#Florida HRT Crisis

[zinniajones]

Florida Adult Trans Care Ban SB 254, June 3, 2023 interim update

(from www.floridaban.com)

INTERIM UPDATE, June 3, 2023:

Rainbow Progress Fund provides a firsthand account of the joint Boards of Medicine committee hearing on June 1, including false and eugenicist claims by Board member Patrick Hunter (a member of the anti-trans Society for Evidence-Based Gender Medicine and Catholic Medical Association) that transitioning "lowers IQ" of trans people.

The committee failed to advance any of the necessary informed consent forms, mandated by SB 254, that are needed by MDs and DOs before they can resume providing new prescriptions. This means that until these forms become available, MDs and DOs cannot prescribe their established trans patients any new change in dosage of their current medication, or add any new medication to their existing HRT regimen.

Simone Chriss of Southern Legal Counsel, a nonprofit currently bringing litigation against SB 254 and its adult care restrictions, explains the current effective policy and status of prescribing restrictions on MDs/DOs as of June 3, 2023:

“While no draft consent forms have been released yet, the Boards are expected to file an emergency rule soon that will provide clarification about continuation of care for patients while the informed consent forms are being developed. The Boards’ discussions over the past two days indicated that, as we’d shared previously, physicians can continue prescribing to patients who provided informed consent and were first prescribed prior to May 17th. The emergency rule should provide guidance on whether and how new prescriptions and adjustments to medications can be prescribed prior to the adoption of informed consent forms. No emergency rule language has been posted yet on the Florida Administrative Register.”

Rainbow Progress Fund explains the unacceptable medical danger of the current situation for trans patients: "Those currently on hormone replacement therapy (HRT) will not be able to adjust their medication until the new consent forms are finalized. This delay poses potential risks to patients whose hormone levels may require immediate attention."

To be clear, even when these forms become available, this does not and will not change SB 254's statutory ban on NPs and APRNs prescribing gender-affirming care. As 80% of trans adults on HRT in Florida receive their prescriptions via an NP or APRN, the effects of SB 254 have permanently disrupted the established prescriptions and ongoing medical treatment of thousands of trans adults across the state. SB 254 continuously jeopardizes the trans community's health and must still be mitigated in its entirety.

No other state has ever imposed SB 254's novel and selective restrictions on NPs and APRNs, who have prescribing authority just as doctors and physicians can prescribe medication. NPs and APRNs in all other states - and in Florida until SB 254 was enacted this May - have always been able to prescribe all gender-affirming hormone therapy, including schedule III medications like testosterone. "NPs have the prescriptive authority to prescribe controlled substances in all fifty states." (Zhang & Patel, 2022) There has never been any reason for this unique new restriction on NPs alone, prohibiting gender-affirming prescriptions alone, other than Florida's intentional targeting of the ongoing medically necessary treatment of almost all trans adults in the state.

The committee concluded that their next meeting will occur in three weeks, on June 23 at an undetermined location or video call, to continue considering the required adult consent forms. This is completely unacceptable. The Boards must issue the mandated informed consent forms immediately in order to restore the ability of MDs and DOs to freely manage and prescribe any new or changed medically necessary treatment for their trans patients, even as this is itself utterly insufficient to mitigate the overwhelming danger to health and life caused by SB 254.

None of this is over until SB 254 is completely reversed.

We will continue to provide updates as we confirm any further policy actions by the Boards and their impacts on trans patients and our providers. The policy chart below will be updated to incorporate this information when it becomes available. Thank you to the trans community of Florida for closely monitoring this situation and assisting us, and to our allies here and abroad. The world will see that we are not alone and you are a part of making that happen. Your strength and unstoppable spirit in an unimaginable situation is what will ensure we survive. As long as Florida exists, Transgender Florida will be a fact. (Zinnia Jones, June 3, 2023)

Please support Florida's local gender clinics and their nurse practitioners as they work to survive this crisis and continue providing care to trans Floridians: https://spektrum.health/DONATE/

[fake-wizard]

I am in no way blaming the person who's mastectomy was almost fatally botched by Gallagher in Florida for what happened. The doctor is entirely to blame and it's incredibly traumatizing to go through that.

