In the month of September, Ohio’s Governor Mike DeWine proposed measures that activists for transgender rights believe could hinder their ability to receive gender-confirming treatment from private clinics and primary care physicians. This could potentially leave numerous adults without proper treatment and exposed to health hazards.

A 31-year-old man named Ashton Colby is concerned that the clinic where he receives his testosterone, which he has been taking since he was 19, may no longer provide it. As a transgender individual living in Columbus, he worries that he may have to switch to a different healthcare provider that meets the updated requirements. However, even a short wait of a few months could result in Colby experiencing a menstrual cycle for the first time in a long time.

Colby expressed that their mental well-being has been negatively impacted. They have been experiencing emotions related to their transgender identity, which they had not felt in a long time. However, they are now overwhelmed with feelings of devastation regarding their experiences as a transgender individual.

DeWine unveiled the suggested regulations amidst a flurry of action that may place Ohio ahead of other states in regulating gender-affirming treatment, potentially making it the second state to implement limitations on adult care.

He issued an executive order prohibiting minors from undergoing gender-affirming surgery, but rejected a bill that would prohibit all types of gender-affirming care for minors. The state’s legislative branch has voted to override the veto, with the other chamber set to vote on Jan. 24.

“The aim of this policy project is to create such burdensome and limiting barriers to accessing healthcare that individuals are practically unable to do so,” stated Kellan Baker, the executive director of the Whitman-Walker Institute, a non-profit in Washington D.C. that prioritizes the well-being of LGBTQ+ individuals.

The draft administrative rules released this month by the Ohio Department of Health and the state’s Department of Mental Health and Addiction Services address policies regarding the care of adults.

Psychiatrists, endocrinologists, and medical ethicists would be involved in developing comprehensive gender-affirming care plans for patients of all ages at the facility. Patients under 21 would also be required to undergo a minimum of six months of mental health counseling before beginning any gender-affirming medical treatment or surgery. Providers would not be allowed to refer minors to treatment outside of the facility, including clinics in other states.

DeWine stated that the measures would guarantee secure care and prevent the operation of unreliable clinics when he made the announcement.

The guidelines do not aim to prevent ongoing treatment for individuals who are already receiving it and align with the standard practices of specialized care, even if it is not always required by the state. According to Dan Tierney, spokesperson for DeWine, the administration is willing to make revisions to the wording in order to clarify the rules.

However, supporters argue that these regulations exceed the expected level of treatment set by reputable organizations such as the World Professional Association for Transgender Health, and there are no questionable gender clinics in the state.

Dara Adkison, board secretary of TransOhio, stated that the current bureaucracy is excessive and unnecessary. She believes that their intentions are clear – they are attempting to limit access to healthcare for as many individuals as possible, which is a blatant move.

Mimi Rivard, a nurse practitioner and clinical director at the Columbus clinic of Central Outreach Wellness Center in Ohio, stated that clinics have already been effectively prescribing hormones without the need for endocrinologists. However, there is a shortage of these specialists in the state to handle the current workload, as well as meet the needs of around 60,000 transgender individuals in Ohio.

According to her, transgender individuals may feel uncomfortable seeking medical care at other facilities, perceiving them as unwelcoming, even for common issues such as high blood pressure or diabetes. However, her clinic provides treatment for these health concerns as well.

“We must conduct ourselves in a manner that aligns with the commitments we have made as caregivers,” stated Rivard. “However, these guidelines do not permit such behavior.”

According to her, individuals who have had surgery and discontinue hormone therapy may be susceptible to osteoporosis and severe exhaustion.

Carl Streed Jr., MD, the leader of the U.S. Professional Association for Transgender Health and a gender-affirming care provider in Boston, pointed out that abortion is the only other area where states have intervened to prevent licensed health professionals from offering their services.

Streed described the rules as excessively harsh and lacking in any standard of care. He believes they create a false sense of security and will ultimately result in a ban.

The impact of the policy on transgender individuals receiving medical treatment may vary depending on their location. Major academic hospitals that offer gender-affirming services already have the necessary experts on staff.

Equitas Health, a non-profit organization in Columbus that specializes in LGBTQ+ healthcare, strongly disagrees with the regulations. However, they have stated that they will comply with the requirements in order to continue providing gender-affirming care if the rules are officially implemented.

Advocates caution that smaller clinics and general practitioners may not offer the necessary care, which could create additional obstacles for transgender individuals from lower-income, minority, and rural communities.

Adkison, a resident of Cleveland, anticipates that their personal care will persist.

“I am a Caucasian individual residing in an urban area with several prominent hospital systems nearby,” they stated. “I am certainly not as anxious as many of my acquaintances.”

Governments controlled by the GOP in 22 other states have already implemented regulations or limitations on gender-affirming medical treatment for minors. However, there has been limited adoption of policies targeting adults.

Currently, there is only one other limitation in place at the state level, specifically in Florida. This law, which went into effect last year, mandates that physicians must supervise all healthcare related to transitioning and that these appointments must be conducted in person. These regulations have been burdensome for individuals who have received care from nurse practitioners or utilized telehealth services.

The timeline and specific details of the implementation of the Ohio regulations are uncertain. The health department is accepting public feedback until February 5th, while the Department of Mental Health and Addiction Services proposal has a shorter comment period, closing on January 26th.

According to Rhea Debussy, a spokesperson for Equitas Health, the rules may be reviewed by a legislative committee to determine if they go beyond the administration’s authority, which is something that DeWine’s proposals currently do.

She stated that he has made a considerable impact in the past two weeks, causing frustration among Democrats, progressives, conservatives, and Republicans throughout Ohio.

On January 5th, the measures were introduced, coinciding with DeWine’s signing of an executive order prohibiting gender-affirming surgery for individuals under 18. Advocates believe that this action will have minimal real-world consequences, as surgeries of this nature are rarely conducted on minors.

“It’s extremely harsh,” stated Erin Upchurch, the executive director of Kaleidoscope Youth Center, a Columbus organization that supports LGBTQ+ youth. “It’s vengeful, cruel, and completely unnecessary.”