Trans adults scramble for care under new Florida law

A recent Florida law signed by Gov. Ron DeSantis (R) bans gender-affirming care for minors, but it also sets up significant barriers for transgender adults to get needed treatment — and puts the providers who care for them at significant risk of losing their licenses.

For transgender Floridians, the law is forcing difficult decisions about where, and even whether, they will be able to get medical care. 

Damon McGuire, a transgender woman and Orlando-based photographer, said Florida’s restrictions took her by surprise. She had been unprepared for the fact that the law, billed by Republicans in the state legislature as a way to protect children, would impact her ability to obtain care as a 35-year-old.

“It’s devastating,” McGuire told The Hill.

McGuire, who only began to seriously explore her gender identity during pandemic lockdowns in 2020, has not yet been able to obtain gender-affirming treatment. 

She had been scheduled to speak with a Planned Parenthood provider about receiving hormone replacement therapy (HRT) on May 20, just three days after DeSantis signed the law. But the measure took effect immediately, and her appointment was canceled.

“You’re talking about potentially tens of thousands of trans people across the state who got a call two weeks ago that their health care provider would no longer be renewing their prescriptions,” said Brandon Wolf, a spokesman for Equality Florida, an LGBTQ-focused civil rights group. “It is nothing short of a health care crisis in the state of Florida for trans adults right now.”

There are an estimated 94,900 transgender adults living in Florida, the second-highest number in the country, according to the Williams Institute at the University of California-Los Angeles School of Law.

Under Florida’s Senate Bill 254, health care providers are prohibited from administering puberty blockers, HRT and surgeries to transgender minors. Those who violate the law risk being convicted of a third-degree felony crime, punishable by up to five years in prison.

Including Florida, 20 states have enacted laws or policies that heavily restrict or ban access to gender-affirming health care for transgender youths, including 17 that have done so this year.

Yet unlike bans on gender-affirming health care in other states, the Florida law mandates adults sign an informed consent form approved by a state medical board appointed by the governor. The form doesn’t exist yet.

The law also states that only physicians are allowed to provide gender-affirming health care, and the initial visit to sign the consent form has to be in person. Violating those requirements is now a criminal offense.

The physician-only provision has proven to be particularly onerous, as health centers that previously relied on nurse practitioners or were telehealth-only suddenly had to pivot. 

Jerrica Kirkley, co-founder and chief medical officer of Plume, said she estimates that about 80 percent of transgender adults have been receiving care from a nurse practitioner.

“That’s a very large portion of the population who is potentially suddenly without care. I think there is a lot of fear, there’s a lot of confusion,” Kirkley said. “If they were getting care from a nurse practitioner, how can they continue their care? If they live in an area where the health centers have been traditionally staffed by nurse practitioners, for example, how are they going to start care? Can folks who have established care via telehealth continue their care?”

Plume is the world’s largest virtual clinic for transgender, nonbinary and gender non-conforming people and operates in 45 states. But in the wake of the law taking effect, Kirkley said they are opening in-person clinics in Florida for the first time since the height of the COVID-19 pandemic. 

The law only requires the initial visit to fill out the consent form to be in person, so Kirkley noted telehealth companies such as Plume will still be able to provide follow-up care virtually.

But removing the ability of patients to have a telehealth visit throws up a significant barrier to access.

“The problem is that a lot of our patients don’t live in big cities. They live in rural cities in Florida that may take them up to two to three hours to get to a health center to seek care. So transportation’s obviously going to be a huge barrier for these patients,” said Samantha Cahen, a nurse practitioner and director of the transgender care program at Planned Parenthood of South, East and North Florida.

Planned Parenthood is one of multiple providers in Florida to temporarily suspend gender-affirming services in response to the new law, although Cahen said care is expected to resume shortly for returning adult patients.

Syvonne Carter, president and CEO of 26Health, a nonprofit health center in Orlando aimed at the LGBTQ population, said seeing the impact of the law on that community has been “heartbreaking.”

The clinic sees about 2,000 patients a year across primary care, mental health and its adoption services. Carter said the new restrictions forced the center to stop providing HRT and other gender-affirming services, which has impacted about a third of their patients.

A growing number of transgender people in the U.S. are leaving states with restrictive laws they say target the LGBTQ community. More than 40 percent of transgender adults surveyed in a recent Data for Progress poll said they had considered moving over anti-LGBTQ legislation in their state.

McGuire, the Orlando photographer, said she is planning to move to Ohio in September, where gender-affirming health care for transgender youths and adults is still legal.

But moving expenses and the cost of housing have skyrocketed in recent years, and for many, leaving isn’t an option.

DJ, a 34-year-old transgender and nonbinary person in Tampa, who asked that their last name be withheld over concerns for their personal safety and privacy, said they have no plans to move. They have enough of their prescribed testosterone to get them through at least the next three months, and plan to go to a Planned Parenthood Clinic after that.

In the meantime, they plan to raise awareness about the plight of transgender people in Florida.

“I feel like there’s a fight in me,” said DJ.

Gender-affirming health care for transgender youths and adults is considered medically necessary and often life-saving by most major medical organizations. For DJ, who has been receiving HRT for more than a year, it has meant being able to look at themselves in the mirror for the first time.

“I see myself fighting for it,” they said of gender-affirming health care. “I see myself happy – sustainably happy – for the first time in my life.”

This story has been updated.