TALLAHASSEE, Fla. — Rito Hendrix is trying not to panic.
After knowing he was transgender since childhood, the 31-year-old finally built up the courage to start hormone replacement therapy. He visited a Planned Parenthood clinic near his home in rural Loxahatchee in Palm Beach County and began taking shots of testosterone.
Just three months in, “I’m the happiest I’ve ever been in my life,” Hendrix said recently.
But on Wednesday, with the stroke of Florida Gov. Ron DeSantis’ pen, access to that gender-affirming health care for Hendrix and thousands of adults across the state is in jeopardy.
Republican leaders across the country have banned minors from accessing transition-related care, going against the guidance of major health authorities including the American Academy of Pediatrics and the World Health Organization. For transgender people and their loved ones, that was bad enough. But under a bill DeSantis signed into law Wednesday, healthcare restrictions will now expand to transgender adults like Hendrix.
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DeSantis targets LGBTQ community
Senate Bill 254 lays out a new informed-consent process that requires patients 18 and over who are seeking gender-affirming care to see a physician in person. That means new patients and some existing patients can’t use telehealth or other health care providers such as nurse practitioners.
The bill includes a carveout for prescription renewals, but providers and experts had different interpretations over whether existing patients can receive refills without going through the new informed-consent process. That ambiguity may prompt providers to stop gender-affirming care altogether, advocates say.
The legislation also has a range of insurance restrictions: governments and public colleges and universities can’t spend state money on gender-affirming care, nor can the state Medicaid program.
The result is massive barriers to care for trans adults, advocates say. The bill has caused panic among providers who could face a misdemeanor if they violate the law and among transngender Floridians whose fears that youth health care bans were just the beginning are now being realized.
“It’s yet another way to slowly creep in further and further laws that want to kick trans people out of the state or otherwise have them eliminated completely within the state,” Hendrix said.
The measure was one of four bills targeting the LGBTQ community that DeSantis signed into law Wednesday. He announced the bills from a Christian school in Tampa, Florida, behind a lectern with a sign that read, “Let kids be kids.”
“It is important that we stand up for our youth,” DeSantis said, “and we’re doing that in a number of ways here today.”
His office did not return a request for comment Wednesday.
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Logistical, personal challenges
Telehealth has grown increasingly popular amid the COVID-19 pandemic. Virtual-only providers have popped up in recent years to offer health care such as birth control pills and hormone injections.
And as many as 80% of trans adults receive care from nurse practitioners, said Lana Dunn, chief operating officer for the LGBTQ health clinic Spektrum Health, which has Florida locations in Orlando and Melbourne.
Dunn is one of those patients. She began hormone treatment four years ago under the care of Spektrum CEO Joey Knoll, a nurse practitioner. Dunn said the entire clinic is staffed by nurse practitioners who see about 2,500 patients who will be impacted by the legislation.
Not only do the restrictions pose a logistical challenge, she said, but they also could interrupt the relationships between patients and their providers that take years to develop — especially for a community that already faces healthcare discrimination.
“It’s something that’s so personal to me,” Dunn said. “I’ve gotten the results that make me happy under his (Knoll’s) care, so we’ve built that trust as a patient-provider relationship.”
Dunn’s clinic and other providers around the state have been scrambling to make sense of the law and figure out how best to serve their patients.
With DeSantis’ signature, Spektrum will no longer be able to prescribe hormones, Dunn said.
Planned Parenthood South, East, and North Florida has more than 2,000 patients who were seeing nurse practitioners for gender-affirming care, said Samantha Cahen, program director for trans and nonbinary care. The network of clinics sent a message to patients Wednesday saying it will pause gender-affirming care services to adapt to the new law and resume care in mid-June.
The plan, Cahen said, is to reschedule patients impacted by the law with doctors. The clinics can take on new patients as long as they can make it in person.
Cahen will have to train the physicians and registered nurses who will help with patient intake and education. As a nurse practitioner herself, she said the law is insulting to her profession because it implies she and her colleagues aren’t competent enough to provide care.
But her bigger concern is for patients. She gets dozens of calls a day from transgender Floridians worried about the status of their care.
“A lot of patients are just really terrified of what’s to come,” Cahen said. “They don’t feel safe anymore within their hometowns, at work, at school, socially.”
Folx Health, an online-only provider, is working to hire physicians who are based in Florida and open in-person locations in hubs across the state, according to an announcement on the provider’s website. Plume, another telehealth-only provider, will no longer be able to prescribe hormones but will still offer non-clinical services to its 1,000 clients in Florida, said co-founder and Chief Medical Officer Dr. Jerrica Kirkley.
“Gender-affirming care is life-saving,” Kirkley said. “Taking away access to that or limiting that in any way — it can be detrimental to people’s lives.”
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Turning down jobs and moving out of Florida
The legislation has already begun upending lives.
Lynne Taylor, 25, dropped out of her philosophy doctorate program at the University of South Florida. She said the ban on government spending means she would no longer be able to receive subsidized care through the university health center and off-campus options are limited because of the other restrictions.
Other anti-transgender policies factored into her decision, too. The bathroom ban would make it unsafe for her to use the restroom on campus. She was also concerned that DeSantis’ higher education overhaul would make it more difficult to pursue her research interests in queer and feminist theory.
“Fortunately, I have managed to find another opportunity at a school in Europe which has made this situation more workable for me,” Taylor said. “But the result is still painful. I have had to leave a lot of friends and colleagues behind, and moving on such a short notice was a significant financial burden.”
Hendrix is also planning to leave his home state. While he works full-time as a caretaker for his disabled father, he’s hoping to find a part-time job working nights so he can start saving money.
He thought he’d move out of Florida someday — but not like this. He’s worried about leaving his father, and he’ll miss parts of his life here: the plentiful South American cuisine and the quiet 2 acres he lives on with his parents and dogs.
“We’re just people. We’re just living our lives. The detractors like to call us monsters and predators,” he said. “I just want to be left alone to live with my family and my dogs.”