Gender-affirming care access for Ohio trans adults to be restricted under new administrative rules

Ohio’s Republican Gov. Mike DeWine on Friday unveiled a slate of administrative rules meant to restrict access to gender-affirming health care for transgender adults, one week after vetoing legislation that would have banned care for minors.

DeWine said during a press conference that Ohio’s Department of Health and Department of Mental Health and Addiction Services would be filing rules for public comment Friday that, once effective, will provide additional protections for transgender minors and adults receiving care.

One of the rules, he said, will require transgender adults seeking access to medications like hormones to retain a multidisciplinary team “including but not limited to an endocrinologist, a bioethicist and a psychiatrist.” Transgender adults in Ohio may currently receive care from a single clinician, though treatment plans differ based on a patient’s individual needs.

“Candidly, as I expressed a week ago, I am concerned that there could be fly-by-night providers and clinics that might be dispensing medication to adults with no counseling and no basic standards to assure quality care,” DeWine said Friday. “The rules that we are announcing today will take care of that. We need to ensure that adults, as well as children, are protected.”

DeWine added that the rules will require transgender adults to obtain from their providers a “comprehensive care plan” including “lengthy” mental health counseling before they can be considered for any medical interventions.

DeWine’s proposal is among the nation’s most stringent for transgender adults seeking access to gender-affirming medical care, and it is likely to bottleneck resources and worsen financial strain on people seeking gender-affirming care.

In Florida, thousands of transgender adults have struggled to access prescription medications since May, when a law signed by Gov. Ron DeSantis (R) quashed the ability of most of the state’s health care providers to administer gender-affirming services.

A second rule announced Friday by DeWine will require health care providers across Ohio to report de-identified data on cases of gender dysphoria and subsequent treatments.

“In plain English, that means that no one will be able to look at the data and tell who it is,” DeWine said. “We do this all the time to protect privacy.”

“The reporting of aggregate data occurs frequently in Ohio,” DeWine added, “from flu cases to causes of food poisoning to data on abortions. This data is used by policymakers, legislators and the public so they can make informed decisions.”

The governor on Friday also signed an executive order prohibiting gender-affirming surgeries for minors. It is the second state to explicitly ban surgeries for minors, after Arizona did so in 2022.

Gender-affirming surgeries, according to guidelines set by the World Professional Association for Transgender Health and the Endocrine Society, are not recommended for transgender children and adolescents younger than 18.

While announcing his veto of House Bill 68, which had sought to ban gender-affirming health care in its entirety for minors, DeWine during a Dec. 29 press conference called the notion that such surgeries were being performed on minors in Ohio “a fallacy.”

On Friday, DeWine, who spent the last few weeks of 2023 talking to medical professionals and families of transgender children, said the executive order is “a good way to take this issue off the table and assure everyone that there are no surgeries going on with minors.”

“You can't prove a negative; I can't say that there's never been a surgery on a minor,” DeWine said Friday. “I have no way of knowing that. I just know the issue never came up in discussions, other than telling me there are no surgeries going on in regard to minors.”

“But again, if there are, we should ban them,” he said.

DeWine’s rejection of House Bill 68, which would have also barred transgender women and girls from competing on female school sports teams, has drawn sharp criticism from conservative Republicans including former President Trump and DeSantis, who is campaigning for the GOP presidential nomination.

Ohio’s Republican-controlled House is expected to hold a vote to override DeWine’s veto next week. The bill passed both the state House and Senate with veto-proof majorities.