Florida’s ban on providing gender-affirming care to new patients went into effect this month after the state’s Boards of Medicine and Osteopathic Medicine voted to approve the rule last year. Under the rule, gender-affirming care includes treatments like puberty blockers, hormone replacement therapy and surgery. The ban makes an exception to allow minors who were already receiving this care before January 2023 to continue their treatments. 

“Everybody is in a kind of chaos right now,” said Joseph Knoll, a nurse practitioner and the CEO of Spektrum Health, a community-based health center located in central Florida that specializes in medical and mental health services for the LGBTQ community and beyond. He told me that the new rules leave healthcare professionals who provide this care “feeling helpless.”

Doctors and other practitioners who violate the ban could lose their medical license and be hit with hefty fines. Many are even considering leaving the state, given the uncertainty of future restrictions on their practice. Part of the dismay comes from feeling that the deck has been unfairly stacked. Local news outlets have reported that Florida Governor Ron DeSantis appointed all the members of the “vociferously apolitical” Board of Medicine, several of whom made contributions to his campaign totaling $80,000. DeSantis is reportedly considering running for president in 2024 and gender-affirming care is an issue that many conservative lawmakers have been pushing across the country.

Florida is now one of 10 or more states that have passed similar legislation. In Utah, the state passed a law at the beginning of the year to ban any healthcare professional from providing any gender-affirming treatments to minors or face a felony charge. In February, South Dakota passed a similar law for minors in which medical professionals providing such treatments stood to lose their licenses. Georgia followed in March. And just days ago, West Virginia enacted a ban on gender-affirming therapies, though it made exceptions for teenagers considered to be at risk for self-harm or suicide. 

Florida, unlike the other states, initially chose not to take a legislative route, instead moving ahead via state medical boards. A bill, though, is currently making its way through the Florida House of Representatives to codify the ban on gender-affirming care. This bill also includes a ban on changing the sex as recorded on a birth certificate, prohibits health insurance providers from covering any treatments related to youth transitioning and prohibits organizations that provide transition-related healthcare to minors from receiving public funds. 

Already, this has led to clinics shutting down preemptively. Outlets reported that the Johns Hopkins All Children Hospital in St. Petersburg and Nicklaus Children’s Hospital in Miami, among others, stopped accepting new patients into programs that provided hormones or puberty blockers well before the law went into effect. The fear of prosecution leaves few providers still offering these services.

With clinics closing and the high potential consequences for providing care, medical professionals are increasingly forced to choose between staying in an environment that makes it challenging to provide the necessary medical care to their patients or leaving to continue practicing elsewhere. 

“Our primary service line is gender affirming treatment,” Knoll, the Spektrum Health CEO, told me, “but we’re a community healthcare clinic that does primary care as well.” He says he is now faced with the choice of abandoning all patients because his clinic’s survival is at stake. “Gender affirming treatment represents somewhere between 50% and 60% of our services,” he said. “Obviously, our biggest concern is the care of people that need to access our services, but we have to be realistic. We don’t have room in our budget to have half of our revenue gone.”

He told me he’s heard of colleagues who are taking the option to leave Florida. The consideration weighs heavily for his transgender staff members. “For them to stay in the state of Florida,” Knoll said, “they have to accept the lack of access to health care while working at a healthcare organization. I mean, it’s nonsense.” 

Nurse practitioners like Knoll play an essential role in this equation. They can prescribe medication, promote disease prevention and diagnose common ailments, often providing this care directly in clinical settings. In 2020, Florida passed a law that grants nurse practitioners full authority to autonomously practice primary care. Losing these healthcare professionals drastically affects the communities they serve. 

Vernon Langford, the president of the Florida Association of Nurse Practitioners, wrote in an email that the state has “a bad shortage of healthcare professionals now and it is not getting better anytime soon.” It’s hard to know exactly how many medical professionals are leaving and what their exact reasons are for doing so, but a 2021 report for the Florida Hospital Association estimates that the state will face a shortage of nearly 6,000 primary care physicians by 2035. The lack of physicians makes it difficult for all patients seeking care in Florida, especially those in rural areas. Additionally, more care providers will be needed as the population increases and ages. A state facing significant shortages in care needs to be able to attract and retain talent. 

The new rules are not helping. Langford said Florida needed to remove barriers to accessing care, not create additional hurdles. “The culture wars have seeped into healthcare,” he said, which introduces more restrictions for the work of nurse practitioners. There has been an increase, he added, “in the desire to relocate to states that have more favorable practice environments.” 

As bans and restrictions on gender-affirming spread around the country, perhaps the only option left for patients who need this care is to file legal challenges. Four anonymous transgender minors sued the state this month, arguing that the medical bans “violate the Equal Protection Clause of the Fourteenth Amendment” and should, as unconstitutional legislation, be thrown out. “It is,” Langford told me, “a very sad thing to see when vulnerable populations are being targeted.”