Psychological evaluations are no longer required for adult transgender patients

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In recognition that an emergency rule overstepped regulators’ authority, the state’s medical boards agreed to strip a month-old requirement from consent forms that transgender adults undergo a “thorough psychological and social evaluation” before initially receiving hormone replacement therapy and every two years thereafter. 

The emergency rules were enacted in response to a new law (SB 254) that limits access to gender-affirming care and requires patients to sign informed consent forms. The law had directed the Board of Medicine and Board of Osteopathic Medicine to create the informed consent forms, which were recommended for adoption by the Joint Rules/Legislative Committee and went into effect July 7.  But Joint Administrative Procedures Committee Chief Attorney Marjorie C. Holladay flagged these new rules suggesting the boards’ requirement for psychological evaluations may have overstepped their legislative authority.

“Please explain the board’s statutory authorization …,” Holladay wrote in separate letters to the legal staff who represent the BOM and BOOM.

While the Joint Rules/Legislative Rules Committee voted Thursday to remove the provision requiring the psychological evaluation, in response to Halladay’s inquiry, the vote wasn’t unanimous.

BOM member and Jacksonville pediatric endocrinologist Matthew R. Benson defended the requirement.

“In the endocrinology guidelines they stipulate that in their recommendations too that there be a thorough psychological evaluation, assessment at baseline and there’s no interfering psychological conditions that could impact the workup or a clinical evaluation,” he said adding that the guidelines were crafted in 2017. “They are saying they might update them soon, but that hasn’t been published yet,” Benson said.

Pensacola pediatrician and BOM member Patrick Hunter also defended the inclusion of the mental health evaluation in the informed consent form.

“I’m looking at a paper from Denmark June 27 since we last met that shows the long term ongoing mental health issues in the adult population. So, the problem exists. We’re just not fully addressing it. I think we recognize that the concern exists but guess this is more of a legal issue, an authority issue. I don’t want us to say we are not recognizing that the problem exists,” Hunter said.

The emergency rules require adults to undergo a “thorough psychological and social evaluation” before receiving hormone replacement therapy. The emergency rules require that a Florida-licensed, board-certified psychologist perform the evaluation and that the evaluations be conducted before an adult takes “feminizing” or “masculinizing” hormones and completes the assessment every two years after that.

Members of the Joint Rules/Legislative Committee also agreed on Thursday to temporarily put the brakes on crafting permanent rules to replace the emergency ones adopted last month. Board Medicine Chairman and joint committee member Scot Ackerman said he thought the emergency rules were “good” but said the boards should assess the impact they are having on physicians and patients before forging ahead with permanent rules.

Ackerman made a motion that named Benson and BOOM member Monica M. Mortensen, also a pediatric endocrinologist from Jacksonville, the lead board members on the issue, a move that the Joint Legislative Rules Committee approved.

Florida  Gov. Ron DeSantis — who is running for president — last year used his broad administrative powers to crack down on gender-affirming and gender-conforming care, starting first with a rule that banned Medicaid from covering the care (which was subsequently successfully challenged). The Governor then pressed the state’s two medical boards to pass rules that prevented physicians from providing the care to minors (those rules are being challenged in federal court.)

The Legislature then followed suit by passing SB 254, which went further, precluding advanced practice nurses and physician assistants from ARNPs from providing the health care, requiring patients to sign informed consent forms and banning the use of telehealth.

Meanwhile, following the brief discussion on the emergency rules and the path the boards should take going forward on permanent replacement rules members of the Joint Rules/Legislative Committee took public testimony.

Equality Florida Senior Policy Advisory Carlos Guillermo Smith, said the new consent forms, required as part of SB 254, have caused disruptions to care.

“It is creating a crisis for care for trans and non-binary folks in the state of Florida,” he said adding that the board members should put public health over politics. “We urge the boards to make rules and forms that are based on reality. And based on facts that reflect the medical consensus, which supports gender-affirming care across the United States. Our trans and non-binary residents of this state are depending on you to adopt rules and forms that are rooted in their well being, the patient’s well being, rather than intentionally creating arbitrary and capricious barriers to care for Floridians.”