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More states increasingly restrict access to medical care for transgender people

LEILA FADEL, HOST:

Access to medical care for transgender people is being restricted in several states where Republicans hold majorities in the legislature. And the number of bans is growing. This week, lawmakers in Texas approved a ban on gender affirming care for minors. In Florida, Governor Ron DeSantis signed a similar ban into law that also restricts some care for trans adults. So what does this mean for medical providers and for their patients? To understand that, we're joined by Joey Knoll, a nurse practitioner and the medical services director at SPEKTRUM Health, a community health center in Orlando, Fla. Good morning, Joey.

JOEY KNOLL: Good morning, Leila.

FADEL: So what care under this new ban can you and can't you provide to your transgender patients now that this ban is law?

KNOLL: Yeah. Essentially, we can continue to provide primary care services to our patients. But the prescribing of any hormones or gender affirming specific regimens are completely banned.

FADEL: So what happens to patients who are in the middle of that type of treatment, hormone therapy treatment? What happens to them?

KNOLL: Yeah, well, we anticipated this coming, so we rushed to see all of our patients and make sure that they had plenty of prescription medications available to get them through as we navigate this and come up with a more long-term solution for their needs.

FADEL: In a recent editorial, you wrote that this ban is a, quote, "cruel and unconscionable, unscientific experiment on young people's bodies" and that Florida's governor is, quote, "cutting off lifesaving support for transgender young people in order to gain attention for his own political career." Can you tell me why this risks young people's lives?

KNOLL: Well, what makes it especially cruel is that we're banning health care. We're banning access to health care. And the DeSantis administration has gone further to restrict educational resources as well. Their argument has been that there's no science to support this, which is factually inaccurate. But if they were really concerned with the health and well-being of Floridians, why would they go to the great lengths of ensuring that universities are not allowed to spend any funds to do any research on this matter?

FADEL: What are your patients asking you in the middle of all this? You said you were preparing your patients. What were they asking you? And what are they saying now?

KNOLL: The biggest question I get from my patients is, do I need to leave Florida? Am I safe here?

FADEL: What about you? How have you adjusted so that you don't run afoul of this new law?

KNOLL: Oh, great question. You know, we're taking great lengths to be compliant and follow all the rules that we can, and also interpret it to ensure that we can do our best to meet the needs of our patients. So to try to navigate it, it's a matter of working with partners inside and outside the states just to bridge access and in the hopes that nobody loses complete access. But this is all happening in real time. And we're already starting to see people that are struggling with access.

FADEL: So what does that actually look like? When you say bridging that access, are you telling your patients to go to another state to get the care they need? I mean, how are you doing that? And what are the consequences for you if you do break this new law?

KNOLL: Yeah, good questions. So we are working with some of our out-of-state colleagues that are going to visit Florida. We have, you know, thousands and thousands of patients who need access to care. And the law does allow, at some point, MDs and DOs to be able to continue these services. It just happens that our organization, like a lot of organizations, is comprised of nurse practitioners. And myself and my colleagues in my practice, we are autonomous nurse practitioners, which means we do not have a requirement to tether to a physician. So we find ourselves in the situation where we did not have an MD or DO. So we're working with some physicians outside of state that will travel to Florida intermittently to serve these patients.

FADEL: Now, for people who actually agree with what the governor has done, who say maybe minors are too young to make these decisions about their bodies, what would you say to them?

KNOLL: Yeah, I would say that they probably haven't spent enough time getting to know trans people. The rhetoric that the governor and, you know, the rest of the opponents to GAC keep using is that they want to protect kids, help kids be kids. The truth is, we're not talking about 5 and 6-year-olds. We're talking about 16, 17, 18-year-olds. And so I think that preserving access to care for these individuals is important. And if we were worried about health and safety, we would ensure that people already on treatment would be able to continue.

FADEL: Joey Knoll is a nurse practitioner and the medical services director at SPEKTRUM Health. Thank you so much.

KNOLL: Thank you. Transcript provided by NPR, Copyright NPR.