Transgender adults in Florida are already dealing with the consequences of Gov. Ron DeSantis’ Senate Bill 254. The bill, which focuses on limiting access to gender-affirming care for youth, also impacts trans adults by limiting the types of clinicians who can provide hormone care and prohibiting telehealth. More affordable health care providers, including Planned Parenthood, are now suspending gender-affirming medical care in Florida, creating additional access barriers for trans adults, who are now forced to consider leaving the state or relying on mutual aid efforts to access essential care.
DeSantis signed the bill into law on May 18, which went into effect immediately. Soon after, three Florida families with transgender children filed a temporary restraining order in an attempt to block it through a federal court. A federal judge ruled in favor of the plaintiffs on Tuesday, June 6, allowing them to continue their use and prescription of puberty blockers. While the injunction only applies to the three families, the judge noted the plaintiffs would most likely be successful in having the law overturned.
As the filings make their way through the Florida legal system and reach a final outcome, Kate Steinle, chief clinical officer at Folx Health, hopes “for a swift and decisive end to this scientifically inaccurate and harmful law, which is creating not just chaos, but the inability for Floridians to access life-saving treatment.”
According to Lana Dunn, chief operating officer for LGBTQIA+ health clinic Spektrum Health, as many as 80% of trans adults receive care from nurse practitioners. Under SB 254, patients will only be able to receive care directly from medical doctors or doctors of osteopathic medicine. Steven Rocha, PRISM Florida’s policy director, says many trans adults like himself have been left “scrambling” to find another provider. Some have faced additional difficulties in getting their pharmacies to fill prescriptions that were written even before the ban was enacted.
“They don’t want to fall on the wrong side of the law, so they just refuse to fill them,” Rocha said. “I expect that there will be a backlog of patients who are now having to change doctors, and those doctors have limited availability.”
Trans patients already face long wait times and other barriers to accessing care. Exacerbating this, DeSantis’ new law also prohibits telehealth prescriptions, making it difficult for those without transportation access. According to a 2022 survey, 42% of transgender Americans used telehealth services in the four weeks prior to being surveyed. Without reliable transportation, many trans adults will face economic and practical hurdles when accessing hormone replacement therapy and other medications.
“The most immediate effect is the psychological and emotional distress of receiving care, and in just a matter of a day, it’s now gone,” Rocha said. “It came as a big shock for a lot of people: one day they just received a message from their provider saying we’re pausing services or we’re just shutting it down permanently.”
Planned Parenthood, one of the country’s largest trans health care providers that also offered an affordable sliding-scale pay method, sent a message to patients when the law was passed saying they would be rescheduling gender-affirming care appointments by June 12. To receive prescriptions for gender-affirming hormones, a patient must meet in person with a medical doctor or doctor of osteopathic medicine to review the informed consent form. On June 6, five locations in the Planned Parenthood of South, East, and North Florida (PPSENFL) network resumed transgender hormone therapy, including locations in Gainesville, Jacksonville, Tallahassee, Kendall, and Golden Glades. However, these locations are not accepting new patients.
“[Hormones] have changed my life for the better,” Rocha said. “I’m able to pass at work and school and live my life the way I want to without people asking too many questions. That’s been really important for me, for my mental health, but also for my personal safety.”
A Florida-based transgender adult who requested to remain anonymous said she knew this was coming. Since February, her nurse practitioner at Planned Parenthood has been warning her that she did not know how much longer they would be able to provide care for the patient. In an abundance of caution, she wrote out a year’s worth of hormone prescriptions. When the patient went to refill her prescriptions at the pharmacy, she said she would be traveling so she could get an extra month of refills. Now, following DeSantis’ law, the patient is unsure if the rest of her prescriptions will still be valid.
“We’re all just guessing, and that’s a scary point,” she said. “We’re all talking to each other, comparing notes, comparing our conversations with doctors, comparing what research we’ve done, and the one consistent thing is everyone doesn’t know.”
According to Steinle, Folx Health is setting up in-person locations across Florida at the start of June in an attempt to minimize this barrier for their members.
“They don’t know what the future of their treatment looks like,” Rocha said. “A lot of trans adults are essentially being forced to pause their medical treatments.”
Rocha said he and others in his community already deal with gender dysphoria, and without gender-affirming care as a treatment, this dysphoria will only worsen.
“It’s very stressful for me, as I haven’t gone to refill my current prescription, and I don’t know if I will be able to,” said Rocha.
