Florida Reverts Adult Transgender Care To 1979 In Violation Of Standards Of Care

A new set of provisions in Florida mostly rewind transgender standards of care to the disastrous standards of 1979. This will whittle down remaining transgender adult care to a trickle in the state.

In an unsettling development, the Florida Board of Medicine unveiled a proposed set of guidelines concerning the treatment of transgender youth and adults, that can only be described as a blast from a draconian past. Released yesterday, these regulations threaten to turn back the hands of time on the care of transgender individuals, reverting to protocols reminiscent of the disastrous 1979 standards of care.

The sweeping, archaic measures stipulate a series of hurdles that transgender individuals must jump. These include exhaustive psychological examinations, an alarming level of gatekeeping which includes a blanket prohibition on care for those diagnosed with “psychological comorbidities,” costly therapy sessions, and a requirement of having a supportive social network as a prerequisite for receiving gender-affirming care.

In a sweeping move prior to the Board of Medicine meeting, the state of Florida issued a ban on nurse practitioners from providing care, effectively cutting off 80% of all adult care. Concurrently, the Board, heavy with anti-trans members hand-picked by Governor Ron DeSantis, was tasked with devising a misinformation form for transgender adults seeking Hormone Replacement Therapy (HRT) before further care could be administered to trans adults. This presented an immediate bureaucratic hurdle that halted the remaining 20% of care. Yesterday, the Board not only generated this misinformation form but further appended crippling stipulations that threaten to destroy what’s left of the now threadbare trans adult care in the state.

You can see the new requirements for adult transition here:

New requirements for adult transition in Florida (obtained via PDF emailed).

There are several new requirements in order to medically transition. Transgender people must have existing social support, or they will be denied their medication. This is perilous given the fact that anti-trans laws in Florida have led to many transgender people going into hiding or delaying coming out. In essence, this mandates that transgender people be publicly out before they obtain care, similar to the “real life experience” requirements of the 1970s that led to extreme harassment and abuse of transgender people. Many trans people wait to come out until they have had enough physical changes from their hormone therapy regimen to pass as their gender identity. The new requirement makes this much harder to do.

Another standard requires that transgender people not have concurrent mental health diagnoses that can “interfere with diagnosis.” We know from proposals in other states that they intend these diagnoses to include anxiety, depression, autism, ADHD, and more. Given that many transgender people do suffer from mental health diagnoses and that many of these are often treated directly by the gender affirming care, it can present a catch-22 to obtaining care for most trans adults.

Alarmingly burdensome is the imposition of recurrent psychiatric evaluations, the obligation for lifelong mental health counseling, and psychiatric gatekeeping for transgender individuals. These tenets hark back to the oppressive 1979 Harry Benjamin Standards of Care, which wreaked havoc on the lives of transgender people. During this era, transitioning was a nearly insurmountable task reserved only for those who had the financial clout to navigate the formidable barriers to care. Overburdened psychiatrists and providers, their services at a premium, commanded exorbitant fees. For transgender individuals lacking the financial resources, access to care was completely unobtainable.

In all 50 states up to this point, transgender care is handled at “informed consent HRT clinics,” clinics that do basic psychological workups and then allow a transgender person to transition without these older requirements. These clinics are espoused by the World Professional Association of Transgender Health Standards of Care 8. This has allowed transgender people to access care much easier, leading to more transgender people being able to come out.

By banning informed consent care, Florida is poised to precipitously decrease the number of trans individuals who can medically transition within its borders. It becomes glaringly evident that these measures are a deliberate attempt by Florida to nearly eradicate transgender individuals in the state by reducing those accessing care to a sliver. Already, transgender Floridians face great difficulty obtaining care as many resort to hoarding hormone therapy medications or seeking refuge beyond the state lines. The handful of healthcare professionals still in the fray of providing care will grapple with mounting barriers, rendering transgender care in the state a rarity.

You can see a map of informed consent clinics here… note that all clinics in Florida will be removed from this map whenever the new provisions come into law:

Erin’s informed consent HRT map.

Bans on gender affirming care have come under heavy scrutiny by judges in recent months, with outright bans in Indiana, Arkansas, and Florida being blocked in court or ruled unconstitutional. Some of these states have responded by instead turning to targeted restrictions, almost copy and paste from the playbook on how these states skirted Roe v. Wade to ban most abortion care with Targeted Restrictions on Abortion Providers (TRAP) laws. Transgender care is particularly susceptible to TRAP laws due to the need to maintain it over a patient’s lifetime.

Florida’s policies will likely come into effect on July 1st if the Board of Medicine approves them. This means that they will occur concurrently with Florida’s new bathroom ban, which imposes lengthy 1-year prison sentences on transgender people who use the bathroom of their gender identity in many circumstances. As a result of the increasing attacks on transgender people nationwide, 130-260k people have already fled their home state - many of those who are fleeing are doing so from Florida.

Given recent attacks on informed consent hormone therapy providers such as Plume by anti-trans leaders like Matt Walsh, it is clear that informed consent care for transgender adults will be the next target nationwide. The grim prospect of states enacting legislation to regress or even outright ban adult transgender care looms large. Activists and watchdogs are expected to counsel transgender individuals to take pre-emptive measures such as securing medication reserves or considering relocation. Meanwhile in Florida, transgender residents are faced with the disheartening reality of being ensnared in the crosshairs of a state that appears hellbent on erasing their existence.