I am going to observe that this person (Rylan) with 11k followers contributed to ridiculing KC Miller, a transman who spoke out about being unhappy with hrt effects like hair loss, after starting it at 16 while in a mental health crisis.

Both these people experienced medical malpractice. But one has zero empathy for the other. One is receiving an outpouring of support while one is bullied relentlessly. And I do not think Rylan's view of Miller will change even after this. (Of course she has bigger things to worry about right now, but you know what I mean).

I do get that the difference is Miller is experiencing typical effects of hrt while Rylan's situation is rare and an unexpected, life-endangering outcome. But also, Rylan pursued transition as a 23 year old while Miller was only 16 and, again, in a mental health crisis so what is an expected outcome for a desperate teenager who can't picture their future in 5 years, pushed into this as the final option? And Miller also had serious complications with her mastectomy (also at 16) - but talking about that didn't gain her any empathy either.

Another big difference in their situations obviously is that Rylan is saying mastectomies are still all good and dandy, it's just this one doctor that was an issue. While Miller is saying that the fact that she was allowed to transition under her circumstances was wrong, and people are interpreting that as "no teens should ever transition" (which, true, but that's not what miller said). If you don't hedge your experience with "But transition is still good for Everyone!! This isn't indicative of anything!!" then your own community will tear you apart.

[inclusiveexcellencecca]

TransInclusive Group

Transinclusive Group, Inc. is a Transgender-Led LGBQ tax exempt, non-profit organization, pursuant to section 501(c)(3) of the Internal Revenue Code. Founded in 2017, TIG is the only African American Trans-Led organization in South Florida that has been providing resources and a “Safe Space” for Transgender and Gender non-conforming people of color to be their authentic selves. Our services include Case Management, Referral and Navigation to HIV Prevention Care and Linkage (PrEP, PEP), Condom Distribution, In-Home HIV Testing, HIV Prevention Education and other essential support services. In addition, our Transinclusive Emergency Crisis Fund (TECF) was established to provide transgender individuals with immediate assistance in their time of need, inclusive of financial aid for prescription drug cost; Lab work for Hormone Replacement Therapy (HRT); Transportation via bus passes; UBER and LYFT; Food Vouchers; Utility Payment for rent, temporary housing inclusive of limited hotel accommodation and other life essential support services. TECF assistance is provided to all transgender individuals regardless of race or ethnicity.  We serve clients within the tri-county areas (Miami-Dade, Broward, and Palm Beach Counties).

[zinniajones]

While I wait for the cowards on the Florida Boards of Medicine to upload the meeting audio of their shameful silence today, here is a policy diagram explaining exactly how nearly all trans adults in Florida are no longer able to fill their HRT prescriptions:

NO OPTIONS LEFT: Florida Adult Trans Care Ban Interlocking Policies Chart by Zinnia Jones, GenderAnalysis.net — current as of 5/23/2023

START HERE

Patient age: Under 18/18 or over?

Under 18: Care not available through any provider

S.B. 254

64B8-9.019, 64B15-14.014 F.A.C.

Patients receiving treatment prior to 5/17/2023 are grandfathered

18 or over: Provider: MD/DO or NP/APRN/other?

NP/APRN: NPs, APRNs and other providers cannot prescribe HRT for adults after 5/17/2023 (S.B. 254)

MORE THAN 80% OF TRANS ADULTS IN FLORIDA RECEIVE THEIR HRT PRESCRIPTION THROUGH AN NP/APRN

Trans adults have historically been able to receive prescriptions for hormone therapy from nurse practitioners and APRNs in every state without this ever being an issue.