As the legal battle plays out, many trans Floridians are struggling with another internal battle: whether or not to leave the state. After the bill was passed, Equality Florida and the Human Rights Campaign issued a travel advisory that detailed risks associated with relocation or travel to Florida.
“I think it’s going to get worse before it gets better,” Rocha said. “I am struggling with wanting to leave Florida because it’s my home … it’s a place where I grew up, so I’ve been wrestling with staying or leaving … I wish [the travel advisory] weren’t necessary, but I feel like at this point it is because, at the very least, it raises awareness of what’s going on.”
Rocha notes that the advisory is especially important for travelers passing through or visiting the state in order to consider their safety. House Bill 1521, a bathroom ban bill which was passed in early May, already creates an unsafe environment for the trans community.
“I think people really need to weigh their options,” Rocha said.
Erica Dawn Lyle, a trans artist who was born and raised in Palm Beach County, Florida, and lives in the state for four months out of the year, said the law has impacted trans adults’ mobility in the country.
“I do feel very afraid of what might happen if I had to visit an emergency room in some parts of Florida,” Lyle said. “Part of the broader implication of this for trans people is there’s a general sort of restriction of movement inside of the U.S. Because if we are not legally able to use the bathroom that’s correct in certain states, that affects our ability to pass through this state.”
Lyle has already faced barriers to accessing her hormones when in Florida. Last winter, she said the pharmacist kept sending her back to her doctor for corrections on the prescription.
“It was a constant battle just to get the most basic thing that my insurance and my doctor want me to have,” Lyle said. “I’ve had situations in Florida where I’ve gone to get my prescriptions for hormones, and it’s literally not available at any … pharmacy for a 16-mile radius. I had to drive over an hour and a half to pick it up from a Target in the suburbs of Orlando.”
While Lyle has faced systemic barriers to accessing essential health care, she notes that she doesn’t feel like she is “the object of hatred or animosity when out in public” in South Florida.
“There’s some parts of Florida where I’ve always avoided since I was young,” Lyle said. “But, I think that this is something that is a manufactured issue that’s coming from DeSantis. I don’t think that the average Floridian is interested in harming trans people. My sense is that this is a political circus that’s been created through his ambitions for power.”
Chaplin Tyler, a designer and artist based in Miami, is particularly concerned for trans youth, who will not have any access to hormone therapy or gender-affirming care.
“I don’t think that there’s been a generation before where the adults can say, ‘Oh, the kids don’t have it better than we do,’” said Tyler. “For them to cut off health care completely for minors … that’s a death sentence.”
The new law has already impacted Tyler, who is no longer able to update her birth certificate. She said she will most likely be leaving the state, as, if she is unable to access the hormones she’s been on for the last decade, she will be at risk of violence and hate crimes.
“We’re going to see a mass exodus of trans people, which is just heartbreaking because it’s terrible to see the trans community and queer community being broken up like this in South Florida,” Tyler said. “We’re being forced to exit a state because the conditions have become so uninhabitable that we have no choice. We’re all seeking asylum, and it’s just the most terrible … thing. I’ve never felt more depressed. I’ve never felt more enraged. I’ve never felt more disappointment.”
The previously mentioned trans adult who requested to remain anonymous is also trying to leave the state after the law impacted her livelihood as a musician and educator. After DeSantis passed a slew of anti-trans and anti-drag legislations in May, she lost a majority of her performing opportunities since the anti-drag legislation can be incorrectly applied to trans performers. As a musician, she has faced heckling and hateful crowds who forced the firing of the venue’s booking agent for hiring a trans musician. As an educator, she resigned at the end of this school year to avoid potential litigation for the institution she worked for.
Now, she has taken up work as an Uber driver and provides private music lessons. She is trying to get out of Florida, where she has lived for more than 30 years.
“It’s a complete nightmare,” she said. “Some people forget how big the trans community in Florida is. It’s horrible because I’m at a point where I’m trying to get myself out, but it’s not even practical, especially when you think of the flood of how many of us are trying to get out of so many red states, right? Where are we all going? Any measures to get people hormones feel like temporary solutions.”
Rocha encourages trans community allies and supporters to donate to emergency funds and mutual aid efforts and to reach out to their trans friends, family, and community members to ask how they can support them on a personal level. Additionally, Steinle suggests writing letters to elected officials and the boards of medicine and osteopathy to speak out about the impact of DeSantis’ law on the trans community.