TALLAHASSEE, Fla. (AP) — The debate surrounding Florida’s new restrictions on gender-affirming care has largely focused on transgender children. But a new law that Republican presidential candidate and Governor Ron DeSantis signed last month has also made it difficult, if not impossible, for many transgender adults to seek treatment.
Eli and Lucas, trans men who are a couple, followed discussions in the Legislative Assembly, where Democrats warned that trans children would be more likely to commit suicide under a ban on gender-affirming care for minors and Republicans responded with inappropriate stories of maimed children. Eli said he and his partner felt “blindsided” when they discovered the bill contained language that would also disrupt their lives.
“There was no communication. … No one was really talking about it in our circles,” Eli, 29, said.
Like many transgender adults in Florida, he and Lucas now face tough choices, including whether to uproot 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 him hormone replacement therapy stopped providing gender-affirming care altogether. The couple are also worried about staying in a state that has enacted several other bills this year targeting the LGBTQ+ community.
“My whole life is here. All my friends, my family. I just got a promotion at my job that I probably won’t be able to keep,” said Lucas, who works at a college financial aid office. “I lose everything except Eli and my animals who move out of here. So it was not a decision that I took lightly.
The Associated Press is not using Eli and Lucas’ surnames because they fear retaliation. While their friends and families know they’re trans, most people who meet them don’t.
The new law that bans gender-affirming care for minors also requires adult patients seeking trans health care to sign an informed consent form. It also requires that a doctor oversee all health care related to the transition and that people see that doctor in person. These rules proved to be particularly onerous, as 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 at FOLX Health, which provides gender-affirming care to trans adults through telemedicine. His company has decided to open in-person clinics and hire more doctors licensed in Florida in order to continue providing care to patients already enrolled, even though this represents a major shift in the company’s business model.
Eli has been seeing a doctor for years and therefore always has access to care. But SPEKTRUM Health Inc., the Orlando clinic that prescribed hormone replacement therapy for Lucas, has stopped providing gender-affirming care.
“There are a lot of people looking for care that we are no longer legally able to provide,” said Lana Dunn, chief operating officer of SPEKTRUM Health.
Florida has the second-largest population of transgender adults in the United States, at about 94,900 people, according to the Williams Institute at the University of California, Los Angeles School of Law. It used state-level population-based surveys to determine its estimates. Not all transgender people seek medical interventions.
At least 19 states have now enacted laws restricting or prohibiting gender-affirming medical care for transgender minors. But adult restrictions have not been part of the conversation in most places. The Missouri attorney general attempted to impose a rule in that state, but it was withdrawn.
Florida is “the proving ground of what they can do,” Dunn said.
Her organization treats about 4,000 people — most in Florida and some out-of-state telehealth patients, she said. Although SPEKTRUM has strengthened its mental health services since the law was passed, it and other organizations rely heavily on nurse practitioners to provide care.
Dunn estimates that 80% of trans adults in the state used to receive their health 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 it says could scare off doctors who would otherwise be willing to treat trans patients, such as a 20-year statute of limitations to continue the care they provide.
As a trans woman herself, Dunn grapples with losing her own access to hormones while trying to provide support for terrified patients. It took “a heavy emotional toll,” she said.
“Not only am I dealing with this lack of care for myself, but a lot of people in the community are also dealing with the same thing, and they’re asking me for advice,” Dunn said. “So I try my best to guide people and comfort them, but no one really contacts me saying, ‘How are you? Are you ok?'”
Lucas, who transitioned eight years ago when he was 18, plans to run out of hormone treatments in June. In the best case he can foresee now, he will be able to get a new prescription in August. He’s worried about getting his period again.
“It’s going to be extremely difficult mentally to have your body change in a way that doesn’t align with your brain,” Lucas said.
Eli and Lucas have moved to a month-to-month lease and tentatively plan to move to Minnesota in November. They said they would leave earlier if they had the means and started an online fundraiser to help them. Moving with your dog and two cats increases the expenses and the difficulty of finding a new home.
“I never thought it could happen this way, this fast and for us,” Eli said.
Beaty reported from New York and Schoenbaum reported from Raleigh, North Carolina.