Resource Guide: Proposed Laws Targeting Gender-Affirming Care for Adults

With so many anti-LGBTQ laws being proposed, we know it can be hard to keep track. FOLX is here to support your continued access to gender-affirming care. Learn more about anti-trans legislation in the U.S. and what FOLX is doing to support the community.

May 3, 2023
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June 6th Florida Update

On June 6th, 2023, SB 254 was blocked by a federal district court.

We believe that the injunction bars Florida officials from enforcing SB 254. But there is a difference of opinion about the scope of the decision, and we cannot offer our legal opinion. What we know for sure is that Judge Hinkle issued a scathing rebuke to anti-trans policymakers and added incredibly strong language in support of our community. We also know that banning trans care is likely unconstitutional. We will update you as this matter continues to develop.

TL;DR: What You Should Know

  • Florida recently passed SB 254 into law, which requires an MD or DO to provide gender-affirming hormone therapy (GAHT, sometimes known as HRT), for adults; among other restrictive measures surrounding gender-affirming care access.
  • Other states where gender-affirming care for adults, including GAHT, may be affected include Missouri and Texas.
  • Texas and Missouri legislation aims to make it harder for adults to get gender-affirming care by adding unreasonable requirements and difficult rules for healthcare providers.
  • The best resources and local organizations for tracking anti-trans legislation (and more) are listed and linked below.
  • We recommend ACLU and individual state legislature websites for current, up-to-date information.
  • FOLX is here to support your continued access to gender-affirming care.

With so many anti-LGBTQ laws being proposed, we know it can be hard to keep track. Finding factual and current info on gender-affirming care laws may feel overwhelming. We are here to provide information on the potential impact of this legislation on our members and the broader transgender and nonbinary communities. Our priority is to ensure you have continuity of care always.

We compiled the best places to go for up-to-date information so you can easily stay informed.

What FOLX is doing

  • Actively monitoring bills that impact gender-affirming healthcare for adults
  • Evaluating and expanding our services to do anything we can to meet new legal requirements that may become law
  • Providing resources for families
  • Offering consults for parents to help navigate what to do
  • Partnering with employers to provide care to their employees
  • Launching new grants through our FOLX HRT Care Fund this summer
  • Providing gender-affirming care to as many trans and nonbinary people as we can

Here at FOLX, we are responding to the legislation in many ways. Some of us have mental health practices we use during these times - such as limiting when we look at the news, meditating, and taking action in ways that feel good to us. As a company, we are continually working to build further access to LGBTQ healthcare by opening in new states, lobbying at the state level, and providing free care through our HRT Care Fund.

Though we do not offer gender-affirming hormone therapy to youth under 18, in most cases, FOLX is able to support parents and provide referrals.

Anti-LGBTQ state-proposed laws

On a national level, the government has affirmed the rights of trans and nonbinary people to access the care they need. However, many states are aiming to pass bills that restrict access.

Gender-affirming care is evidence-based and considered necessary and safe by every major medical institution. It has been shown to reduce gender dysphoria and save lives. Renowned organizations, including the American Medical Association and American Academy of Pediatrics, have issued statements opposing restrictions on gender-affirming healthcare.

Below we highlight legislation in Florida and Texas, and an emergency rule in Missouri because these recent state actions may affect our adult members.

What to pay attention to:

When looking at laws and proposed bills, consider a few key details.

  • Where the legislation takes effect
  • Who is targeted, whether that is minors, adults, or both
  • The effective date of the law or pending bill
  • Any current or ongoing litigation, i.e., if the legislation is being fought in court

State Actions that affect gender-affirming care for adults


What is happening in Florida

Several anti-trans and anti-LGBTQIA+ bills are being debated in the Florida House and Senate. Most recently, SB 254 was signed by Florida Governor DeSantis on May 17th, 2023. This law implements restrictions on gender-affirming care for adults.

Under SB 254, gender-affirming care for adults has additional requirements, including an in-person visit with a physician (MD or DO). Because of the high likelihood that this law will be challenged in court, we do not yet know if the new requirements for prescribing gender-affirming hormones will impact care immediately or be paused for legal action.

We know this causes a lot of anxiety, and we want you to feel as prepared as possible. We are here for you and are taking measures to ensure continuity of care for all of our members.

What FOLX has done to ensure continued care:

  • Sent timely refills for current members
  • Created access to same-day telehealth appointments for Florida residents
  • Expanded MD and DO coverage in the state
  • Worked to establish in-person locations
  • Created partnerships with local Florida care providers

Details on the bills

Florida Republicans helped pass SB 254, which aims to prohibit Medicaid and private insurance coverage for gender-affirming health care for transgender adults. The bill says it will limit transgender health care by "prohibiting certain public entities from expending state funds for the provision of sex-reassignment prescriptions or procedures." With SB 254 as a new law, health insurance policies may not provide coverage for gender-affirming treatments or gender-affirming surgeries.

