Florida Senate Bill 254, signed into law on May 17, 2023, bans gender-affirming medical care for anyone under 18 and imposes strict conditions on adults who seek the same treatment. It also creates felony penalties for providers who treat minors, restricts prescribing authority to licensed physicians, expands Florida court jurisdiction over related custody disputes, and blocks state funds from paying for the care. After a June 2025 U.S. Supreme Court decision upholding a similar Tennessee ban, SB 254 is fully in effect while the federal challenge continues on appeal.
What Treatments the Law Covers
Florida defines “sex-reassignment prescriptions or procedures” to include three categories: puberty blockers used to delay normal puberty, hormones or hormone antagonists prescribed to align a patient’s physical characteristics with their gender identity, and surgical procedures performed for the same purpose.1The 2025 Florida Statutes. Florida Statutes 456.001 – Definitions
The statute carves out exceptions. Treatments for children born with medically verifiable disorders of sexual development are not restricted. Neither are treatments for infections, injuries, or conditions caused by a prior gender-affirming procedure, or care needed to prevent imminent danger of death or impairment of a major bodily function.1The 2025 Florida Statutes. Florida Statutes 456.001 – Definitions
The Ban on Care for Patients Under 18
SB 254 prohibits every healthcare practitioner from prescribing, administering, or performing sex-reassignment treatments on patients younger than 18.2Florida Senate. CS for SB 254, Enrolled Puberty blockers, cross-sex hormones, hormone antagonists, and surgeries all fall inside the prohibition. Parental consent does not create an exception. A physician’s clinical judgment does not create one either.
Narrow Grandfathering for Existing Patients
Minors who were already on puberty blockers or hormone therapy before the law took effect may continue their existing course of treatment under standards set by the Florida Board of Medicine.3Florida Senate. CS for SB 254, First Engrossed The Board adopted Rule 64B8-9.019 to spell out the conditions.4Florida Board of Medicine. 64B8-9.019 Standards of Practice for the Treatment of Gender Dysphoria in Minors The provision is narrow. Grandfathered patients can stay on the treatment they were already receiving, but they cannot move up to a new type, for example starting hormones after being on puberty blockers alone.
Felony Charges and Automatic License Suspension
A healthcare practitioner who knowingly provides prohibited gender-affirming treatment to a minor commits a third-degree felony,3Florida Senate. CS for SB 254, First Engrossed which carries up to five years in prison.5The 2025 Florida Statutes. Florida Statutes 775.082 – Penalties, Applicability of Sentencing Structures, Notification to Victims The Florida Department of Health must immediately suspend the license of any practitioner arrested for violating or attempting to violate the ban. The suspension follows the arrest, not a conviction. A provider’s ability to practice ends before trial.2Florida Senate. CS for SB 254, Enrolled
Custody Consequences That Reach Across State Lines
SB 254 expanded Florida’s authority over child custody disputes tied to gender-affirming care. Florida courts may exercise temporary emergency jurisdiction over any child present in the state who has been subjected to, or is threatened with, sex-reassignment treatment.2Florida Senate. CS for SB 254, Enrolled In practice, a parent can bring a child into Florida and ask a Florida court to intervene in a custody arrangement from another state on the ground that the child faces this care elsewhere.
The law also redefines “serious physical harm” in child custody enforcement to include being subjected to sex-reassignment procedures. That expanded definition can support warrants to take physical custody of a child.2Florida Senate. CS for SB 254, Enrolled Parents with out-of-state custody orders that permit gender-affirming care for their child should treat these provisions as active risks, not theoretical ones.
What Adults Have to Do to Get Care
The law does not ban gender-affirming care for adults, but it puts strict conditions in front of it. Every adult patient must complete a state-mandated informed consent process. The consent has to be in writing, on forms created by the Florida Board of Medicine and the Board of Osteopathic Medicine, and signed while the patient is physically in the same room as the prescribing physician.6The 2025 Florida Statutes. Florida Statutes 456.52 – Sex-Reassignment Prescriptions and Procedures, Prohibitions, Informed Consent Telehealth, phone, and video do not satisfy the initial consent requirement.
The physician must inform the patient about the nature and risks of the treatment during that in-person meeting. The specific disclosures on the consent form are set by the medical boards through rulemaking rather than by the statute.6The 2025 Florida Statutes. Florida Statutes 456.52 – Sex-Reassignment Prescriptions and Procedures, Prohibitions, Informed Consent The practical requirements can shift when the boards update their rules, so confirm the current version with your physician or the Board of Medicine before assuming a form you have seen before is still the operative one.
Who Can Legally Prescribe
Only a physician licensed under Florida Chapter 458 (medical doctors) or Chapter 459 (osteopathic physicians) may prescribe or perform sex-reassignment treatments.2Florida Senate. CS for SB 254, Enrolled Advanced practice registered nurses, nurse practitioners, and physician assistants cannot prescribe or administer this care, even under physician supervision. Many patients had been getting hormone prescriptions from a nurse practitioner or PA, and the law forces them to find a licensed physician willing to take over.
Providers who violate the adult-care rules face discipline from the medical boards, including possible suspension or revocation of their license. The felony charge and automatic license suspension on arrest are reserved for violations involving minor patients, but the regulatory consequences for improperly treating adults can still end a practice.
No State Money for These Treatments
SB 254 prohibits state entities from spending public funds on sex-reassignment treatments.7Florida Senate. CS/SB 254 – Treatments for Sex Reassignment The ban reaches state-funded health programs, public university health systems, and any other publicly funded healthcare provider. Patients on state employee health plans or Florida Medicaid should not expect coverage for gender-affirming procedures or prescriptions while the law is in force.
Is the Law Currently Being Enforced
Yes. SB 254 is fully in effect. A federal district court judge issued a permanent injunction in June 2024 striking down the law’s restrictions on both minors and adults as unconstitutional, finding that Florida could regulate these treatments but could not single out transgender patients for a blanket denial of care that remained available to non-transgender patients for other conditions.8WUSF. Federal Judge Blocks Florida Law Restricting Transgender Health Care The Eleventh Circuit stayed that injunction in August 2024, putting every provision of SB 254 back into force pending appeal.
On June 18, 2025, the U.S. Supreme Court decided United States v. Skrmetti, a challenge to Tennessee’s similar ban on gender-affirming care for minors. The Court held that laws restricting these treatments for minors are subject only to rational basis review, the lowest level of judicial scrutiny, and upheld Tennessee’s ban.9Supreme Court of the United States. United States v. Skrmetti, No. 23-477 The Court reasoned that the Tennessee law classified patients by age and by medical diagnosis, not by sex or transgender status, and that those classifications do not trigger heightened constitutional protection.
Skrmetti sharply weakens the challenge to SB 254. The Eleventh Circuit had already signaled skepticism toward the plaintiffs’ arguments, and the Supreme Court’s decision removes the strongest constitutional theory that was available. The minor ban is very likely to survive on appeal. The adult restrictions present a somewhat different question because Skrmetti addressed only minors, but the Court’s reasoning about sex-based classifications applies broadly and makes those challenges harder as well.
The case challenging SB 254, Doe v. Ladapo, remains open at the Eleventh Circuit. Until that court rules, the law applies in full. Providers who violate it during this period face administrative discipline, civil liability, and felony prosecution for treating minors. Anyone receiving or seeking gender-affirming care in Florida should talk with a healthcare provider familiar with the current enforcement landscape before making treatment decisions.