Fleeing Key West and Florida

Stacy Jones and her husband will be leaving Key West, possibly forever, very soon. It isn’t for a job promotion or out of desire to leave right away. They are young, in their mid-20’s, and might leave at some point in any event. But now there is an urgency that is beyond a simple dream for a change of place. To put it in the words she herself uses, Stacy (not her real name to protect her privacy) is literally fleeing Key West. And she is not the only one. Why?

To understand why, consider some of the things being proposed by the Florida legislature, most of which have a very good chance of becoming law very soon.

Senate Bill 254 flatly forbids the treatment and medical support of transgender youth, even in situations where the young person, the parents and their medical providers all agree it is in the child’s best interest. Surgical alterations are extremely rare for minors, so the bill’s main effects will be to stop puberty blockers, hormones, and the like that allow the person to live his or her true identity from being prescribed . In Florida it simply won’t be possible to fully live as a transgender teenager until one is 18 years old because the state proposes to MANDATE that teenagers endure unwanted secondary sexual characteristics like a beard, chest hair, female breasts, etc. regardless of their own wishes or needs (or what their parent’s think). The amount of psychological damage that will ensue in those crucial late teen years isn’t a concern for the governor or the bill’s sponsor.

Stacy remembers her own difficult days in high school in a small town, but the prohibition on medical care for minors won’t directly affect her now. Nonetheless, it is painful for her to envision living in a state that literally defines people like her as a threat to society.

She knows full well that when professional medical care is prohibited, young people will often turn to the black market.

“I remember I bought hormones when I was in high school from an offshore pharmacy… and I took them for a while... a couple months, but, of course I was in high school so I did not have that much money.

Indeed, with no legal form of care, more teenagers may try to self-medicate without any kind of medical supervision. Moreover, Senate bill 254 ensures that local professionals cannot refer a patient to out of state providers. As a condition for a business or medical license, every medical provider in Florida will have to sign an attestation that it does not “refer patients to other providers for such services”. If you’re seventeen and you want information, the Florida medical community will not be able to treat you, inform you, or refer you. It is one more gag order on professionals (as already exists with teachers) to prevent the spread of information about medically approved treatments.

Aside from its effect on youth, there are also real consequences in the bill for Stacy as an adult.

Senate bill 254, for example, abolishes telehealth appointments and prescriptions from nurse practitioners and physician’s assistants. Right now its not clear if any doctor in Key West may be willing to prescribe hormone therapy. If not, there will be no source for lifegiving hormone therapy in the Keys.

“The biggest hurdle I faced when I started transitioning a number of years ago was there was no doctor who would prescribe it [hormones] for me. I knew a woman who was actually taking hormones illegally for the first two or three months because there was no doctor who would prescribe it (hormones) for her.”

[Note, that unlike her earlier time of using offshore pharmacy hormones in high school, this was well after Stacy was an adult and she and her friend were legally entitled to the care.]

“There are [now] two telehealth services. They prescribe hormones but it is a nurse practitioner. That will become illegal any day. Most people will be forced to either leave or ‘de-transition”.

It’s not possible for people who work for hourly wages to run up to Miami every time one needs to confer with her physician. For good measure, the bill also prohibits any governmental agency (including local governments, schools, state universities and other organizations, from covering trans medical care under insurance.) It also prohibits public hospitals and health departments from dispensing prescriptions for trans care.  It isn’t as if many, or any, do now. But it’s just another reminder of Stacy’s outcast status in the eyes of the state government.

Because there is no evidence that the current system has caused any harm to the adults who rely on it. The bill is not about safety. It is about making it hard for transgender people to even exist. And, it’s never been easy for them:

“I was poor and literally did not have enough money to transition. So, I took some steps back until became financially stable enough at age 21 to ‘take the plunge. I have spent probably tens of thousands of dollars between hormones, a legal name change, and a gender marker change” [changing the gender noted on a Florida driver’s license or ID card].

Unlike a similar bill filed in the state House of Representatives (HB 1421), the current iteration of SB 254 doesn’t flatly forbid trans health care for adults, but it aims to make it nearly impossible. The bill (as written on April 19. 2023) would all but ensure that no physician would ever want to offer trans care in Florida. It provides a 20 year window to bring legal actions against a physician, not only for malpractice as generally understood, but for any perceived “physical, psychological, emotional, or physiological injury”. The usual cap on punitive damages will not apply. It requires insurance coverage for this huge liability exposure (deliberately created by the legislature) for 20 years.

