The debate around Florida’s new restrictions on gender-affirming care has focused largely on transgender children. But a new law that allows the Republican presidential nominee and Gov. Ron DeSantis signing on last month also made it difficult or even impossible for many transgender adults to get treatment.

Eli and Lucas, trans men who are a couple, followed the discussions in the legislature, where Democrats warned that trans children would be more prone to suicide under a ban on gender-affirming care for minors, and Republicans responded with misguided stories about mutilated children. Eli said he and his partner felt blindsided when they discovered the bill contained language that would also disrupt their lives.

There was no communication. No one really talked about it in our circles, said 29-year-old Eli.

Like many transgender adults in Florida, he and Lucas now face difficult choices, including whether to uproot their lives so they can continue to have access to gender-affirming care. Clinics are also trying to figure out how to operate under regulations that have made Florida a test case for adult disability.

Lucas, 26, lost access to treatment when the Orlando clinic that prescribed him hormone replacement therapy stopped providing gender-affirming care altogether. The pair are also concerned about staying in a state that has passed several other laws this year targeting the LGBTQ+ community.

My whole life is here. All my friends, my family. I just got a promotion at work, which I probably didn’t

[going]

to keep, said Lucas, who works in a college financial aid service. I’m losing everything except Eli and my pets leaving here. So this was not a decision I took lightly at all.

The Associated Press does not use last names of Elis and Lucas because they fear reprisals. Although their friends and family know they are trans, most people who meet them don’t.

The new law banning gender-affirming care for minors also requires adult patients seeking transmedicine to sign an informed consent form, a doctor to oversee all transition-related health care, and people to see that doctor in person . Those rules have proven themselves

dn

particularly heavy because many people received care from nurse specialists and used telehealth. The law also made it a crime to violate the new requirements.

Another new law that allows doctors and pharmacists to refuse to treat transgender people further limits their options.

For trans adults, it’s devastating, says Kate Steinle, chief clinical officer at FOLX Health, which provides gender-affirming care to trans adults via telemedicine. Her company decided to open in-person clinics and hire more Florida-licensed physicians to continue providing care to patients who have already enrolled, even though it represents a major change in the company’s business model.

Eli has been seeing a doctor for years and therefore still has access to care. But SPEKTRUM Health Inc., the Orlando clinic that prescribed Lucas hormone replacement therapy, has stopped providing gender-affirming care.

There are many people looking for care they can no longer legally provide, says Lana Dunn, chief operating officer of SPEKTRUM Health.

According to UCLA’s Williams Institute, Florida has the second-largest population of transgender people in the US at an estimated 94,900 people.

University of California, Los Angeles

School of Law. It used state-level population surveys to determine its estimates. Not all trans people seek medical intervention.

Have at least 19 states

now

enacted laws restricting or prohibiting gender-affirming medical care for transgender minors. But adult restrictions have not been part of the conversation in most places. The Missouri Attorney General tried to impose a rule in that state, but it was withdrawn.

Florida is the proving ground of what they can get away with, Dunn said.

Her organization treats about 4,000 people mostly in Florida and some out-of-state telehealth patients, she said. While SPEKTRUM has strengthened its mental health services since the law was passed, it and other organizations rely heavily on nurse practitioners to provide care.

Dunn estimates that 80% of trans adults in the state received their health care from a nurse practitioner and are now denied access.

“What we’re seeing in the community right now is just chaos, Dunn said.

The law also contains language that she says could deter doctors who would otherwise be willing to treat trans patients, such as a 20-year statute of limitations to sue over the care they provide.

As a trans woman, Dunn struggles with losing her own access to hormones as she tries to bring help to terrified patients. That has taken a significant emotional toll, she said.

Not only do I face this lack of self-care, but many people within the community also face the same thing, and they reach out to me for guidance, Dunn said. So I do my best to guide and comfort people, but no one really reaches out to me and says, “How are you?” Is everything all right?’

Lucas, who switched eight years ago when he was 18, expects hormone treatments to run out in June. At best, he can provide,

now,

he will be able to get a new prescription in August. He is afraid that he will menstruate again.

It just becomes extremely difficult mentally to get your body to change in a way that doesn’t match your brain, Lucas said.

Eli and Lucas have moved to a month-to-month lease and tentatively plan to move to Minnesota in November. They said they

shall

are leaving earlier if they can afford it and have started an online fundraiser to help. Moving with their dog and two cats increases the cost and difficulty of finding a new place.

I just never thought it could happen this way, so fast and with us, Eli said.

___Beaty reported from New York City and Schoenbaum reported from Raleigh, North Carolina.