Ohio Governor Mike DeWine announced proposals this month that transgender advocates say could block access to gender-affirming care from independent clinics and primary care physicians, leaving thousands of adults seeking treatment and facing health risks.
Ashton Colby, 31, fears the clinic where he receives the testosterone he has been taking since he was 19 will no longer offer it. The transgender Columbus man believes he could eventually be treated by another provider who would meet the new requirements. But even if he waits a few months, Colby may experience a menstrual cycle for the first time in many years.
“My mental health is taking a toll,” Colby said. “These are feelings associated with being transgender that I haven’t felt in years, but now I feel devastated about my experience as transgender.”
DeWine announced the proposed rules amid a whirlwind of activity that could push Ohio further than most other states in controlling gender-affirming care, and make it only the second to impose restrictions on adult care.
He also signed an executive order banning gender-affirming surgeries for minors, but vetoed a bill that would ban all gender-affirming care for minors. One chamber of the state legislature has already overridden it and the other will vote Jan. 24 on whether to do so.
“It’s a policy project that tries to make it so difficult and so restrictive to get care that people are functionally unable to do so,” said Kellan Baker, executive director of the Whitman-Walker Institute, a Washington-based organization that focuses on healthcare. the health of LGBTQ+ people.
The policy aimed at adult care is included in draft administrative rules released this month by the Ohio Department of Health and the state Department of Mental Health and Addiction Services.
They would require psychiatrists, endocrinologists and medical ethicists to play a role in creating institution-wide gender-affirming care plans for patients of all ages. Patients under the age of 21 should receive at least six months of mental health care before starting gender-affirming medications or surgery. Providers would not be allowed to refer minors to treatment elsewhere, such as clinics in other states.
When he announced the measures, DeWine said they would ensure safe treatment and make it impossible to operate fly-by-night clinics.
The rules are not intended to stop treatment for those already receiving it and are consistent with the way specialty care is generally practiced, even if the approach is not always mandated by the state, DeWine spokesperson said Dan Tierney, who noted that the administration is open. to wording changes to clarify the rules.
Still, advocates say these rules go beyond the standard of care set by organizations including the World Professional Association for Transgender Health, and at least there are no vague gender clinics in the state.
“It’s bad and unnecessary bureaucracy, and we know what they’re trying to do — and they hope to cut off health care to as many people as possible,” said Dara Adkison, board secretary of the advocacy group TransOhio. “It’s not subtle.”
Mimi Rivard, a nurse and clinical director of the Columbus clinic of Central Outreach Wellness Center in Ohio, said clinics already successfully prescribe hormones without the involvement of endocrinologists and that there aren’t enough of those specialists in the state to match the current work to do, plus an estimated 60,000 Ohioans with transgender experience.
Many transgender patients are wary of other medical environments, which they may consider unfriendly, for more routine needs like high blood pressure or diabetes, but clinics like hers also treat them for those conditions, she said.
“We must conduct ourselves in a manner consistent with the oath we took as health care providers,” Rivard said. “And these guidelines do not allow this.”
Patients who have had surgery and stopped hormones may be at risk for osteoporosis and extreme fatigue, she said.
Dr. Carl Streed Jr., president of the US Professional Association for Transgender Health, which provides gender-affirming care in Boston, noted that abortion is the only other area where states have gone out of their way to ban health care workers from providing services allowed by their license .
“The rules are draconian. They don’t follow any standard of care,” Streed said. “It is a veil of this false sense of security that will effectively lead to a ban.”
The consequences of this policy for transgender patients may depend on where they are treated. The major academic medical centers that provide gender-affirming care already have the necessary specialists on staff.
Equitas Health, a Columbus-based nonprofit focused on LGBTQ+ health care, strongly opposes the regulations but also says it will comply with requirements to continue offering gender-affirming care once the rules are finalized.
Advocates warn that care may not be available through smaller clinics or primary care physicians, creating more barriers to care for lower-income, minority and transgender people in rural areas.
Adkison, who lives in Cleveland, expects their own treatment to continue.
“I am white and live in the city, near several major hospitals,” they said. “I’m definitely not as worried as a lot of my friends.”
GOP-controlled governments in 22 other states have already passed bans or restrictions on gender-affirming care for minors. However, so far the adoption of policies aimed at adults has been rare.
The only other restriction currently in place at the state level is in Florida, where a law went into effect last year requiring doctors to oversee all health care related to the transition, and those appointments must take place in person. These rules are burdensome for people who have received care from nurses or used telehealth.
It’s not clear when the Ohio rules could go into effect, or in what form if they are final. The health department is taking public comment until February 5; the Department of Mental Health and Addiction Services’ proposal will only allow public comment until Jan. 26.
The rules are also subject to review by a legislative committee examining whether the rules exceed the government’s power, something DeWine’s proposals do, said Rhea Debussy, spokesperson for Equitas Health.
“He’s done a really impressive job over the last two weeks, which has made a lot of Democrats, a lot of progressives, a lot of conservatives and Republicans in the state of Ohio very angry with him,” she said.
The measures were unveiled on January 5, the same day DeWine signed an executive order banning gender confirmation surgeries for people under 18. Supporters expect that the measure will have little practical impact, because such operations are almost never performed on minors.
“It’s very cruel,” said Erin Upchurch, executive director of Kaleidoscope Youth Center, a Columbus-based organization that serves young LGBTQ+ people. “It is vindictive, mean and unnecessary.”