No doctor or other health care provider can afford to insure against liability for 20 years for perceived “psychological or emotional injury”. It is terrorism by excess liability designed to completely shut down care. Stacy does not [reasonably] expect any doctor in Key West to be willing to take the risk to prescribe the necessary hormones.

As originally drafted, Senate Bill 254 allowed the state licensing boards for physicians to adopt rules under which those youth who are already being treated can continue their treatment. The House has amended the bill so that it only allows continued treatment until the end of the year (2023) for “solely for the purpose of gradual discontinuation of such therapies”. Then the young person must live as the legislature says, not as she or he knows is right for herself or himself (even if the parents support that decision). And certainly not as she or he may have lived for several years now.

Youth who have been presenting in accordance with their true perceived genders (perhaps for some time now) will be forcibly required to “de-transition” unless they too “flee” Florida. It could be socially, as well as psychologically and physically painful. None of this is lost on Stacey or the other transgender women she knows in Florida.

“I have two other friends, who are trans women. They both live in West Palm… here in Florida. One of them is already making plans to leave about the same time as me in June. [Stacy has since accelerated her departure date to be before May.] The other one is too poor to leave just yet, but she is trying everything she can to also leave. Not a single person who is trans and has the means to leave is not leaving Florida. There is no reason to stay here, no reason to come here…this place is lost… lost. The hate is palpable.”

Stacy, usually calm and straightforward, becomes a bit reflective.

“If a Republican wins in 2024…[pause].. that would be beyond petrifying for trans people. We’d all have to flee to Canada. Staying here as a trans person is literally reckless and dangerous at this point. Why would you do this to yourself?”

De-transitioning isn’t an option for Stacy or most trans people. In her words, “De-transitioning is like death. I am not a [expletive] man.” So, she will soon be leaving her adopted state. Stacy has found a place that will be safer . . . for the moment. But for others like her, the options are often distant from Key West and Florida.

“Trans people only have so many choices when it comes to going somewhere new. You have Hawaii, California, Washington State, Colorado, and most New England states except New Hampshire. I have already booked my flight. These [legislative] bills are moving at a far faster rate than we might have thought. So, we have to leave.”

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Epilogue:

In my interview with Stacy we did not discuss one other bill, the so called bathroom bill, that will also impact trans life in Key West.  Senate Bill 1674 flatly forbids a transgender person, on penalty of a criminal conviction (punishable by up to 60 days in jail or a $500 fine - as well as having a “criminal record) to use a restroom not assigned to him or her at birth. (In the case of females, “belonging at birth to the biological sex which has the specific reproductive role of producing eggs”, in the case of males “the biological sex which has the specific reproductive role of producing sperm.”)

If the bill passes, which seems likely, one’s restroom choice is set at birth. No matter how many years one has lived as a different gender. No matter how much biological change has taken place via hormones or surgery, nothing but the determination at birth matters.

In the context of Key West this could put transgender people in a practically impossible situation unless a business has single person unisex restrooms. A trans woman entering a male restroom, appropriately dressed for who she is, will be subject to ugly commentary (at the least) and possible violence as well. A trans male, perhaps with a full beard, who enters a women’s room will face not only potentially startled women, but the potentially violent mix of alcohol and boyfriends (or husbands) not schooled in the law or the realities of transitions. It is a recipe for harassment and violence.

And just to make sure no local business decides to let it slide and maintain Key West’s traditional tolerance, the bill also gives Florida’s Attorney General the right to seek injunctive relief, attorney fees and a fine of up to $10,000, plus the promise of vaguely defined “licensure or regulatory disciplinary action” (think liquor licenses and restaurant licenses) against a non compliant business who “allows” {God forbid} somebody to enter the “wrong” restroom.

As with most things coming from Tallahassee these days, it is meant to be controlling, terrorizing and to allow no room for dissent.

[On April 19, the Florida House of Representatives passed its version of SB 1674, HB 1521, and it now awaits action (and likely approval) by the state Senate.]