Clinics that offer hormonal replacement therapy are now adjusting their practices after Florida’s ban on transgender therapies was reinstated last month. The legal back and forth now bans access to clinic care to minors, and limits who can provide treatment, but some Central Florida providers are working around the legal hurdles to provide care.
That includes the founder of Spektrum Health, Joey Knoll, who was on vacation when a federal appeals court re-enforced Florida’s ban on transgender therapies.
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 [Court of Appeals].”
Spektrum Health is the largest clinic in Central Florida offering gender-affirming care. It treats over 3,000 transgender patients. In August, the U.S. 11th Circuit Court of Appeals 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, or HRT, by limiting prescriptions to only physicians.
The law went into effect last year, and a legal battle followed. In June of 2024, 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 currently in effect once again after a stay from a higher court. The appeals court ruled that the law banning care would remain in place while the court considered an appeal filed after Hinkle’s ruling.
Knoll’s clinic Spektrum Health anticipated the legal battle and had a plan ready to pivot its treatment strategy when the bans on transgender treatments were allowed to continue due to a court ruling in August.
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 healthcare providers for patients at the clinic. Florida’s ban attacked this model by requiring transgender adults to receive HRT from a physician. Nursing practitioners were the most accessible way for transgender patients to receive their medication.
So Spektrum slightly changed its model and hired an MD 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.
“Nobody wants to work in a place where your ability to deliver quality care is hampered by politicians who are completely unaware and misinformed.”Joey Knoll
The clinic’s new physician started in the spring. Knoll said it wasn’t easy to find a doctor.
Recruitment was stymied by fear that Florida’s legislature could impose more restrictions over healthcare, 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, just in case. In the meantime, Spektrum is still seeing the effects of the August appeals court decision, as many patients in the area still aren’t familiar with the latest enforcement of the band.
“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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