This Twitter post (from Erin Reed) shows Florida Agency for Health Care Administration's memo that discusses banning Medicaid coverage for trans adults. Fortunately, the ACLU of Florida said they vehemently oppose the passage of this bill into law.

How to track bills in Florida

To keep up to date on the details of this bill and the status of others, we recommend following the ACLU of Florida and Lambda Legal. Additionally, you can track bills in the Florida House and Senate at

Florida resources

  • Equality Florida is the largest LGBTQ civil rights organization in Florida dedicated to securing full equality for Florida’s LGBTQ community. You can also donate to support their advocacy efforts here.
  • Metro Inclusive Health is an LGBTQ center in several locations in Florida.
  • Transpire Help offers LGBTQIA+ housing and healthcare resources in Florida.
  • SPEKTRUM Health is a nurse practitioner-led, gender-affirming care clinic in Florida.

Missouri's emergency ruling

The Missouri Attorney General issued an emergency rule severely limiting gender-affirming care for all transgender people. The ruling’s language contains extensive requirements for prescribing and receiving GAHT. It would create unreasonable barriers to gender-affirming health care for trans and nonbinary adults.

What happened in Missouri

After the state's attorney general issued an emergency rule, Lambda Legal and the Missouri ACLU filed a court petition for a temporary restraining order. The restraining order blocked the implementation of the rule until May 15th, 2023. A preliminary injunction hearing is scheduled on May 11th, 2023, which will determine if the rule will be further blocked. You can track the case at Lambda Legal.

What happens if the emergency ruling becomes effective?

If the ruling becomes effective, it essentially makes obtaining medically-necessary gender-affirming care for transgender adults impossible. The rule targets both trans people and gender-affirming healthcare providers.

How to track bills and the emergency rule in Missouri

Contact the Missouri state legislature to oppose the healthcare ban and track related bills. You can also contact Lambda Legal and the ACLU of Missouri to follow their opposition to the action in court.

Missouri resources

FOLX is not currently offering hormone therapy in Missouri, not due to this rule but due to working on getting clinicians licensed in this state. We are planning to open care in Missouri soon and continue to work towards that goal.

Texas bills target gender-affirming healthcare providers


What is happening in Texas

Texas proposes that physicians be "financially liable for their patients' lifetime medical and mental health." Under SB 1029, any complications of gender-affirming medical care could put providers at fault, even when they're not. These bills create unreasonable barriers for providers’ licenses and would make it financially risky for healthcare providers to offer gender-affirming care to adults. If passed into law, this would put Texans of all ages at risk of losing lifesaving gender-affirming care.

What happens if the legislation passes?

Because of Texas's size, with approximately 93,000 trans adults in the state, this law could have a major impact on trans Americans. Texas has one of the largest trans communities in the nation.

How to track bills in Texas

Track bills in the Texas House and Senate at the Texas Legislature online website. 

Resources for trans adults and parents of trans kids

The Transgender Education Network of Texas (TENT) is the largest trans-led organization in Texas dedicated to protecting transgender rights. You can also find more resources for Texan trans kids and parents here.

Nationwide sources for up-to-date information

The ACLU is a trustworthy national resource. You can track bills and legislative progress and even filter by issue. The ACLU is also good for tracking individual lawsuits. You can also check Lambda Legal for tracking lawsuits. Additionally, the Transgender Law Center (TLC) provides resources for parents of trans youth as well as interpretation services.

Independent reporter Erin Reed's Erin in the Morning substack is dedicated to the anti-trans and anti-LGBTQIA+ legislation sweeping the nation. She does monthly Anti-Trans Legislative Risk Maps. She also tracks bills on this open Google sheet.

State resources for tracking and information

The best way to stay up to date about bills is to go to your local chapter of the ACLU. The ACLU has an interactive map where you can search for up-to-date information by state, issue, and status.

You can also track bills on individual state legislator websites. You can even get email updates about bills from most state legislator sites. Local organizations are also good sources of information, like Equality Florida.

Organizations you can donate to

Some good news

The ACLU and the Department of Justice will likely prosecute these laws, and there will be pushback. You can read up on the most protected states from independent journalist Erin Reed.

FOLX is here to support you

FOLX is here to try to ensure you have continuity of healthcare always. Your gender identity, hormone therapy, mental health, and overall well-being matter. We are united against the discriminatory anti-trans healthcare measures in Texas, Florida, Missouri, and throughout the United States.

While telehealth companies will be forced to abide by any legal changes made at the state level, FOLX will work to meet any requirements we are able to in order to continue to serve our members.

As anti-LGBTQ laws are being proposed and passed at an alarming rate, many of us are feeling more on edge and anxious. Please know that the majority of these bills are not impacting adults right now. Most of these bills affect transgender youth, and we are deeply concerned about their impact on trans and nonbinary young people.

Please reach out to the FOLX Help Center or your clinician with any questions or concerns. Remember to care for yourself during these challenging times. We are here to support your holistic well-being as we continue to advocate for gender-affirming healthcare nationwide.

Additional resources:


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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