For Trans Medical Professionals, the Fight for Their Existence Is an All-Too-Familiar Battleground
Years ago, Michael Mueller walked through the doors of SPEKTRUM Health, a Central Florida nonprofit specializing in LGBTQ medical services, as a young person seeking life-saving care. Now, as a mental health counselor in the clinic, she double checks that they’re properly locked up when she’s not actively with patients of her own.
“We’ve had to be more careful about who comes in and whom we talk to this year,” Mueller, who uses they/them and she/her pronouns, explained over the phone. “We’ve gotten anti-trans groups trying to get dirt on our practice before.”
In the neighboring state of Georgia, family nurse practitioner Luke Scarborough feels a tinge of worry for his own safety as a trans man whenever a prospective patient books an appointment with him. He works at QueerMed, a Decatur-based LGBTQ-healthcare clinic that holds licensure to provide gender-affirming care in over 25 states.
For protective measure, most of his sessions have gone virtual for new patient sign-ups, in the chance of an anti-LGBTQ advocate entering the premises.
“Anyone can sign up for QueerMed services,” he explained, “but that has its own risks. Sometimes I don’t know who it is that signed up for my appointment times. If it’s a patient I’ve seen before who needs a shot, that’s understandable. But brand new signups? I don’t know if it’s someone who is pretending to be someone else, and actually wants to harm me because of who I am, or because of what I do.”
“And to be honest,” Scarborough added to me, “I had to look you up before I gave you my number.”
Mueller and Scarborough represent the sliver of medical professionals who identify as transgender and/or nonbinary in the U.S. For context, according to a 2018 student survey by the Association of American Medical Colleges, only 0.7% of matriculating medical students identified with a gender different from the sex they were assigned at birth. Demographic data for the overall health industry remains scarce.
Both licensed providers occupy a niche within the medical field that makes them targets of the GOP culture war in two ways: first, as professionals aiding LGBTQ patients, and second, as trans and nonbinary people themselves seeking treatment. Their anxieties are twofold: They race against a ticking clock to establish safe medical spaces for queer patients, while they internally cope with their own conflicts with receiving life-saving care.
A slate of hate in the South
As a therapist at SPEKTRUM, Mueller assesses mental health disorders, identity development, PTSD/trauma, and life transition concerns. They specialize in feminist-oriented sessions for queer and trans patients, some of whom are children. In the past few months, however, the Republican-controlled state government advanced measures that threaten their practice—and their own wellbeing as a nonbinary, transfemme person.
In May, Governor Ron DeSantis signed into law a slew of anti-LGBTQ bills, affecting a state that is home to 94,000 trans people, according to UCLA School of Law. Among them: Senate Bill 254, which threatens to suspend the licenses of medical professionals who offer gender-affirming care. They are prohibited from prescribing HRT, surgeries, and puberty blockers to minors, with an exception for minors who received care before January 2023. Breaking the law means risking a third-degree felony charge, punishable by up to five years in prison.
SB 254 additionally mandates that trans adults sign an informed consent form in person at health centers before continuing treatment. Approved in late June by Florida medical boards, the form states “medical treatment of people with gender dysphoria is based on very limited, poor-quality research with only subtle improvements seen in some patient’s psychological functioning in some, but not all, research studies.” Only physicians are now permitted to offer gender-affirming care to patients who sign the form, although an estimated 80% of trans patients receive treatment from nurse practitioners, as journalist Erin Reed reports.
Consequently, SPEKTRUM and other Florida-based LGBTQ-healthcare clinics suffered blows to their medical services. Primarily run by nurse practitioners to treat around 4,000 patients, SPEKTRUM closed its HRT services altogether to avoid breaking the law. Planned Parenthood of South, East, and North Florida, which similarly relies on nurse practitioners more heavily than physicians, shuttered appointments for new patients. These restrictions, Mueller reflected, feel like a more “personal and painful” sting—and a jarring reality check as a trans patient of SPEKTRUM herself.
“The reason why I even work for SPEKTRUM is that I was a patient here first,” Mueller said. “When we lost our ability to prescribe medicine, I lost my healthcare. I openly disclosed to my patients that I’m worried too. I make it my life mission to comfort people in need, but I’d be lying if I said I find it easy to cope with our collective trauma.”
