Ohio Gov. Mike DeWine unveiled proposals this month that transgender advocates could block access to gender-affirming care provided by independent clinics and general practitioners, leaving thousands of adults struggling for treatment and facing health risks.
Ashton Colby, 31, fears the clinic that has been taking the testosterone he’s been taking since he was 19 will no longer offer it. A transgender Columbus man believes he can be treated by another provider who meets the new requirements. But even a few months of waiting could lead to Colby getting her first period in years.
“My mental health took a hit,” Colby said. “These are feelings about being transgender that I haven’t felt in years, but now I’m frustrated by my experience as a transgender person.”
DeWine announced the proposed rules amid a move that could push Ohio further than other states in controlling gender-affirming care and make it the second state to impose restrictions on care for minors.
He also signed an executive order banning sex-affirming surgery for minors, but vetoed a bill banning all sex-affirming care for minors. The state legislature has one house has already surpassed it the other votes on January 24 whether to do so.
“This is a policy project that tries to make getting care so burdensome, so restrictive, that people are functionally unable to do it,” said Kellan Baker, executive director of the Washington-based Whitman-Walker Institute. The health of LGBTQ people.
Policies aimed at providing care to adults are outlined in draft administrative rules released this month by the Ohio Department of Health and the state Department of Mental Health and Addiction Services.
They will demand that psychiatrists, endocrinologists, and medical ethicists have a role in creating gender-affirming care plans for patients of all ages. Patients under the age of 21 should receive at least six months of mental health counseling before starting gender-affirming drugs or surgery. Providers would be prohibited from sending minors for treatment in other states, such as clinics.
In announcing the measures, DeWine said they would ensure safe treatment and make it impossible for “fly-by-night” clinics to operate.
DeWine spokesman Dan Tierney, who noted that the administration is open, said the rules are not intended to stop treatment for those already receiving it, and that the approach is consistent with how specialty care is generally administered, although it is not always mandated by the state. to textual changes to clarify the rules.
However, advocates say the rules fall outside the standards of care set by organizations including the World Professional Association for Transgender Health, and that there aren’t a smattering of gender clinics in the state anyway.
“This is bad and unnecessary bureaucracy, and we know what they’re trying to do — and they’re hoping to cut health care for as many people as possible,” said Dara Adkison, board secretary for the advocacy group TransOhio. “It’s not subtle.”
Mimi Rivard, a nurse practitioner and clinical director at the Columbus, Ohio clinic, said clinics are already successfully prescribing hormones without endocrinologists involved, and the state doesn’t have enough specialists to do the current work. nearly 60,000 Ohioans experience transgender.
Many transgender patients are wary of other medical conditions they see as unfriendly to more everyday needs, such as hypertension or diabetes, but clinics like hers treat them for those conditions, she said.
“We must act according to the oaths we take as caretakers,” Rivard said. “And these guidelines won’t allow that.”
He said patients who have surgery and stop hormones may be at risk for osteoporosis and extreme fatigue.
Dr. Carl Strid Jr., president of the Transgender Health Professional Association of America, which provides gender-affirming care in Boston. noted that abortion is the only other area in which states have considered preventing health care providers from providing services authorized by their licenses.
“The rules are strict. They are not following any standard of care,” Streed said. “It’s a veil of this false sense of security that will effectively lead to a ban.”
How the policy affects transgender patients may depend on where they are treated. Large academic medical centers providing gender-affirming care are already recruiting in-demand specialists.
Equitas Health, a Columbus-based nonprofit focused on LGBTQ health, strongly opposes the rules, but says it will comply with demands to continue offering gender-affirming care if the rules are finalized.
Advocates warn that care may not be available through small clinics or general practitioners, creating more barriers to care for low-income, minority and rural transgender people.
Adkison, who lives in Cleveland, expects her treatment to continue.
“I’m a white person who lives in a city near many large hospital systems,” they said. “I’m not as worried as a lot of my friends.”
In 22 other states, GOP-controlled governments have already imposed bans or restrictions on gender-affirming care for minors. Although it is still accepted policies aimed at adults is rare.
The only other restriction currently in place at the state level is in Florida, where the law went into effect last year requires the supervision of doctors any health care related to the transition and having these appointments in person. These rules have been onerous for people who receive care from nurse practitioners or use telehealth.
It’s unclear when Ohio’s rules will go into effect or what form they will take if they are finalized. The health department is accepting public comment until February 5; Public comment for the Department of Mental Health and Addiction Services proposal is only open until January 26.
Rhea Debussy, spokeswoman for Equitas Health, said the rules are also subject to review by a legislative committee, which is looking to make sure that something DeWine’s proposals do does not exceed the administration’s authority.
“He’s really done an impressive job in the last two weeks and made a lot of Democrats, a lot of progressives, a lot of conservatives and Republicans very angry at him in Ohio,” he said.
The measures were announced on January 5, the same day DeWine signed the executive order Prohibits gender-affirming surgeries for those under 18. Advocates expect the move to have little practical effect because such operations are rarely performed on minors.
“It’s brutal,” said Erin Upchurch, executive director of the Kaleidoscope Youth Center, a Columbus-based organization that serves young LGBTQ people. “It’s vindictive, mean and unnecessary.”