Ohio Appeals Court Rules Trans Care Is Healthcare, Strikes Down Ban For Trans Youth

The ruling was in part based on a 2011 Amendment in the state guaranteeing healthcare freedom, originally meant to challenge Obamacare.

Ohio Capitol Building // Wikimedia Commons

In a landmark decision on Tuesday, a three-judge panel for the Ohio Tenth District Court of Appeals struck down the state’s ban on gender-affirming care for transgender youth. The ruling rested on two key findings: first, that gender-affirming care constitutes legitimate medical treatment, and second, that parents have the constitutional right to make healthcare decisions for their children. Notably—and with a touch of irony—the court’s decision was made possible by Ohio’s Health Care Freedom Amendment, a Republican-backed constitutional provision originally designed to undermine the Affordable Care Act. Now, the same amendment has been used to dismantle a key pillar of the state’s anti-trans legislation.

“The medical evidence and clinical experience presented in this case demonstrate that, when provided in appropriate circumstances, gender-affirming care can meaningfully improve the health and well-being of transgender adolescents with gender dysphoria by lowering rates of depression and the severity of other mental health issues, as well as increasing patients’ quality of life,” reads the ruling, affirming many studies showing the importance of gender affirming care on the wellbeing of transgender youth.

This finding was significant. In 2011, a state constitutional amendment was passed by Republicans in 2011 to prevent the implementation of the Affordable Care Act (Obamacare). The amendment reads as follows:

(B) No federal, state, or local law or rule shall prohibit the purchase or sale of health care or health insurance.

C) No federal, state, or local law or rule shall impose a penalty or fine for the sale or purchase of health care or health insurance.

As a result, Ohioans now have broader constitutional protections around healthcare access—protections that, in this case, worked against Republican lawmakers’ attempts to restrict gender-affirming care.

In defending the ban, the state argued that gender-affirming care does not qualify as healthcare, relying on testimony from anti-trans medical “experts” and asserting that it was up to the legislature—not the courts—to determine what constitutes medical treatment. The judges rejected both arguments outright, affirming that gender-affirming care falls squarely within the legal definition of healthcare.

The court thoroughly dismantled the credibility of the state’s witnesses, going so far as to eviscerate them in judicial footnotes. Of Dr. James Cantor, the ruling notes that he “is not a physician, has never practiced as a licensed clinical psychologist in the United States, is not licensed to treat patients under the age of 16, and has never provided treatments to patients under the age of 16.” Dr. Paul Hruz fared no better, with the court pointing out that “he never diagnosed or treated a patient with gender dysphoria.” The ruling also highlighted his history of anti-trans advocacy, citing his testimony in a transgender bathroom ban case, where he stated: “Conditioning children into believing that a lifetime of impersonating someone of the opposite sex, achievable only through chemical and surgical interventions, is a form of child abuse.”

Even the state’s sole witness with marginal qualification, Dr. Stephen Levine, ultimately undercut its case. The court noted that while Dr. Levine has experience in the field, he testified that he does not support a categorical ban on gender-affirming care and provided no evidence that such care is substandard in Ohio. In other words, the state’s own expert failed to justify the ban.

See the court’s critical appraisal of the witnesses, often cited in many anti-trans cases

p. 7-8, Ohio Ruling

The court dismissed the state’s anti-trans witnesses outright, instead finding the testimony of 22 leading medical organizations and numerous appellate witnesses—many with decades of experience in transgender healthcare—far more credible. Citing extensive studies on the positive impact of gender-affirming care in reducing suicidality and depression, the court made clear that the overwhelming weight of medical evidence supports access to this care.

The court also rejected the state’s claim that the legislature has the authority to unilaterally define what qualifies as healthcare. “The General Assembly cannot simply declare any type of health care to be ‘wrongdoing’ and swallow up the right enshrined in the Ohio Constitution by direct vote of Ohio’s citizens,” the ruling stated. Instead, the court asserted that the state must present a compelling case as to why a widely accepted standard of care should be excluded from the definition of healthcare. Not only did the state fail to make that case, but it also could not provide a single alternative standard of care with evidence of positive outcomes for transgender youth.

Though this would have been in and of itself enough to overturn the law, the court proceeded to also rule that the anti-trans ban was a violation of the parental right to direct a child’s healthcare: “Based on the foregoing, we conclude that parents have a fundamental right to seek medical care for their children, which naturally includes the right of parents to, ‘in conjunction with their [minor] child’s consent and their [medical providers’] recommendation, make a judgment that such medical care is necessary.’”

Freda Levenson, Legal Director at the ACLU of Ohio, celebrated the decision: “Today, we celebrate this win not only for our brave plaintiffs but for all LGBTQ+ Ohioans and their families. This win restores the right of trans youth in Ohio to choose vitally important health care, with the support of their families and physicians. We are gratified by the Court’s decision, which soundly rejects this interference of politicians with Ohioans’ bodily autonomy. Although this litigation will likely not end here, we remain fervently committed to preventing this egregious bill from ever again taking effect. The path towards protecting the rights and civil liberties of trans Ohioans goes on, and we will continue to hold the torch.”

The ruling will likely be appealed in coming days to the Ohio Supreme Court.

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Erin In The Morning would like to thank Folx Health for sponsoring our reporting. At a time when access to trans healthcare is under attack, FOLX Health is making sure the transgender community gets the care they deserve. FOLX provides expert, affirming virtual care—including gender-affirming hormone therapy (HRT), mental health care, therapy, and primary care—designed by and for LGBTQIA+ people. No gatekeeping, no judgment—just providers who understand you and a community that has your back. Along with healthcare, FOLX members get access to a private community platform built for connection, support, and resources. If this sounds like it could be good for you or someone you care about, visit folxhealth.com/erinreed.

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