Trans people were able to receive HRT prescriptions from NPs and APRNs in Florida for decades, until Wednesday, May 17, 2023.

MD/DO: Date: Before 7/16/2023, or 7/17/2023 or later?

After 7/16/2023 or once emergency rules are issued: MDs/DOs can write HRT prescriptions under rules and consent forms issued by BoM/BoOM (rules unknown until day of publication) (S.B. 254)

ADULTS -MIGHT- BE ABLE TO RECEIVE NEW HRT PRESCRIPTIONS FROM MDs/DOs BY MID-JULY

The Boards contain at least one member of the anti-trans Society for Evidence-based Gender Medicine (SEGM).

Two other members were appointed by Ron DeSantis after they had submitted a letter to the Boards in favor of a trans youth care ban and in favor of anti-trans conversion therapy. trans.sh/nemours

Before 7/16/2023: Prescription type: New prescription or refill of existing prescription?

New prescription: MDs/DOs cannot write new HRT prescriptions for adults until BoM/BoOM "emergency rule" state-written mandatory informed consent forms are published for use (any time before 7/16) (S.B. 254)

No trans adults seeking to start HRT can begin treatment after 5/17/2023 until these informed consent forms are available.

Trans adults in Florida have historically been able to start HRT at a time that their own provider determines is appropriate.

Existing prescription: MDs/DOs can continue to renew existing HRT prescriptions for adults

Note: This remaining sliver is the only way trans adults in Florida can access their prescribed HRT as of 5/17/2023.

TAKE ACTION NOW:

LEARN more about how Florida legislators and state agencies inflicted this injury on the trans community: by hiring conversion therapists and a recognized hate group to write state policy. trans.sh/experts

HELP by giving to the Central Florida Emergency Trans Care Fund tinyurl.com/CFLTransFund

ACT to make your voice heard by the Boards of Medicine at their Joint Rules Committee meeting on the proposed mandatory informed consent forms for adults!

Thursday, June 1 2:45 PM The Westshore Grand 4860 West Kennedy Boulevard Tampa, FL 33609

Text of thread at https://kolektiva.social/@zinnia/110418489814171631:

Yes - this is what is happening in Florida due to SB 254, which was signed into law on Tuesday 5/17/2023, taking immediate effect. This immediately cut off 80%+ of adult trans people in Florida from having their HRT refilled, because SB 254 uniquely prohibits only nurse practitioners from prescribing only gender-affirming medications.

This has already been in effect for 7 days now.

Trans adults in Florida have already been cut off from their HRT refills for a week now, including those of us who have been stable on these medications for years or decades.

This is VERY different from the general situation of trans youth care bans in 19 states, many still working their way through the courts.

This has *already* happened, to *all* of us: all trans adults in the third most populous state in the US.

The number of trans adults on HRT massively exceeds the sliver of the population that are under 18 and are prescribed puberty blockers or hormone therapy.

These laws, advanced under the pretext of 'protecting children', are now directly impacting a far larger group of people who are not children and are not subject to those pretextual concerns.

Other arguments about withholding public Medicaid funding for transition treatment also do not apply here: SB 254 does not even allow receiving this care through private insurance or paying cash out of pocket. The care isn't simply not covered - the care itself cannot be provided regardless.

What is happening in Florida requires special attention above the situation of trans youth care bans nationally. This is having a vastly larger impact quantifiably.

It will have worse impacts qualitatively as well: adults are responsible for taking care of and protecting trans kids and making sure they do not hurt themselves.

Whereas as a trans adult, we have no one standing guard at the brink but our own self and the void to which we are accountable.

These are the facts as they stand right now. These are the facts as they have stood for a WEEK and NO ONE nationally is putting any attention on this because there are 19 trans youth care bans all across the country going on, along with everything else targeting trans people and the LGBT community broadly.

This is a specific harm that is happening now and has been happening for 168 hours.

