Florida’s Anti-Trans Laws Could Completely Wipe Out LGBTQ Clinics

After nurse practitioner Joey Knoll struggled to get adequate healthcare as a gay man, he decided to start his own clinic that would offer LGBTQ patients effective and safe healthcare.

“My goal was to create a way to provide LGBTQ people with care so they’d be comfortable talking about their health needs and wouldn’t avoid certain topics because of fear of judgment from healthcare providers,” he told VICE News.

Knoll founded SPEKTRUM Health in 2018, and trans medicine has been a subspecialty at the clinic because, Knoll says, “I’ve always recognized that as much as I struggled with access to healthcare, it hasn’t compared to how hard it is for trans people.”

But now, Knoll and gender-affirming care providers like him are watching as Florida lawmakers try to ban and criminalize their work, proposing and passing an onslaught of legislation that targets trans people and the medical professionals who treat them. Knoll worries that his clinic, and others like it, could be put out of business, leaving thousands of trans Floridians—and some out-of-state patients—without care.

“Things are devolving really quickly,” Knoll told VICE News. “There is going to be a massive health crisis as all these bans go into effect… Organizations like mine could collapse completely.”

At least 15 states have passed gender-affirming care bans, but Florida Republicans, led by Gov. Ron DeSantis, have pursued one of the most aggressive anti-trans agendas in the country. Such bans are driving healthcare providers out of Florida at a time when the state is in desperate need of more.

Floridians have seen an onslaught of anti-trans bills, including one that would disincentivize businesses from covering gender-affirming care in their health insurance plans by making those that do cover it responsible for costs associated with detransitioning as well—even though detransitioning is extremely rare. Then, there’s HB1421, which would prohibit insurance providers, including private insurers, from covering gender-affirming care, which can cost thousands of dollars out of pocket. Senate Bill 254 would allow the state to forcibly remove trans children receiving care from affirming parents, criminalize healthcare providers who provide gender-affirming care and revoke their healthcare licences, and would ban the use of public funds for gender-affirming care for people of all ages. It also stipulates that only “physicians” can prescribe such medical interventions (notably, Florida’s Board of Medicine and Board of Osteopathic Medicine, which governs doctors—not nurses like Knoll who can legally provide primary care in the state—already passed its own guidelines that ban gender-affirming care for minors seeking it after January of this year, and four families are suing over them).

SPEKTRUM cares for thousands of patients, and Knoll estimates that about 15 percent live out-of-state and receive care through telehealth. The vast majority, though, live in Florida. Many of these patients depend on the clinic for critical care, and the clinic’s own Chief Operating Officer, Svetlana Dunn, is at risk of losing access to care herself. 

“It’s particularly disturbing to me that I run a practice that serves the needs of thousands of transgender patients across Florida, both adolescents and adults. All of them are going to lose access to care if these bills are passed, including me,” Dunn said. 

Like the legislation passed in other states, Florida’s anti-trans bills aren’t rooted in fact—and the state even twisted science to usher in some of its anti-trans policies. Studies show that gender-affirming care isn’t harmful; it’s life-saving. Trans people are more likely to experience mental health struggles, including anxiety, depression, PTSD, and thoughts of suicide, than cisgender people. Nearly half of all LGBTQ youth have seriously considered suicide. Experts say some of these risks can be mitigated with gender-affirming care, which includes puberty blockers and other therapies.These interventions are endorsed by several major national medical associations as safe and effective.

Detransitioning is also extremely rare, with studies showing that an average of 97 percent of trans people say they’re happy with their transition. Of the people who voice some regret, even fewer actually reverse their transitions, and those who do usually do it because of stigma and societal pressures from family, school, or work—not because they themselves want to de-transition. The most common drivers for detransitioning were lack of familial support, poor workplace environments, harassment, and discrimination, according to the National Center for Transgender Equality. 

“We treat hundreds of kids here and I've seen so many of them grow into adulthood from youth and continue on in their transition,” said Dunn. “I’ve never seen anyone desist in thousands of patients.”

One bill, SB 254, threatens to impose criminal penalties on providers who prescribe puberty blockers and hormones to minors, which would make the situation more alarming for care providers like Knoll and Dunn. Few explicit details are known about how the bill’s provisions would be enforced, and critics point out that a lot of the language in the bills is vague and hard to interpret. 

Dunn doesn’t want to break the law, but worries that without clarity, it will be hard to figure out what the clinic can and can’t legally do. “We’ve always done everything by the book as much as we can, and for this to be happening it really puts us in a difficult position,” Dunn said.“Overall, the sense is that it’s just absolute fear of total annihilation of our community right now.”

SPEKTRUM Health doesn’t have a concrete plan for next steps because it’s unclear which bills will pass and how they’ll be amended before they do. In the meantime, Knoll said the clinic is devoting “lots of resources” in order to monitor the situation day by day. 

“It’s consuming resources and it’s very wasteful,” Knoll said. “But it’s necessary to follow this very closely to protect our organization and patients.”

Knoll added that the team is in touch with nationwide advocacy organizations and is focusing on fundraising, so that when and if it’s time to adapt to new laws, they have the financial resources to do so. “We’ve been lucky because we haven’t come across anything where we've been restricted, but we know it’s only a matter of time,” Knoll said. 

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