Providers halt services after court allows Florida to enforce ban on transgender care for minors

Advocates say transgender patients are facing barriers to “potentially life-saving health care" after a federal appeals court ruled that a Florida law banning gender-affirming care can be enforced while a legal challenge plays out.

The decision handed down by the 11th U.S. Circuit Court of Appeals in Atlanta on Monday cleared the way for Florida to prohibit transgender minors from being prescribed puberty blockers and hormonal treatments, even with their parents’ permission. The law also requires that transgender adults only receive treatment from a doctor and not from a registered nurse or other qualified provider.

Jon Harris Maurer, the public policy director for LGBTQ+ rights group Equality Florida, characterized the law as government intrusion into "vital health care".

“We have parents, understandably very concerned about their children’s wellbeing, who want to make sure that they have the right to make the best decisions for their kids,” Maurer said. “This ruling puts back in place a law that interferes with that. And it puts their kids and their families at risk.”

Suicide is a leading cause of death among young people, and transgender and nonbinary youth are at a significantly increased risk.

At least 26 states have adopted laws restricting or banning gender-affirming medical care for transgender minors, but Florida was the first state to restrict health care for transgender adults, according to the LGBTQ+ advocacy group the Human Rights Campaign.

Enforcement of the Florida law had been on hold since June, after U.S. District Judge Robert Hinkle struck down the ban as unconstitutional.

Gov. Ron DeSantis, who signed the law in May of 2023, has made anti-LGBTQ+ legislation a large part of his agenda and his national political profile. Asked for comment on the decision, a spokesperson pointed to statements DeSantis made in June, predicting that Hinkle’s ruling would be overturned.

“We are going to stand up for duly enacted statutes. We’re going to stand up for protecting the innocence of these kids,” DeSantis said. “We'll win that appeal.”

The American Academy of Pediatrics has repeatedly affirmed gender-affirming care for children, noting that transgender adolescents and adults have high rates of depression, self-harm and suicide, and stating that providers have an “essential role” in supporting patients and their families in evidence-based decision making.

“The AAP opposes any laws or regulations that discriminate against transgender and gender-diverse individuals, or that interfere in the doctor-patient relationship,” the organization said in a statement in August of 2023 reaffirming its gender-affirming care policy.

For nurse practitioner Joseph Knoll, the 2-1 ruling handed down on Monday was a disappointment but not a surprise.

While the law has been on hold for the past two months, Knoll and other providers at Spektrum Health in Orlando have been racing the clock to work through a backlog of patients who had been denied care under the provision.

Spektrum specializes in LGBTQ+ primary care and the majority of its 5,000 patients come to the clinic for gender-affirming care and medical transition services, according to Knoll, who is also Spektrum’s CEO.

“During this little freedom period as I call it … we made good use of that time to make sure all of our patients were well supplied with medication,” Knoll told The Associated Press. “Although I had hoped that it wouldn’t have been necessary, at least now we can say, I’m glad we did all the things that we did."

As recently as last week, the clinic was onboarding new patients and scheduling them for their appointments. The ruling this week changed that.

“Now it’s telling them that we can’t book them for that appointment. Or we can do a consultation appointment, but we won’t be able to prescribe anything at this time,” Knoll said.

Knoll said he hopes the legwork the clinic did writing prescription refills over the last few months is enough to carry patients through the next phase of the legal fight. But he's worried that state lawmakers intent on banning procedures they deem harmful, even contrary to medical best practices, may not stop with gender-affirming care.

“If they use this technique to limit health care that they don’t like or they don’t agree with, where does that stop?” said Knoll. “What are they going to do next?”

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This story includes discussion of suicide. If you or someone you know needs help, please call the National Suicide Prevention Lifeline at 988.

___ Kate Payne is a corps member for The Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.