated, along with the health risks they tend to offset.
“When females lose estrogen naturally, we replace it because it is so crucial for health,” said Dr. Florence. “So, why would we ever administer drugs to block estrogen in little girls, at the most critical stage of their development? How is it good, healthy medicine to block something that is so crucial for all females?”
Simply put, she stated, there is no proof of a lasting benefit to arresting puberty in minors.
“But we do know many risks of those interventions,” she said.
For instance, puberty blockers reduce bone density, raising the risk of early osteoporosis and fractures; interfere with brain development; and worsen blood sugar and cholesterol, she said.
She noted further that nearly every patient she’s treated who has gender dysphoria has also been diagnosed with some other mental health condition.
“All have had anxiety and depression,” she said. “There are almost always other underlying health issues, including a history of abuse or other kinds of trauma.”
They also tend to show signs of being withdrawn and lacking a sense of true meaning in their lives, “and they’re looking to fill the void,” she said.
“And unfortunately, they’re received with people telling them the only way to do that is change their bodies, change their names and join this disordered movement.”
At the same time, she noted, 80 to 90 percent of children with gender dysphoria will naturally reconcile with their biological sex if they are allowed to go through natural puberty.
She pointed out that despite what families are often told, most children receiving puberty-blocking drugs will begin taking cross-sex hormones in as little as three months, which will effectively sterilize them.
“Hence, puberty blocking is not buying time,” she said. “Rather, it’s the gateway to a journey of lifelong medical interventions.”
Then come the surgeries.
“These procedures remove healthy, functioning organs,” Dr. Florence noted. “They cause permanent infertility. They carry lifelong consequences, sometimes with poor healing, requiring a number of revision surgeries.”
The negative emotional impact also continues.
“This is something we have to talk about, something we have to educate people about, so they know the truth,” said Dr. Florence. “Affirming gender dysphoria is not scientific, and it’s not good care.”
By passing Amendment 3, she said, Missouri can lead “not by being extreme but by being thoughtful, ethical and grounded in real science.”
“Missouri children deserve better,” she stated. “They deserve compassionate mental health care. They need excellent therapists to walk with them carefully and honestly. Rushing a child toward irreversible change is not real compassion.”
Necessary safeguards
Amendment 3 would also restore many safeguards for women that were erased or weakened by the narrow passage of a previous, abortion-friendly amendment to the state’s constitution in 2024.
Specifically, Amendment 3 would:
- reinstate health and safety standards and allows for inspections at abortion clinics;
- reestablish the ability to sue physicians or facilities for malpractice, injury or death due to abortion or reproductive healthcare procedures;
- require parental consent for minors seeking abortion;
- ban fetal organ harvesting; and
- ensure proper licensing for abortion facilities and physicians.
Amendment 3 would allow abortions to be restricted to cases of medical emergency, rape and incest under 12 weeks gestation, and fetal anomalies. It would continue to ensure women’s ability to access medical care for medical emergencies, ectopic pregnancies and miscarriages.
Dr. Florence insisted that restoring common sense safeguards is essential to providing proper medical care.
She said that if abortion is “healthcare” as its proponents claim, it should meet the same standards as the rest of medicine: clean clinics, clear protocols, reliable follow-up, fully informed decision-making, and qualified physicians held to the same legal and clinical expectations as any other facet of healthcare.
“In Missouri, abortion services are delivered across fragmented settings, with uneven oversight and inconsistent follow-up,” she said. “Real medicine does not skip safeguards. When care is inconsistent, patients bear the risk.”
Dr. Florence pointed out that an early ultrasound is a standard part of pregnancy assessment. But that doesn’t happen when women receive abortion drugs without visiting a qualified healthcare professional.
In such instances, a woman could take an abortion drug with the intent of ending an undiagnosed ectopic pregnancy, a condition that can rapidly become fatal.
“Even small errors of dating the pregnancy increase the risk of failed or complicated abortion and serious harm to the mother,” she stated.
Sending abortion pills by mail removes needed safeguards entirely, eliminating in-person evaluation and continuity of care, and limiting a physician’s ability to identify coercion on or other domestic concerns that influence the mother.
“So, the question is simple,” said Dr. Florence. “If this is truly healthcare, why are we removing the basic diagnostic and clinical safeguards required everywhere else in medicine?”
They deserve better
Dr. Florence rejects the claim by people who oppose Amendment 3 that women would not receive proper reproductive healthcare if the amendment passes.
“Let me be clear,” she stated. “When a woman’s life is in danger, doctors act in ethical and effective ways that respect the life and dignity of both a mother and the baby she’s carrying.”
That care is to be expected.
“But I have also cared for women harmed by lack of abortion standards, abandoned with complications left for others like me to manage,” she said.
Dr. Florence has worked in multiple hospital systems where elective abortion was not permitted.
“And yet, every time, we treated miscarriages, ectopic pregnancy and other obstetric emergencies without need for induced abortion,” she said.
With all of that in mind, Dr. Florence urges all Missourians to set aside time and follow through on voting “yes” on Amendment 3.
“We should not accept lower standards of care for women,” she said. “We should not experiment on children in the name of compassion, and we should not abandon evidence when it matters most.”
