HRT and gender-affirming care for adults in Florida under fire
Hormone medication. Photo courtesy of Soledad Gonzalez.

HRT and gender-affirming care for adults in Florida under fire

Florida is no stranger to the increase in anti-LGBTQ+ legislation that has appeared in the past few years. Many such bills have been neutralized or stopped by the efforts of groups such as Equality Florida and GLBTQ Legal Advocates & Defenders (GLAD). But on May 17, 2023, Gov. Ron Desantis signed SB 254. This bill states that administering gender-affirming care to minors will be punishable by law, and it also restricts adults’ access to hormones and the health care providers who prescribe such medications. In the months since its signing, Florida residents have seen and felt its repercussions. The Catalyst spoke with students, Equality Florida and New College alumni on the impacts of SB 254.

Doe v. Ladapo, a three-day trial challenging SB 254, concluded on Dec. 21.  Four parents of transgender children and four transgender adults testified before the court, sharing their personal stories regarding the harm of restricting and criminalizing the administration of gender-affirming health care. According to Queer Doc, a ruling on Doe v. Ladapo is expected in 2024. Meanwhile, the law remains in effect with plaintiffs and allies across the state awaiting a verdict.

The restrictions physicians across the state are facing trickle down to those seeking care. Soledad Gonzalez (‘24) shared her struggles with securing gender-affirming care in the past year. “I’m uninsured and so that already presents a financial challenge in getting my appointments and blood work,” she told the Catalyst.

“It’s an even bigger struggle now because you can’t do Telehealth to start Hormone Replacement Treatment (HRT), or in my situation, reopen a T-blocker prescription that was already given to you by a doctor,” Gonzalez continued. “I don’t really know how to navigate the health care system without insurance.”

She described the anxiety of returning to campus last fall and not knowing the general attitudes of physicians towards transgender individuals in Sarasota since the bill had gone into effect. She said she became increasingly conscious of how “absurd it is that health care is so inaccessible.” And this was after the summer at home in Miami with no access to her HRT medication for more than a month and a half.

“The lack of safe spaces was so severe, and to make things infinitely worse, I was feeling mild physical withdrawal symptoms that made it hard to look at myself sometimes,” Gonzalez stated. “I had that awareness that things were reverting, even if it was slow. Nobody could really be there for me the way I needed them and I began to abandon myself too.”

According to Equality Florida, the majority of transgender and gender-affirming care is facilitated by nurse practitioners, Advanced Practice Providers (APPs) or via Telehealth—all of which were rendered unavailable by SB 254. Those who had previously sought care at Planned Parenthood, or with an APP over Telehealth were forced to seek a physician. 

According to SB 254, after finding a physician who is open to new patients, those seeking gender-affirming care  must be given an informed consent form by the State of Florida, to be signed in the same room as the health care provider. These informed consent forms have undergone changes in language over the course of the year,  namely to “remove the language requiring a visit with a psychologist or psychiatrist from the informed consent process for adults,” according to the National Law Review.

“There was a process through my provider through which I had to re-do the informed consent paperwork,” a third-year New College student whose name was withheld by request  told the Catalyst via text. “Availability was so little that I had to book maybe three months out, knowing I would spend at least a month or so off of my hormones. My partner had to drive me an hour in order to get my paperwork signed. Since hormones can’t be prescribed by a [nurse practitioner] anymore, I don’t really have anyone I recognize for talking about my health in regards to trans health.”

The already strenuous system of receiving health care, with or without insurance, makes getting an appointment with a physician a lengthy process. The restrictions only exacerbate this issue for transgender adults, including those in college, who have been made to wait for appointments and prescriptions, leaving them to go for long stretches of time without access to their hormone treatments.

According to Stanford Medicine, transgender adults and adolescents report better mental health and wellbeing while seeking gender-affirming care, but being denied access “can cause significant distress.”

“I think when this [SB 254] happened I had maybe hit almost a year or so on hormones,” the third-year student recalled. “I remember feeling dread. Not entirely because of myself, but because I know some people who are dependent on their hormones to literally stay alive. Someone with a full hysterectomy who suddenly loses access to their hormones is suddenly in danger of so many more declining health issues in the future. I’m not sure if I plan to be on hormones for the rest of my life, but they’ve put me in a better mental spot…  Realizing that me and people like me will be barred from resources like this made me realize I can’t stay in Florida after I graduate.”