It is not a hypothetical issue to raise awareness of, as if it were at the stage of some proposal that needs to be fought back. This has already happened and is happening right now. Active harm is happening until this law is rolled back.

For all of Florida's history since the inception of the applicable regulatory and licensing bodies, nurse practitioners have been allowed to prescribe hormone therapy, testosterone blockers and other relevant gender-affirming medications.

That has been the case since I moved here in 2011. There was no reason why this wouldn't be the case. It's also the case in every other state.

This new law is a carveout of prescriptions when used for one purpose, gender-affirming care, from nurse practitioners specifically, in a way that has never been done before. It affects all ages.

It has immediately obstructed access to HRT prescription refills for more than 80% of TRANS ADULTS in Florida.

It has also prohibited first appointments for HRT via telehealth with in-state or out-of-state MDs or DOs - first appointments must be in person. This will require expensive and time-consuming travel that is beyond most trans people's means: driving to Georgia from Florida can take 8 hours.

This was an intentional targeting of almost all trans adults in Florida, and the means by which we have received our generic, FDA-approved medications for years. And it included closing every possible door that would let us find another way to keep taking the medications we have taken for...

Well, for me it was 3,891 days when the clock stopped

[zinniajones]

FLORIDA HRT CRISIS: SB 254, effective May 17 2023, banned nearly all new HRT prescriptions and refills of existing prescriptions for trans adults, for up to 6 more weeks or until “emergency” state-mandated consent forms are published by the Boards of Medicine.

Trans care bans were never about “protecting children” — they were about making all trans existence completely impossible. See for yourself.

(Full quality version)

Please share to help Florida's trans community survive SB 254!

[zinniajones]

Florida, SB 254, total HRT ban for adults: 5/25/2023 update

FLORIDA HRT CRISIS DAY 8

Note that in the span of two days, we have had to revise this policy map from including one last way (green) for adults in Florida to get refills (no new prescriptions) from an MD/DO, to removing the one last green endpoint, and replacing it with red/yellow stripe. It actually is unknown whether even refills can be prescribed by MDs/DOs; and because of that unknown, MDs and DOs are choosing not to provide refills either.

There are now NO ways for trans adults in Florida to even obtain refills of their established HRT prescriptions.

This is based on the reports we're receiving of trans people's current experiences attempting to fill their established prescriptions since 5/17/2023 - in a complete vacuum of any information for patients who just lost access to their medication, whether from state agencies or even from the state LGBT organizations that were supposed to protect us from exactly this happening to us.

This shouldn't come down to us alone. WE NEED YOU TO STEP UP.

TRANS ADULTS IN FLORIDA ARE NOT ABLE TO GET THEIR HRT PRESCRIPTIONS FILLED OR REFILLED ANYWHERE.

WE HAVE NOT BEEN ABLE TO DO SO SINCE WEDNESDAY MAY 17

IT HAS BEEN 8 DAYS

THE CLOCK IS RUNNING

The next in-person meeting of the Boards of Medicine, to draft highly restrictive "emergency rules" further regulating adult HRT, is next week!

Florida Board of Medicine/Board of Osteopathic Medicine Joint Rules/Legislative Committee

THURSDAY, JUNE 1 - 2:45 PM The Westshore Grand 4860 West Kennedy Boulevard Tampa, FL 33609

And by the way? DESANTIS HIRED THE FLORIDA HATE GROUP THAT WAS RESPONSIBLE FOR A LAW FIRM'S $15,000 HIT JOB ON WPATH SOC

DESANTIS APPOINTEES ON THE BOARDS OF MEDICINE ARE RESPONSIBLE FOR PROMOTING CONVERSION THERAPY AND INVOLUNTARY PSYCHIATRIC HOSPITALIZATION OF TRANS PEOPLE

The Florida GOP and the DeSantis administration are directly responsible for a crime in progress against thousands of transgender Floridians!

GIVE US BACK OUR PRESCRIBED MEDICATIONS NOW