Jul 13, 2023 - Health

Florida medical boards issue new rules for trans health care

Illustration of a red circle, with the state of Florida forming a bar across it, with the transgender pride flag underneath.

Illustration: Brendan Lynch/Axios

Transgender people in Florida are facing more restrictions to their medical care, even after two recent court rulings lambasted the state's approach to gender-affirming health care regulation.

Driving the news: The state boards of medicine and osteopathic medicine issued new rules last week for trans adults to undergo hormone replacement therapy and surgery. The guidance is part of an informed consent process required by Senate Bill 254, which went into effect in May.

  • The rules mandate that adults undergo psychological evaluations every two years to continue hormone treatment and require a witness signature in addition to the patient and their doctor.

Plus: The boards also issued a separate set of forms for trans minors requiring that they undergo a suicide risk assessment every three months and continue counseling with a mental health professional throughout treatment.

  • That's on top of statewide bans barring new minor patients from starting care. Youth who were already receiving the care before the bans went into effect were grandfathered in.

Why it matters: The requirements put up more barriers to care for patients who, in some cases, have been on treatment for years, advocates say.

State of play: Adult patients are also required to see a physician in person to start hormone therapy. That means other clinicians, like nurse practitioners, can't prescribe hormones, nor can providers who see patients over telehealth.

  • Medical providers can also deny care to patients based on their religious, moral or ethical beliefs, which trans people and advocates say could further shrink the pool of gender-affirming care providers.

The big picture: The new rules issued by state medical boards are part of the fallout from a nationwide onslaught of attacks on health care access and public life for transgender people and the LGBTQ community.

Yes, but: Several of the policies in Florida and beyond have hit roadblocks in federal court, calling into question why the regulations were proposed in the first place.

  • For example, in blocking Florida's ban on Medicaid coverage for gender-affirming care last month, U.S. District Judge Robert Hinkle wrote that the policy came out of a "biased effort to justify a predetermined outcome, not a fair analysis of the evidence."

The other side: The state has appealed Hinkle's ruling and another decision that blocked enforcement of gender-affirming care restrictions for three of the lawsuit's plaintiffs. State leaders, including Gov. Ron DeSantis and Surgeon General Joseph Ladapo, have maintained the care is experimental and ineffective.

Zoom in: The forms issued by the boards echo those claims, saying that transition-related medical care is "based on very limited, poor-quality research."

  • That contradicts the assessment of major medical associations including the American Medical Association and the American Academy of Pediatrics, which support gender-affirming care as evidenced-based, and in some cases, life-saving treatment.
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