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As transgender healthcare guidelines have been called into question by Gov. Ron DeSantis administration and multiple Florida healthcare agencies, a Brevard clinic serving the LGBTQ community is grappling to figure out a response.

Spektrum, an LGBTQ-focused clinic with an office in Orlando and in Melbourne,serves about 3,500 patients. They provide gender-affirming healthcare for all ages, which includes hormone replacement therapy, blockers, support letters for gender-affirming surgeries and mental health services.

With the Florida Department of Health, the Agency for Health Care Administration and DeSantis administration looking to potentially restrict transgender peoples access to healthcare specifically those on Medicaid and those under 18 years oldthe clinic is facing manyunknowns.

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"We have to wait until we see what sticks to the wall before we can fully plan our response, but of course we're kind of preparing for everything, said Joey Knoll, founder and CEO of Spektrum.

With so much uncertainty, the clinic is struggling to keep up with the number of patients it needsto see. Typically, they could see about 40 to 50 patients a day. But with so many people coming in with fears about whats going to happen, that number has dropped to 30.

Our patients and their families' appointments are taking longer because they're all panicking, he said. What used to just be a quick appointment we're checking your labs, things are looking good, how are you feeling, what results are you noticing? Now it's, do I need to move and what's going to happen? Am I going to get my medicine?

Transgender healthcare has been a topic of discussion for several months with a focus on gender dysphoria, which is defined by the federal government as "significant distress that a person may feel when sex or gender assigned at birth is not the same as their identity." It was previously called gender identity disorder.

Transgender healthcare was first brought into question in April, when the Florida Department of Health released a guidance seeking to "clarify evidence" regarding the treatment of gender dysphoria in anyone under the age of 18. It advised not only that medical transition should not be allowed under the age of 18, but also social transition, which can involve allowing a transgender child to go by a preferred name, pronouns and different clothing options.

Since then, the Agency for Health Care Administration released a 46-page report on June 2 titled "Generally Accepted Professional Medical Standards Determination on the Treatment of Gender Dysphoria." The six medical professionals who compiled the report said treatment for gender dysphoria which can include gender reassignment surgery, hormone replacement therapy and puberty blockers had the potential for harmful long-term effects, saying the treatments were "experimental and investigational."

At the time of the release of the report, AHCA requested Florida's Medicaid program review whether treatments for gender dysphoria met generally accepted professional medical standards, additionally arguing that treatments didn't meet the definition of "medically necessity." If this were found to be the case, low-income and adolescent transgender individuals would no longer have their treatments covered by Medicaid.

Separately, DeSantis' administration has asked the Florida Board of Medicine to review their findings and create a standard of care for "those complex and irreversible procedures" for gender dysphoria.

Since the initial release of its guidance in April, the Florida Department of Healthfiled a petition on July 28 to initiate rulemaking related to trans healthcare, saying that "children do not possess the cognitive or emotional maturity to comprehend the consequences of ... invasive and irreversible procedures."

In itsproposed standard of care, itsuggestedprocedures and treatments such as sex reassignment surgeries or anything altering primary or secondary sexual characteristics, puberty blockers, hormone replacement therapy and hormone antagonists be banned for transgender patients under the age of 18.

Friday the Florida Board of Medicine advanced aplan to ban healthcare providers from offering gender affirming treatments such as puberty blockers and hormone therapy to people under age 18.

Department of Health Secretary Joseph Ladapo arguedthe current standards of care were a departure from "the level of evidence and data surrounding this issue."

"Maybe it is effective, but the scientific studies that have been published today do not support that," he said at the Friday meeting in Fort Lauderdale. "Could that change in the future? Its possible. I think its very unlikely considering what Ive reviewed, but its possible."

Knoll, who has helped more than 10,000 people transition over the course of his career, said he believes the studies cited in the proposed guidelines have been misrepresented or twisted.

"It's outdated research that began in 1975 that talks about persisters and desisters when it comes to gender identity, failing to include the fact that in 1975, how was someone going to access gender affirming care?" he said.

Persistersreferto people who continued to identify as transgender into adulthood; desisters are those whoeventually reverted back to identifying with their gender assigned at birth.

"Maybe they are classified as a desister because they are living in their birth-assigned gender, but it could have been because they didn't have access to affirming care or a support system it doesn't mean that their gender identity wasn't real, so that's very terrible information for them to take,"Knoll said.

Sebastian Cook, a 17-year-old transgender boy from Melbourne, said the proposed changes are dehumanizing.

"It's honestly really scary, because it makes us look like we're just political objects and not real people, he said. We have feelings, we're human, and we just want to have our bodies feel and look the way that (they're) supposed to."

Cook will turn 18 in a few weeks, which should keep proposed guidelines surrounding healthcare for trans minors from applying to him. However, hes still facing uncertainty regarding covering the cost of hormone replacement therapy and is worried about how the guidelines will affect younger people.

"Gender-affirming healthcare it definitely does save lives, he said. We know what we want and we know how to achieve what we want, and that's something that will actually save our lives ...When it's restricted, it's going to cause so many more issues down the road, leading to depression and suicide and stuff like that."

Though its not clear how Spektrum will be required to proceed, Knoll, who has helped more than 10,000 people transition over the course of his career, has ideas for counteracting what he believes to be misinformation cited in the proposed guidelines.

"One of the things that we're trying to do to combat this is put together some research or get something published, but I'm not a publisher, I don't know how to do that stuff, I'm not a statistician," he said.

His goal is to gather statistics from the practice regarding transgender patients and their experiences. But without experience in publishing and a lack of resources in this area, he needsa volunteer to help.

The truth is, organizations like mine, other organizations around the state, we just don't have the bandwidth to gather this information, he said. "We just need help that's the hold up."

Finch Walker is a Breaking News Reporter at FLORIDA TODAY.Contact Walker at 321-290-4744orfwalker@floridatoday.com. Twitter:@_finchwalker

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Brevard LGBTQ clinic responds to proposed restrictions on trans healthcare - Florida Today

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