Academia Slaying - HRT Blocked by Red Tape in Florida, Even for People who Still Qualify

Red tape is a scarily effective de facto ban, even if it isn’t technically a ban

By Artemis T. Douglas & Jane Migliara Brigham

On Nov. 22, the scientific journal Social Science & Medicine published a new peer-reviewed article titled "At the mercy of the State”: Transgender and nonbinary young adults’ experiences navigating restrictive healthcare legislation. The article is the result of a collaboration between a sociology department and two medicine departments across three different universities. 

The article’s six authors summarize their findings before the article’s abstract using four highlights.

The highlights include that legislation affecting transsexual medicine (the study calls it GAMT- gender-affirming medical treatment) has increased and that restrictions harm trans young adults.

Further, the study also states that legislative restrictions (anti-trans laws) use and mainstream misinformation and disinformation as well as that trans people- including trans youth- denied access to transsexual medicine will carve their own paths to it.

The study collected in-depth interviews from 105 trans young adults, aged 18-26 years olds.

Researchers collected this interview data across the 19 months immediately following the passage of Florida SB 254.

One of the worst anti-trans laws in the United States at the time of its passage, the bill was among the first laws which banned HRT and puberty blockers for children.  

SB 254 also severely limited the accessibility of HRT for adults by preventing state funds from going to providers of transsexual medicine, and forcing those trying to access it to sign legal documents attesting that they understood, among other things, that HRT is ineffective and has a high regret rate, both of which are patently false.

The most severe piece of the law was the provision that allowed parents to be stripped of their right to raise their children if it was alleged that they were allowing the child to have access to transsexual medicine, including if it was being provided outside of Florida.

The researchers measured the length and severity of the gaps in access to medicine which were brought on by the new restrictions.  Patients were categorized as having gaps in medicine, came close to having gaps, or those who were not affected.

Of course, the presumably cis researchers may not realize how bad even the “near-gaps” or “no impact on access” respondents may have it, and seem to undercount the negative implications of delaying access to desired care for transsexuals.

The research showed that SB 254 resulted in the halting or delay of treatment for 86% of patients attempting to access some form of transsexual medicine. This includes total loss of access, as well as those facing unnecessary delays.

While no formal bans on access to HRT for adults was ever enacted, the red tape put into place by the law was so effective as to temporarily block access for most people seeking it, if not make it totally inaccessible.

They also found that participants were not passively accepting the new restrictions, but were finding ways to defy them. 

The subjects sought out informal and grey-area ways of accessing care.  This included rationing their hormones until the next dose comes in, sharing excess doses with those who need them, or using DIY HRT (HRT which is not prescribed). 

Of course, DIY HRT is not morally bad, unlike how it is framed in the study. It is one way among many that people get what they need.  

It is also not medically harmful, as the knowledge to use it effectively is already available online.

The persistent willingness of the participants to access medicine by whatever means are necessary shows how important bodily autonomy is to transsexuals.  

Unfortunately, what is important to transsexuals and what is discussed among cissexuals about trans people are often very different.

They use an existing type of academic framework called “political determinants of health”. This framework looks at political processes as things that improve or decrease overall health, and views political choices as means of changing health outcomes.

This framework grounds the researchers’ discussions of their study and its results. What that means is, they use the idea that political choices affect individual health throughout their paper.

The study results are unsurprising.  Given how few medical institutions are willing to prescribe HRT, and how annoying it is to obtain otherwise, any restrictions on the few above-board and legal providers will cause a large bottleneck of people who want it but who can't get it. 

It’s not a bad thing to have these style of findings enter the body of academic knowledge. 

Rather, the lateness and shortcomings of this study and its associated paper could be rectified if funding bodies started funding transsexual researchers to a similar and equitable degree. 

These results are years behind what trans people have learned about the medical system in Florida, and we didn’t need our own research budget to understand that.

We didn’t need a study or cis researchers to learn what the study shows; you could’ve just asked us. If trans people had the same resources as these researchers, we could have given you these results years ago.