The Catalyst reached out by email to New College alum June Bloch (’11), currently a Visiting Assistant Professor of Sociology and Anthropology at Agnes Scott College in Georgia. Bloch, who has done research on the impact of anti-trans legislation, offered their insight on the importance of supporting students of diverse identities, and on the similarities between Florida and Georgia. “As a professor, I see how much students learn from their peers,” Bloch stated. “I cannot overstate how diversity of all sorts promotes students’ intellectual as well as moral development, because you end up learning how to see the world beyond the necessarily limited vantage point of your personal life experience. You learn to see more of the whole.

“Both states are restricting and even criminalizing gender-affirming care for minors—and using the same kinds of misinformation and arguments to do it—but Florida is already severely limiting access for adults (in de facto as well as de jure ways),” Bloch continued. “But we’re also seeing bills like GA SB 88, which is another sort of ‘Don’t Say Gay’ bill.”

Many transgender people and their families have opted to move out of Florida. Bloch described the impacts of such occurrences in tandem with the law. “Bills like this [SB 254] are impacting transgender people’s ability to even go back to the places where they grew up or visit family. What does it mean for a child to be ‘threatened’ with gender affirming care, and what are the legal boundaries around that? I don’t have kids, but given the bathroom bills, I’ve accepted that I will not be able to ever return to Tallahassee, where I grew up, or many of the places where I once conducted my academic research.”

The Catalyst interviewed Community Organizer at Equality Florida Jules Rayne by email to get a better understanding of the work they do to combat anti-LGBTQ+ legislation and to foster safe spaces for queer and trans communities in Florida.

“These are the lawmakers that are supposed to represent the best interests of all Floridians and they are taking away the bodily autonomy of youth, adults and their families because they’ve bought into the narrative that transgender people are somehow a threat to society,” Rayne stated. “These laws go against every major medical and psychological association in this country and the ignorance of these politicians and deliberate harm being caused made me very upset.”

This anger has manifested in action. Rayne works with Equality Florida to advocate for transgender people across the state through direct political outreach and by providing resources and information to aid transgender people living in Florida in finding health care and navigating life. One example is the TransAction program, meant to educate, inform and advocate for the transgender and nonbinary community through a wide array of initiatives.

“TransAction is a leading voice in responding to attacks on transgender people,” Rayne explained. “Additionally, the program has conducted hundreds of diversity trainings throughout the state at major corporations, health care systems, law enforcement agencies, faith organizations, schools and universities. In doing so, creating a broader base of understanding and multi-level support from societal institutions which interface with the transgender community.”

Rayne emphasized the need for transgender youth to maintain hope above all. “We are seeing progress. Of the 22 anti-LGBTQ+ bills filed this year, only one made it into law, and it’s likely going to be struck down in court as unconstitutional. No anti-transgender bills made it into law in Florida in 2024—they were all defeated during this year’s legislative session because of the work of Equality Florida, the ACLU, the Human Rights Campaign and many other partner organizations. You don’t have to be an activist to be involved in making the transgender community a safer, more welcoming space.”

For any readers who are running into roadblocks receiving gender-affirming care or other assistance, the Catalyst has researched this list of resources in the Sarasota/Manatee area that have been idenitifed by Rayne and Gonzalez:

Florida Transgender Alliance

This organization is dedicated to bringing transgender individuals from across the state, more specifically Manatee and Sarasota counties, together through peer-led support groups, social events, providing information on health care access and organizing political action at local and state levels.

Trevor Project

The Trevor Project offers crisis counselors 24/7 via phone, text and chat specifically tailored to the LGBTQ+ community to provide constant access to help. According to their website, their mission is “to end suicide among LGBTQ young people.”

Trans Lifeline

According to the Trans Lifeline website, they are “a grassroots hotline and microgrants 501(c)(3) non-profit organization offering direct emotional and financial support to trans people in crisis–for the trans community, by the trans community.”

Harvest House and Turning Points 

These organizations exist to aid anyone in a difficult financial situation, offering aid for affordable housing, paying electric bills, finding employment and accessing affordable health care.

CAN Community Health

Community AIDS Network (CAN) provides comprehensive medical and dental care as well as counseling, case management and peer support groups. From HIV testing to housing support, CAN offers access to a wide breadth of support.

For readers who are looking to become more active in local LGBTQ+ organizations, the following organizations are always looking for volunteers,  assistance in preventing anti-LGBTQ+ legislation and help in creating safe spaces for both youth and adults: ALSO Youth, Project Pride and Stonewall Democratic Caucus of Sarasota.

Equality Florida’s Transgender Resource Guide is chock full of resources in counties across the state. Although the guide hasn’t been updated since April 2023, Rayne assures students that they’re currently working on a Sarasota and Manatee County-specific guide that will be released later this year.

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