Governor DeWine Uses Anti-Abortion Tactic To Target Trans Adults With Defacto Ban

DeWine announced rules on trans care on Friday in order to stave off a potential veto override of the state's youth gender affirming care ban. These rules would kick most adults off their care.

On Friday, Governor DeWine announced a new set of rules that would severely limit trans care at any age. According to the governor's press conference, these rules would go "well beyond HB68," the bill banning gender-affirming care for trans youth. Under the announced restrictions on trans care, including care for trans adults, care for transgender people would have to be signed off by a psychiatrist, an endocrinologist, and a bioethicist. Furthermore, it would require the reporting of each trans diagnosis to the state. Shortly after the press conference, an announcement was posted on the Ohio Department of Health website, containing a slew of burdensome rules that appear borrowed from similar tactics used to close abortion clinics. The rules included also included an expansive surveillance system for all trans care with no opt-out.

The rules, detailed in three separate documents on the Ohio Department of Health website, outline a series of restrictions a clinic must comply with to offer care. To provide care to a trans person of any age, a clinic must employ a psychiatrist, an endocrinologist, and a bioethicist. The bioethicist is required to complete a “comprehensive, multi-disciplinary care plan” involving services from both the psychiatrist and endocrinologist.

The first set of restrictions can be seen here:

Ohio 5122-26-19 DOH

To people not familiar with trans care, this may seem reasonable - after all, why not get the best quality care for everyone? Journalist Evan Urquhart expertly explains the issue in a thread on twitter reacting to the restrictions by comparing the restrictions to diabetes:

“Imagine you have diabetes. There are five top diabetes specialists in your state, but you like most patients get your care from your primary care physician. The specialists provide better care, and their patients do better.

Now, imagine the impact of a regulation requiring all patients in your state to get diabetes treatment from one of those five. If you can't see one of them your diabetes goes untreated.

If you're an ordinary patient, the most likely outcome is that you lose treatment for your diabetes entirely. You don't get improved care- there are still just five specialists, and they have no where near the capacity to see everyone with diabetes in the state.”

The regulations would essentially end most adult trans care in the state, instituting a defacto ban for many trans patients. Individual private practice doctors, fertility clinics, community health clinics, and potentially even Planned Parenthood would likely not be able to offer care. The results would be devastating in underserved communities. Meanwhile, the few places that could comply with the regulations will likely see a ballooning of demand, leading to extensive waitlists.

If this sounds familiar to you, it should; Republicans have used these exact tactics to target abortion providers and shut down clinics. These types of restrictions, called “TRAP” laws, or “Targeted Restrictions on Abortion Providers,” would mandate things like “hospital admission privileges,” specialist forms, and waiting periods in order to access care. Even for the few clinics that were able to meet the new regulations, Republican legislators simply added more regulations until they were unable to provide care.

The regulations continue with further restrictions. See section C:

5122-26-19 OH DOH Section C

For transgender people under 21, there would be a mandatory six month waiting period with a requirement for extensive and comprehensive mental health evaluations. Those who are already receiving care are not opted out of this, meaning that it is likely that every trans person under 21 years old would be pulled off care. Similarly, people who move into the state from other states would face similar issues. Smaller clinics would likewise be uncertain of how to comply with this regulation and confirm the receipt of such care, leading to large disruptions of care.

Another section of the rules would institute an extensive surveillance system of transgender diagnoses in the state. They would require, for each diagnosis of gender dysphoria, a report from the healthcare provider within 30 days. These reports would also include the prescriptions, the age and assigned sex at birth of the individual, “change of treatment plan” and the reason why, and more.

See these restrictions here:

Reporting system under 3701-3-17 OH DOH.

The end result of all of these restrictions will likely mean an end to most trans care, both for trans youth and trans adults, in the state. In 2023, two states tried similar restrictions. Attorney General Andrew Bailey of Missouri instituted trans restrictions at any age resulting in many people being kicked off of their medication. Trans adults scrambled across state lines to find alternate places to obtain care or were made to discontinued their care altogether, amounting to forced medical detransition. The effect of the rules were referred to as “horrifying” by local media outlets. These rules were overturned in court as uniquely discriminatory to transgender care.

In Florida, a state law barred gender affirming care unless it was prescribed by a MD. This meant that no nurse practitioner could prescribe care in the state. The most common way in which transgender adults obtain care is through the use of nurse practitioners through clinics such as Planned Parenthood. This allows low-income trans people, trans people in rural areas, and trans people who cannot afford extensive appointments with specialists to still obtain their medication. After the Florida restriction went into place, trans adults were “blindsided” with the loss of care, according to the Associated Press.

Though DeWine likely drew up these restrictions in an attempt to stave off a veto override of the state’s gender affirming care ban for trans youth, many trans adults will likely see this scenario as worse than the original bill the governor vetoed. These restrictions will now go through an accelerated public comment period.

You can send in a comment on the rules here.