"At the mercy of the State": Transgender and nonbinary young adults' experiences navigating restrictive healthcare...

Florida Senate Bill (SB) 254 is among legislation restricting gender-affirming medical treatment (GAMT) for transgender and nonbinary (TNB) people, which has surged in the U.S. Restrictive healthcare legislation is a political determinant of health, associated with poor health outcomes for TNB people. It remains uncertain how legislation operates in healthcare experiences, especially among diverse TNB young adults.

This study involved a thematic analysis of qualitative in-depth interviews regarding healthcare access and utilization conducted with 105 TNB young adults (aged 18-26) of diverse racial, ethnic, and socioeconomic backgrounds recruited from across the state of Florida during the 19 months following implementation of SB 254.

Participants described multiple ways SB 254 impacted their access to GAMT, especially gender-affirming hormone therapies (GAHT), including gaps in access, near-gaps or no impact on access, and delaying desired treatment. Aspects of SB 254 that impacted participants' experiences were clinical restrictions for administering GAMT, mandatory consent forms, and confusion, chaos, and misinformation created by the legislation. Strategies participants used to access GAMT in the context of SB 254 included navigating the Florida healthcare system, traveling to obtain GAMT outside of Florida, modifying prescribed GAHT, and using unprescribed GAHT.

This study provides salient data regarding experiences of TNB young adults navigating Florida's healthcare system couched in a hostile legislative climate, revealing the impact of social positions on their experiences. These findings highlight the implications of restrictive GAMT policies for patients, and have implications for clinicians, researchers, and policy makers as legislative restrictions continue.