FOLX HRT Care in Florida After SB 254

New laws have created additional requirements for receiving gender-affirming hormone therapy (GAHT, sometimes known as HRT) in Florida. Here's what you need to know about receiving care at FOLX including consent forms and in-person care.

August 16, 2023
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This article was updated on 9/5/23 by the FOLX Editorial Team. Florida members no longer need a psychosocial assessment before starting or when taking GAHT.

TL;DR:

  • The passage of SB 254 made it so consent forms must be signed in person to take  GAHT (gender-affirming hormone therapy) medication in Florida. Regardless of when you started GAHT, all folks in Florida need to get an in-person consent form signed in 2023.
  • If you started GAHT on or before 5/17/23, this means you need an in-person consent form signed by the end of 2023.
  • If you started GAHT after 5/17/23, this means you need an in-person consent form signed before you can start GAHT.

As of late, it has been really hard to be trans, nonbinary, or taking GAHT (gender-affirming hormone therapy) in Florida. Since the passage of the "Don't Say Gay Bill," it has seemed like an onslaught of anti-trans and anti-LGBTQIA rhetoric and laws have ensued.

We want you to know: we are here for you. We understand how confusing and gatekeeping the laws related to GAHT (sometimes known as HRT or hormone replacement therapy) in Florida have been. This article is a guide to what requirements you need, depending on which GAHT medication you take (estrogen or testosterone) and when you started on GAHT.

The passage of SB 254 made it so consent forms must be signed in person prior to starting GAHT medication. GAHT medications include estrogen and testosterone. All GAHT medications must also be prescribed by an MD or DO.

What does Florida SB 254 mean for my care?

Florida Senate Bill 254 (SB 254) is a state law that impacts gender-affirming care in Florida. SB 254 was signed into law on May 17, 2023, and became effective immediately.

When these guidelines were passed, specific requirements launched into effect based on when you started GAHT.

In-person signed consent requirement

In Florida, all people taking GAHT must have an in-person visit with an MD or DO to review and sign an informed consent form. Some people have a little more time than others, depending on when you started GAHT. 

  • People who started GAHT (with proof) before SB 254 was enacted have until the end of 2023 to have that consent signed in person.
  • Anyone who started GAHT after SB 254 was enacted needs to have that consent signed in person before they can start GAHT.

From 5/17/23 onward, you must be seen by an in-person physician (either an MD or DO) before starting on GAHT.

If you have a change to your GAHT medication (changing routes, adding a new GAHT medication, or switching oils due to an allergic reaction), you will also need to sign a new informed consent in person for the new GAHT medication you are taking. Note that if you want to change routes of medication, such as switching from estrogen (E) patches to E pills, for example, you have to go in person before your provider can order pills.

For allergic reactions, we can send a one-time refill of the new medication. However, you then need to be seen in person to sign a new informed consent form before we can send any additional medication refills.

For any changes in dosage, you do not need an in-person visit, nor do you need to sign a new consent form. Dosage changes can be done virtually! Message your Care Team in your Athena Patient Portal, or schedule a video visit if you’d like to discuss face-to-face.

How to provide documented proof of when I started GAHT

If you started HRT for gender-affirming care on or before 5/17/23, you will need an in-person visit by the end of 2023 (12/30/23). If you're able, please provide documentation of your previous GAHT prescription. In that case, we can write you a prescription after your telehealth visit with FOLX. To show you were prescribed GAHT before 5/17/23, you can use any official documents listed in this FAQ.

When you start GAHT, and what you need

For any GAHT medication, you must sign an in-person consent form by the end of the year. This is for both estrogen and testosterone.

Estrogen (E)

  1. I'm taking E and started GAHT on or before 5/17/23. You'll need an in-person consent form signed by an MD or DO by 12/30/23.
  2. I'm taking E and started GAHT after 5/17/23. You'll need an in-person consent form signed by an MD or DO before starting GAHT.

Any combination of switching routes of GAHT requires an in-person visit to sign a new consent form with a physician.

Estrogen examples

Here are some examples of when you have to go to an in-person physician (MD or DO) to get your estrogen informed consent form signed if you're taking estrogen:

  1. I switched from oral estradiol to estradiol patches.
  2. I switched from injectable estradiol to oral estradiol.
  3. I switched from estradiol patches to injectable estradiol.

Other examples of when you have to go to an in-person clinician (MD or DO) to get your estrogen informed consent form signed:

  1. I had an allergic reaction to my estrogen and need to change the estradiol route.
  2. I increased my dose of estrogen.
  3. I decreased my dose of estrogen.
  4. I added anti-androgens (spironolactone, progesterone, finasteride, dutasteride).

Consent form for E is required by the Florida Board of Medicine for GAHT.

If you are increasing or decreasing your dose of estrogen, you can meet with a practitioner virtually and do not need to come in person to change your dose. Additionally, if you stop taking a medication (like an anti-androgen), you do not need to come in.

Testosterone (T)

  1. I'm taking T and started GAHT on or before 5/17/23. First, you’ll need to submit documentation that you were taking GAHT medications on or before 5/17/23. We can send one refill for you through telehealth before you need an in-person consent form signed by an MD or DO.
  2. I'm taking T and started GAHT after 5/17/23. You'll need an in-person consent form signed by an MD or DO before starting GAHT.

Testosterone examples

Here are some examples of when you have to go to an in-person clinician (MD or DO) to get your testosterone informed consent form signed:

  1. I was taking T cypionate injections and switched to T gel/want to switch to gel.
  2. I switched from injectable testosterone to gel testosterone.
  3. I had an allergic reaction to my testosterone (gel or injection).

Consent form for T is required by the Florida Board of Medicine for GAHT.

If you are increasing or decreasing your dose of testosterone, you can meet with a practitioner virtually, and do not need to come in person to change your dose.

The Florida member experience

We do things a little differently in Florida in order to meet these requirements to serve our Floridan FOLX members. We work more as a care team in Florida. You will have an MD or DO assigned to your care. Then an Advanced Practice Provider (APP) or Nurse Practitioner (NP) will also work with you and the physician to get your medications refilled, your form signed, and any other care needs you may have.

We know we've said it seventeen times, but if you're new to GAHT and you live in Florida, you have to see a physician in-person to start. The other caveat? If you have an allergic reaction, if you change routes: you have to get a new consent form signed in person. ANY changes at all in GAHT mean you have to go in person to see a physician to get this form signed, unfortunately.

Please reach out to Member Support if you have questions about Florida documents via the Help Center. If you are a FOLX member, please upload your documents through your Athena Patient Portal. For more information on GAHT in Florida, visit our Florida Member FAQ page.

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FOLX Health is the first digital healthcare company designed by and for the LGBTQIA+ community. Our services include virtual primary care, gender-affirming hormone therapy including estrogen and testosterone (HRT), mental health care, sexual and reproductive health care, preventive care, and fertility consultations. FOLX memberships give you access to LGBTQIA+ expert clinicians, peer support, thousands of LGBTQIA+ resources, and more. Whether you're lesbian, gay, bisexual, transgender, queer, gender non-conforming, or nonbinary, you can find LGBTQIA+-specialized health care that helps you meet your wellness goals. FOLX Health is health care that's queer all year. Get all the benefits of becoming a FOLX member and sign up today!

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