Providers of gender-affirming care face an uncertain future when restrictions go into effect
Transgender youth and the health workers who treat them were already concerned about restrictions state medical boards prepare to implement. Now there are more threats to access.
Rules barring doctors from providing gender affirming treatments like puberty blockers and hormones to minors will go into effect next week, and Republican state lawmakers want to further restrict access to care.
They filed bills last week that would make it illegal to provide such treatments to minors. This comes after the Florida Boards of Medicine and Osteopathic Medicine voted to restrict the doctors they regulate from providing gender-affirming medications and surgeries to children, with exceptions for those who’ve already started receiving care.
The legislation (HB 1421 and SB 254) would also make it harder for adults to get care, prevent insurers and public institutions from helping pay for it and prevent people from changing the sex listed on their birth certificate.
For now, clinical psychologist Jennifer Evans with the University of Florida Health's Youth Gender Program said she and her colleagues are working to provide the best possible care while they still can. She talked with Health News Florida's Stephanie Colombini.
Talk about why your role as a psychologist may be more important than ever now that kids won't have other options for treatment like hormones.
I'm gearing up to try to do some group therapy so that we can try to provide services to more of these patients who are having their access restricted. I'm thinking of potentially doing a group for parents of kids who maybe would have been ready to start puberty blockers, and then also looking at that, like high school age range.
I think 16 is kind of the average age where our patients have been starting on hormones – if that's appropriate for them and it’s consented to by the family and the patient. Because they're going to see the goal is kind of in reach at 18. And it's really painful for them to have to wait from 14 to 18, knowing it's around the corner, and [feeling like] “There's nothing I can do to get more comfortable in my body.”
And they will be going through physical changes during puberty that don't align with their identity. What kind of mental support are they going to need during that time?
I think group therapy, individual therapy to address symptoms of depression, body image, and eating disorder-type difficulties -- that's sometimes sort of a creative way that patients try to address dysphoria. Anxiety is going to be a big one, including social anxiety. Increases in substance use, potentially, to help people cope with that discomfort, that anxiety, that depression.
So we’ve got to be ready to support patients in those areas if symptoms start to increase or flare up.
And your clinic was already one of the few places in this state that was providing gender-affirming care. So if its future is threatened, what could that mean?
Yeah, so my understanding at this point is that the UF Youth Gender Program is the last remaining youth gender program in the state. The three or four others that existed closed down pretty early once the Board of Medicine started to gear up to roll out these changes. I've heard of a number of providers leaving the state.
And yeah, you're absolutely right, there's already so few medical and mental health providers that do this work. And then the ones that we did have are dropping like flies because it's a scary time to be doing this practice. And the systems that these providers work in aren’t always supportive of continuing that work amidst the political controversy around this issue.
What's keeping you going?
As a member of the queer community, I don't feel like I can step out of it. This feels very personal for me.
I just refuse to back down because I know so many people that this health care has made such a huge impact on their lives in such a positive way. And the trans adults that I know in my personal life constantly tell me, “If only I could have accessed this as a minor, if that had been a thing,” or, “If my parents had been affirming of it, my life could have been totally different much sooner.” And so for me, it's just such a personal issue that I don't know what it would take for me to back down and stop providing this care.
Certainly, if laws prohibited me from doing it, I'd have to make a really tough decision about whether I would move out of state to continue doing the work I do or not, or if I would shift gears. Which it's painful to even think about what I would do in that situation.
Knowing how badly the state needs people who advocate for this trans-affirming care for minors and for adults, I'm really hesitant to let it push me out of the state. Because that doesn't ever create change in the way that we need it to go if we all leave.
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