On Friday, several state and national civil rights groups filed an amended complaint to an existing Florida lawsuit, asking a federal judge to bar the state from enforcing provisions of a state law that greatly hinder transgender adults from obtaining gender-affirming care.
Friday’s motion comes several weeks after district judge Robert Hinkle issued an injunction barring the state from enforcing provisions of the law. He also ruled then that the plaintiffs were likely to prevail on their claim that those prohibitions are unconstitutional. But the protections issued in that initial ruling did not extend to adults.
SB 254, which came into effect on 17 May, has probably affected the vast majority of transgender adults in Florida by limiting who can prescribe hormones and creating significant hurdles to obtaining them. According to a 2022 report issued by the Williams Institute at the UCLA School of Law, Florida has an estimated 94,900 transgender adult residents, the second-largest population in the country.
Health providers who violate the adult provisions of the law can face misdemeanor criminal charges as well as disciplinary action by professional bodies.
“SB 254’s restrictions on well-established medical care cause profound harm, serve no legitimate purpose and reflect gross legislative overreach. SB 254 takes away Floridians’ ability to make important decisions about their own lives and hands it over to the government instead,” said the organizations that filed the suit, including Southern Legal Counsel, GLBTQ Legal Advocates & Defenders, the Human Rights Campaign and the National Center for Lesbian Rights.
Though state laws barring or limiting gender-affirming for youth have been proliferating across the country in recent years, Florida’s legislation went further by substantially curtailing care for adults. The law bars Advanced Practice Registered Nurses (APRNs), such as nurse practitioners, from prescribing hormones to transgender individuals. An estimated 80% of the state’s transgender adults, or about 76,000 people, previously obtained their prescription through an APRN, according to Lana Dunn, chief operating officer for the Orlando LGBTQIA+ clinic Spektrum Health.
Under SB 254, any initial visit with a physician for gender-affirming care cannot be completed via telehealth, creating an additional strain on patients in Florida’s rural communities.
According to the lawsuit, many transgender adults have been unable to obtain needed medical care since the laws came into force. Some physicians have reportedly stopped seeing transgender patients altogether, while other clinics that employ both APRNs and physicians have ceased taking on additional patients for the time being. Other patients have reportedly had their gender-affirming surgeries cancelled.
“A full ban on gender-affirming care has been instituted – if not by statute, certainly by drastic reduction in accessibility,” said Joseph Knoll, APRN and founder and president of Spektrum Health. “We are asking trans Floridians to be patient as we seek justice and legal correction.”
Though they are barred from prescribing hormones such as testosterone and estradiol to transgender and non-binary patients, APRNs are still permitted to prescribe the same medication to cisgender patients for other purposes.
SB 254 also directed the state’s Boards of Medicine and Osteopathic Medicine to issue rules governing how doctors could conduct gender-affirming care. The emergency rules and informed consent forms, which were not finalized until 7 July, require anyone beginning hormones to undergo a “thorough psychological and social evaluation” by a psychiatrist or psychologist. This mandate creates additional logistical and financial roadblocks to initiating care, said advocates, and is out of step with widely accepted standards of care put forth by the World Professional Organization for Transgender Health.
In addition, anyone beginning hormone therapy or obtaining a new prescription is required to sign and repeatedly initial an informed consent form that spans 10 to 12 pages (form for trans men; form for trans women), which states that gender-affirming care is “based on very limited, poor-quality research” and “purely speculative”. Every major medical association in the US has issued statements in support of gender-affirming care. In addition, every major insurance company, as well as Medicare, covers gender-affirming care and recognizes it as medically necessary.
The lawsuit against SB 254 names several defendants, including Florida’s surgeon general, Joseph Ladapo, members of the state’s Boards of Medicine and Osteopathic Medicine and two state attorneys. If Judge Hinkle extends the injunction to include transgender adults, the state will be barred from enforcing those provisions of the law until the case proceeds to trial.
A representative of the Florida department of health said his office does not comment on pending litigation.
One of the plaintiffs listed in the suit, Lucien Hamel, is a 27-year-old transgender man who has been unable to obtain testosterone since 28 June.
“Being forced to go without testosterone has caused, and will continue to cause, severe and irreparable physical, emotional, and psychological consequences for Lucien,” states the lawsuit.
“He is also harmed because he cannot continue to receive care from the medical provider with whom he has built a relationship of trust and who knows about his medical history and needs.”