Mueller added that telemedicine—virtual consultation with medical providers—is no longer an option for patients who seek informed consent forms from her, adding a travel barrier for people in more remotely-located Florida cities. She also took concern with the wording of the consent forms.
“The language stigmatizes a process that medical professionals—and trans therapists like me—have said is safe and saves lives. It saved mine,” they argued. “And I worry that they’ll restrict this process again in the future. What if only psychiatrists can hand out consent forms in the future, just like only doctors can prescribe gender affirming treatment now? It devalues our expertise, and clearly they don’t care about my experience as a trans person.”
In Georgia, a GOP-led salvo of anti-trans legislation wreaked havoc on their own community healthcare clinics, threatening practitioners and their patients. A law signed by Governor Brian Kemp went into effect this month, banning certain gender-affirming care for minors. Violation of the law could suspend medical professionals’ health licenses and charge the providers with civil or criminal charges. An exception, however, allows for children who started HRT before July 1 to continue their treatment. And unlike other states with bans on gender-affirming care, doctors are still able to prescribe puberty blockers under the new Georgia law.
Scarborough, the nurse practitioner who works part-time at QueerMed, told DC Report about the clinic’s scramble to consult with new minor patients before July 1. The deadline was so onerous, he said, that the ordeal “was a constant state of anxiety” for the practitioners.
“We promised to take in as many patients as we can all the way up until the very last second of June 30,” he continued. “Families were terrified.”
At his peak, he met around 45 patients a week. Nowadays, he welcomes visits from around 30 a week from various states, each with their own provisions regarding trans healthcare. The logistics through which Scarborough offers care has become all the more complicated in an already-labyrinthine process that includes recommended therapy consultations, months-long mental health examinations, and hormone level supervision.
“There are many barriers, and my greatest worry is that they make more,” he concluded. “Long-term use of puberty blockers, which are still legal, is not healthy for teenagers and young adults. And we might see hormone treatment get completely banned for adults in Georgia. That’ll bog us down.”
Keeping optimistic
Scarborough continues to offer care from QueerMed through thorough consultation. Transition for minors, for one, could require several appointments with QueerMed’s medical providers, he explained, including gender dysphoria diagnosis; organ tests to ensure that the patient can handle HRT; parental approval; and months-long trials of low doses of testosterone or estrogen. Although QueerMed operates on an informed-consent model (meaning, a therapist’s sign-off isn’t necessary for a patient to make their decisions), Scarborough recommends that his patients see therapists for mental health care supervision.
Telehealth also remains a valid option for QueerMed patients in Georgia who have the wherewithal to travel across state lines—as long as QueerMed is licensed in the other state.
“How the law works is that we can see patients from any state where we have a license,” Scarborough explained. “That means a patient from Georgia, if they feel unsafe to seek treatment in Georgia, can travel to Alabama, and dial in from there. We can see them legally from outside of Georgia state lines that way.”
Despite their nightmarish situation in Florida, Mueller keeps their chin up when greeting their therapy patients.
“I tell all my patients that a couple of sad little Florida men with an ‘R’ next to their names will never, ever get rid of us,” they declared. “Trans people have been around since the dawn of human civilization. And it’s healthcare workers like us who are leading the current charge.”
As a neurodivergent therapist, Mueller ensures that patients with mental disorders receive sessions that highlight the ways in which disability rights align with their treatment. They pointed out that transition often brings with it changes to hair and skin texture, chest growth, and body oil and temperature dysregulation, which could feel over-invasive for some patients.
“I have ADHD, so I get it,” Mueller said. “So my practice emphasizes that it can be traumatic for some people, but in the end, you will be okay. And seeing patients grow comfortable in their own bodies helps me feel calm against everything.”
She’s hopeful that the trend of federal courts overturning or blocking trans care restrictions in other states shines some light on a brighter future. For now, she relays a message to those watching the chaos unfolding in the South.
“Some trans people want to leave Florida. Other people say they want to saw off Florida and let it sink. But for the sake of us who proudly call Florida home or cannot flee Florida, don’t forget us. We’re doing the best we can.”