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Limits on transgender care force some Florida health centers to pause treatment for adults

A law that says only doctors can prescribe gender-affirming treatments is causing problems for transgender patients who have relied on nurse practitioners to access care.
A law that says only doctors can prescribe gender-affirming treatments is causing problems for transgender patients who have relied on nurse practitioners to access care.

Much of the attention surrounding transgender care in Florida lately has focused on minors. But a new law that criminalizes providing gender-affirming care to most children is also disrupting access for adults.

For support, contact the National Transgender Lifeline at 1-877-565-8860 (additional resources below.)

The shot of testosterone Noah Lovell takes each week has become a form of resistance for him since Florida officials started limited transgender rights.

“No matter what, I’m not going to let them take my joy,” Lovell said.

For the last year or so, the Lakeland resident has received hormone therapy (HRT), through Planned Parenthood and says it’s critical to helping his body align with his identity.

A nurse practitioner prescribed the medication but can’t anymore.

A law that Gov. Ron DeSantis signed this month states that only doctors can prescribe these treatments moving forward. It’s one of several new requirements posing challenges for transgender patients and forcing some health centers in the state to pause providing gender-affirming hormones and surgeries.

Weeks away from needing a refill, Lovell, who is 30 and uses he/they pronouns, says they asked their primary care doctor for a hormone prescription, but she said she didn’t feel comfortable. Lovell hopes to find an alternative soon.

I know that my mental health is so much better on HRT and testosterone, so the fear of, like, what is going to happen if I’m not able to get my medication, what is that going to feel like for me, how am I going to be able to function,” Lovell said.

Noah Lovell (left) attended a recent LGBTQ self defense class in Clearwater with his partner. They're worried Lovell could experience a disruption in hormone therapy.
Stephanie Colombini
Noah Lovell (left) attended a recent LGBTQ self defense class in Clearwater with his partner. They're worried Lovell could experience a disruption in hormone therapy.

Barriers to care for trans adults

The new law, which also criminalizes providing gender-affirming care to most youth, went into effect as soon as the governor signed it.

Although adults can still legally access care, the law immediately caused problems for thousands of patients and the health professionals who treat them, says Samantha Cahen, program director for trans and nonbinary care at Planned Parenthood of South, East and North Florida.

“It’s horrible, because everyone should have the same access,” Cahen said.

Like some other clinics that provide LGBTQ health care, Cahen says Planned Parenthood centers around Florida have a lot more nurse practitioners on staff than doctors.

A nurse practitioner herself, she says she has been prescribing gender-affirming hormones for four years and considers the law an insult to the hard work and training she has invested.

But mostly, Cahen worries how the law will limit appointment availability for the nearly 2,000 patients who seek gender-affirming care at the nine centers in her region.

“Now we have to go by what the doctors' schedules are, what they have available, and it's not something that will be a Monday-Friday thing, so that definitely puts a huge barrier to our patients,” Cahen said.

Planned Parenthood is pausing gender-affirming care until mid-June to figure out how to comply with the new restrictions.

“This law places medically unnecessary and intentionally targeted restrictions on the way gender-affirming care is provided and is intended to severely restrict access to care,” Miranda Colavito, spokesperson for Planned Parenthood of Southwest and Central Florida, said in a statement. That organization covers the region where Lovell gets care.

Other health centers are also stopping treatments, which state officials say are experimental.

Another barrier is that the law requires patients to sign a consent form acknowledging they’re aware of the risks associated with gender-affirming prescriptions and procedures. State medical boards have been tasked with drafting the forms, but they haven’t yet, leaving care in limbo.

Once a state-approved form becomes available, patients will have to sign it in front of a doctor, which Cahen said could be difficult for people who get care through telehealth.

“So now means of transportation have to be considered, you know, time, scheduling off from their work,” Cahen said.

Providers say they're determined to resume treatments

Staff tried to give some patients refills before the bill was signed, according to Cahen. Other patients told her they have found doctors in the community to take over their care. But securing a prescription doesn't guarantee a positive medical experience.

“I built such a relationship with them, and now it's like they have to go and try to get trust from this new doctor that they don't know and open up again,” Cahen said.

It's a concern some transgender Floridians share. Tampa Bay region resident Ingrid, who asked to go only by her first name for fear of retaliation, also got hormones from a nurse practitioner at Planned Parenthood.

Ingrid worried what seeking care elsewhere would mean. Would staff refer to her by her "dead name" assigned at birth that's still listed on legal documents?

With support from other members of the trans community, Ingrid says she was able to find a doctor who could help. But with the current political climate in Florida, she still feels uneasy.

“It's not about what's going on now — what will happen next, who will be targeted next, what avenues will be closed next time?” Ingrid said. “It’s scary.”

Planned Parenthood centers are continuing to offer trans and nonbinary patients other forms of health care as staff prepare to resume hormone therapy. Cahen says she's training doctors who will take on prescribing gender-affirming treatments to create respectful environments for their patients.

Trans residents say the community is coming together to support each other during this difficult time.

How to get help

Planned Parenthood centers in Florida have more information about the status of hormone therapy availability on their websites. You can also contact them for support:

Southwest and Central Florida - 941-567-3800

South, East and North Florida - 561-472-9991

Equality Florida's transgender resource guide is a statewide directory of quality, transgender-friendly service providers from across the state.

You can reach the National Transgender Lifeline (staffed by trans individuals} at 1-877-565-8860.

The Trevor Project also operates a 24-hour lifeline at 866-488-7386

Copyright 2023 WUSF 89.7

Stephanie Colombini joined WUSF Public Media in December 2016 as Producer of Florida Matters, WUSF’s public affairs show. She’s also a reporter for WUSF’s Health News Florida project.