Clinics that offer hormonal replacement therapy are adjusting their practices after Florida’s ban on transgender therapies was reinstated last month. The state bans clinic access to minors, and limits who can provide treatment, but some providers are working around the legal hurdles to provide care.
That includes the founder of Spektrum Health, Joey Knoll, who was on vacation when the 11th Circuit Court of Appeals ruled to allow the state to resume the ban.
Knoll was disappointed, but not surprised.
“It sucked,” he said. “But we expected this all along. The expectations have been metered. We know what we're up against with the 11th Circuit.”
Spektrum Health in Orlando is the largest clinic in Central Florida offering gender-affirming care. It treats over 3,000 transgender patients.
In August, the 11th Circuit issued a stay on a federal judge’s June decision to block Florida’s ban on gender dysphoria treatments for minors and impeding adults’ access to hormone replacement therapy by limiting prescriptions to only physicians.
The law went into effect last year, and a legal battle followed. In June, Judge Robert L. Hinkle of the U.S. District Court for the Northern District of Florida blocked the law’s restrictions and said that it was “discriminate against transgender individuals just for being transgender.”
But the law is in effect again after a stay from the appellate court, which ruled that the law would remain in place while the court considered an appeal filed after Hinkle’s ruling.
Spektrum Health had a plan ready to pivot its treatment strategy before the appellate ruling.
Spektrum Health prescribed enough HRT medication to patients for the next few months, some lasting until December, ”buying as much time as possible as this process plays out,” Knoll said.
But the clinic did something else in anticipation of the ban returning.
It changed its model.
Spektrum Health uses an advanced nursing practice model of primary care, meaning registered nurse practitioners are the primary health providers at the clinic. Florida’s ban attacked this model by requiring transgender adults to receive hormonal replacement therapy from a physician. Nursing practitioners were the most accessible way for patients to receive their medication.
So Spektrum slightly changed its model and hired a physician.
“It’s a little more labor intensive, and certainly less efficient. It has more obstacles and barriers for patients. But we do have some experience in making that work for our patients,” Knoll said.
The physician started in the spring. Knoll said it wasn’t easy to find a doctor. Recruitment was stymied by apprehension that Florida’s Legislature could impose more restrictions over health care, Knoll said.
“A lot of them wanted to help. But as they learned more, they were too fearful to relocate to Florida or spend time in Florida or practice professionally in Florida,” he said. “Nobody wants to work in a place where your ability to deliver quality care is hampered by politicians who are completely unaware and misinformed.”
While the ban remains under appeal, Knoll said his clinic is preparing for worse outcomes. In the meantime, Spektrum is still seeing the effects of the appeals court decision, as many patients still aren’t familiar with the latest enforcement of the ban.
“It's 2024. People don't watch the news. They don't check emails, and so sometimes they’re still finding that out,” Knoll said. “From our patients who do know, I haven’t heard a whole lot other than, ‘It's still damaging, it's still hurtful and demeaning.’”
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