Orlando clinics resume transgender care after ban ends, but legal battles continue

For the first time in over a year, transgender patients in Orlando can reliably get treatment following a federal district court ruling.

Judge Robert Hinkle’s June 11 decision to overturn most of a 2023 Florida law (HB 254) limiting transgender care has allowed Orlando LGBTQ clinics that paused care to prescribe hormones again .

“I just saw a patient earlier this morning who hadn’t been on his testosterone in eight months. Just hearing the intense anxiety and depression that he’s been under for eight months, I’m so glad that we got this verdict when we did,” said Joseph Knoll, CEO of Spektrum Health. “Because it sounds like the last year of his life has just been complete misery.”

The 2023 law — deemed unconstitutionally discriminatory —  prohibited medical professionals from prescribing transgender teens puberty blockers, which temporarily delay puberty, or cross-sex hormone therapy, where people are given estrogen or testosterone in order to develop characteristics of their gender identity.

The law threatened parents with a loss of custody if they helped their kids transition and threatened providers with a felony charge. It also imposed restrictions that made it difficult for some adults to get care, including requiring that only physicians — but not other health professionals who are legally allowed to write prescriptions, like nurse practitioners — prescribe these medications.

“I honestly thought I was going to have to move. … My friends and family are all here, and I hated the thought of leaving them, and my home, just so I could safely get healthcare,” said Rex, a 34-year-old transgender man who asked to be identified only by his first name because he has not told coworkers he is transgender.

He was able to keep taking testosterone the last few months, he said, but it was hard to get an appointment with one of the few in-state physicians still prescribing it. At one point he had to ration doses by taking smaller amounts than he normally would.

Despite the legal victory this month, the future for transgender healthcare is uncertain.

In the wake of the judge’s ruling, clinics are rushing to re-establish care for their patients, who advocates say have suffered both physically and psychologically from treatment interruptions.

But the state has filed an appeal to the 11th Circuit Court of Appeals, which previously upheld an Alabama law that banned medical care for transgender teens. This fall, the U.S. Supreme Court will take up a challenge based on a law in Tennessee – one of several Republican-led states with similar restrictions – that could impact transgender care in Florida.

The ongoing legal battles and the potential for further restrictive legislation have left a lingering sense of anxiety within Florida’s transgender community – an estimated 94,000 people.

“While the relief of it being overturned definitely feels nice, I kind of can’t help but feel like I’m waiting for the other shoe to fall. Yeah, this one got overturned, but when is the next one gonna slip into the cruel vacancy that it left behind?” said Rex via text.

Impact on clinics

The law technically allowed those who started care before the legislation passed to keep receiving it. Some local clinics – such as those run by Planned Parenthood of Southwest and Central Florida – were able to keep offering care for established patients. Harmony Healthcare in downtown Orlando brought in a physician several times a month to serve the community.

But many local clinics shut down. They relied on providers such as nurse practitioners amid the state’s massive physician shortage, and struggled to afford or even find a physician to comply with the new rules.

“There was no regard to whether people could actually access the care,” said Knoll, who is a nurse practitioner.

He estimates his clinic treated about 2,700 transgender people – primarily Orlando residents – before the 2023 law took effect. After the ban, Spektrum Health temporarily paused hormone therapy at its Orlando clinic and permanently closed a second location in Brevard County.

The clinic is now rapidly rebuilding its patient base, having seen hundreds since the ban was reversed.

Another LGBTQ-focused clinic, Pineapple Healthcare, also halted treatment when the law went into effect because it lacked an in-person physician. CEO Ethan Suarez noted that they treated about 50 transgender patients before the ban and are now treating about 25.

26Health halted treatment for over 120 patients when the ban took effect due to legal concerns. Interim CEO Latrice Stewart confirmed that the clinic would resume services for adults on July 1 but will no longer treat people under 18.

Struggles continue

As Orlando clinics work to re-establish care for patients, they know the chaos of the last year could start all over again, if the state is successful in appealing Hinkle’s ruling.

In a June 12 Tampa press conference, Gov. Ron DeSantis expressed confidence that the state would win its appeal and questioned the necessity of gender-affirming care.

“You’re not affirming that. You’re trying to change their basic biology, which you cannot do … How you are born is what you are,” DeSantis said.

He also recounted allegations, made by many of the law’s supporters, that minors were being mutilated.

“It’s wrong to mutilate minors. It is wrong to perform a sex-change on a 16-year-old. You’re not allowed to get a tattoo, but somehow you can have your privates cut off. Give me a break,” DeSantis said.

Hinkle did not reverse Florida’s ban on gender-affirming surgery for minors because it was not a part of the appeal, but he called out accusations children were being “castrated” or “mutilated” in his ruling as far removed from reality and unsupported by evidence.

“Insofar as has been shown by this record, no transgender minor has ever been castrated or intentionally sterilized in Florida or elsewhere,” he wrote.

Major U.S. medical organizations endorse the care for teens suffering from gender dysphoria. But debate about treating minors continues, especially after the United Kingdom in May banned puberty blockers for adolescents except in exceptional circumstances, following a review that determined “for the majority of young people, a medical pathway may not be the best way to manage their gender-related distress.”

Uncertain future

Florida’s appeal is something 26Health’s legal team is “watching closely,” Stewart said.

“We just want to do our part to make sure that everyone has access to the health care that that they deserve,” she added.

Suarez said he is “optimistic” the judge’s decision will hold, even on appeal. “The science shows this is a valid diagnosis. This is a legitimate practice of medicine and this is healthcare,” he added.

Knoll said he has helped thousands of people transition in his career, including adolescents, and hasn’t encountered anyone who regretted it, adding that treatment requires an extensive mental health evaluation.

But he worries what the courts will decide. Knoll managed to hire a physician this spring, but his clinic still relies primarily on a team of nurses and nurse practitioners.

“I want to say I’m relieved, but really, what we’re doing is hustling, because we don’t know,” he said. “There is a fear.”

Ccatherman@orlandosentinel.com