TALLAHASSEE, Fla. (AP) — The debate surrounding Florida’s new restrictions on gender-affirming care has focused primarily on transgender children. But a new law that Republican presidential candidate and Governor Ron DeSantis signed last month it also made it difficult, even impossible, for many transgender adults to receive treatment.
Eli and Lucas, trans men who are a couple, followed the discussions in the Legislature, where Democrats warned that trans children would be more prone to suicide under the ban on gender-affirming care for minors, and Republicans responded with out-of-place stories of mutilated children. Eli said he and his partner were “shocked” when they discovered the bill contained language that would also disrupt their lives.
“There was no communication. … Nobody really talked about it in our circles,” said Eli, 29.
Like many transgender adults in Florida, he and Lucas now face difficult decisions, including uprooting their lives. so they can continue to access gender confirmation care. Clinics are also trying to figure out how to operate under regulations that have made Florida a test case for adult restrictions.
Lucas, 26, lost his access to treatment when the Orlando clinic that prescribed his hormone replacement therapy stopped providing gender-affirming care altogether. The couple also cares about staying in a state that this year enacted several other bills targeting the LGBTQ+ community.
“My whole life is here. All my friends, my family. I just got a promotion at my job, which I probably can’t keep,” said Lucas, who works in a college financial aid office. “I’m losing everything except Eli and my pets by moving out of here. So this was not a decision I took lightly at all.”
The Associated Press is not using the last names of Eli and Lucas because they fear reprisals. Although their friends and family know they are trans, most people who know them do not.
The new law that prohibits gender-affirming care for minors also requires adult patients seeking trans medical care to sign an informed consent form. It also requires that a doctor oversee any transition-related medical care and that people see that doctor in person. Those rules have proven particularly onerous because many people received care from nurse practitioners and used telehealth. The law also made it a crime to violate the new requirements.
Another new law that allows doctors and pharmacists to refuse to treat transgender people further limits their options.
“For trans adults, it’s devastating,” said Kate Steinle, clinical director of FOLX Health, which provides gender-affirming care to trans adults via telemedicine. Her company decided to open in-person clinics and hire more Florida-licensed physicians to continue providing care to patients who have already enrolled, although that represents a significant change in the company’s business model.
Eli has been seeing a doctor for years and therefore still has access to care. But SPEKTRUM Health Inc., the Orlando clinic that prescribed Lucas’ hormone replacement therapy, has stopped providing gender-affirming care.
“There are a lot of people seeking care that we can no longer legally provide,” said Lana Dunn, chief operating officer for SPEKTRUM Health.
Florida has the second largest population of transgender adults in the US, with an estimated 94,900 people, according to the Williams Institute at the University of California Los Angeles School of Law. He used statewide population-based surveys to determine his estimates. Not all transgender people seek medical interventions.
At least 19 states have enacted laws restricting or prohibiting gender-affirming health care for transgender minors. But restrictions on adults have not been part of the conversation in most places. The Missouri attorney general tried to impose a rule in that state, but it was withdrawn.
Florida is “the testing ground for what they can do,” Dunn said.
His organization treats about 4,000 people, mostly in Florida and some out-of-state telehealth patients, he said. Although SPEKTRUM has bolstered its mental health services since the law was passed, it and other organizations rely heavily on nurse practitioners to deliver care.
Dunn estimates that 80% of trans adults in the state used to receive care from a nurse practitioner and have now lost access.
“Right now what we’re seeing in the community is just chaos,” Dunn said.
The law also contains language that she says could scare off doctors who might otherwise be willing to treat trans patients, such as a 20-year statute of limitations to sue for the care they provide.
As a trans woman, Dunn is dealing with losing her own access to hormones while trying to provide support to terrified patients. That has taken “a significant emotional toll,” she said.
“Not only am I facing this lack of care for myself, but many people within the community are also facing the same thing and are reaching out to me for guidance,” Dunn said. “So I’m doing my best to help guide people and comfort them, but no one really comes up to me and says, ‘How are you? Are you OK?'”
Lucas, who transitioned eight years ago when he was 18, anticipates running out of hormone treatments in June. In the best case scenario that he can foresee now, he will be able to get a new prescription in August. He fears that he may get his period again.
“It’s going to be mentally extremely difficult to make your body change in a way that doesn’t align with your brain,” Lucas said.
Eli and Lucas have switched to a month-to-month lease and tentatively plan to move to Minnesota in November. They said they would leave early if they could afford it and started an online fundraiser to help. Moving with your dog and two cats adds to the expense and difficulty of finding a new place.
“I never thought it could happen this way, so fast and for us,” Eli said.
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Beaty reported from New York City and Schoenbaum reported from Raleigh, North Carolina.
