New regulations could force trans Ohioans like me to detransition. I’m terrified.

On the first Friday of 2024, Ohio Governor Mike DeWine (R) hosted a press conference in response to conservative outcry over his veto of the anti-trans bill H.B. 68, which would have banned all gender-affirming medical treatments for minors (including medication) as well as transgender women from female scholastic sports. 

Explaining that he spoke to people on both sides of the aisle about trans rights, he proceeded to announce a slate of proposed new laws and regulations.

Related:

Ohio’s governor just made life a lot harder for transgender people

Mike DeWine’s new draft rules would impose restrictions on gender-affirming care for adults.

Most media coverage focused on his announcement of an executive order that banned gender-affirming surgery for minors (something that by and large does not happen), but far more egregious are the regulations he announced for Ohio health agencies. These regulations propose the strictest guidelines in the nation for adult transgender care.

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“As they stand, these have the potential to eliminate care for thousands of trans children and adults in Ohio,” Carson Hartlage, a trans medical student in Ohio, told LGBTQ Nation. “For those who do access care, waiting time and costs could increase. This will fall disproportionately on trans people of color and trans people in rural communities who already face barriers to care.” 

The proposed regulations are split into three separate documents as draft rules under the Ohio Department of Health (ODH), along with two rules under the Ohio Department of Mental Health & Addiction Services (ODMH). 

For a draft rule to become law, it must go through an initial review process by interested parties, followed by a filing with Ohio’s Joint Committee on Agency Rule Review (JCARR). This initial period typically lasts 30 days (though the ODMH rules only have a comment period of two weeks). Following this period, JCARR holds an additional public comment period, this time including oral testimony. Following additional reviews by the Committee and one final period during their review, a draft rule can be turned into law.

The ODH draft rules (3701-3-17, 3701-59-07, and 3701-83-61) focus primarily on restricting adult transgender care. One of their main goals is to mandate that each individual patient receiving gender-affirming care has a care team consisting of an endocrinologist, a psychiatrist, and a bioethicist who each approves or facilitates their care. 

This is entirely unrealistic and will trap essential medical care behind bureaucratic walls. As we’ve seen in Florida and Missouri, a regulation like this will essentially bring all gender-affirming care to a standstill. Many clinics may cease to offer this care because it’s easier than trying to work around these new restrictions.

“Providers may also… leave the state altogether, draining Ohio of medical experts who treat cisgender patients, too,” Hartlage says. 

These regulations are especially harmful when you consider that – based on my research – Ohio has no official certifications for a bioethicist, making it dubious as to how clinics can comply with these new rules while finding someone unbiased and qualified. There are also very few people who market themselves as professional bioethicists in the state, creating even more strain on both trans people and the medical community.

In essence, thousands of trans people will be forcibly detransitioned, with potentially months or even years until they can hope to transition again without leaving the state. The proposed laws have been compared to anti-abortion TRAP laws, which have shut down clinics in states restricting abortion access.

Further restrictions are placed on those under 21. The proposed rules would make it mandatory for “minors” to receive a minimum of 6 months of therapy and psychiatric evaluations before transitioning. There is a small grandfather clause for those currently transitioning, but considering the other proposed guidelines, these individuals will still likely be forced to detransition, and many others will find it hard to even begin the process.

The ODH regulations conclude with a proposal for mass surveillance of transgender people. They would require providers to send detailed information including demographic information, information on who the providers are, and specific care plans to the state government. It would even require tracking of every single gender dysphoria diagnosis. While these would be anonymized to some degree, it nevertheless creates a database of everyone in Ohio who is transitioning. This gives the state far too much power over trans people and sets a dangerous precedent for the rest of the country.

“As a future physician, I am frustrated that I have to train in a state where our government continues to try to interfere in the practice of medicine,” says Hartlage. “I’ve already heard from multiple classmates that they no longer intend to pursue residency training in Ohio due to what’s been going on with trans healthcare.” 

As for the ODMH regulations, as stated they’re divided into two separate regulations. O.A.C. 5122-26-19 is effectively the same as the ODH regulations that seek to restrict who can receive gender-affirming care. 

O.A.C. 5122-14-12, on the other hand, is notable, as it would ban transitioning for those in psychiatric units if they’re under 21. This is incredibly dangerous, as those in psychiatric units are already an extremely vulnerable population. Taking away necessary care from folks in these units could be a death sentence.

In short, these regulations would lock away essential, lifesaving care. If they take effect, many will be forced to flee the state, and the many more who are unable to leave will face state-mandated detransitions. 

I’m a trans Ohioan, and I’m currently trying to scrape together a plan for how I’d abruptly leave the state so I can keep transitioning. If the rules pass and I stay, I will be forced to detransition.

But it’s not too late to fight back.

Therapist Jessica Kant put together a detailed list of ways to voice opposition to Ohio lawmakers, including means to reach out to the ODH and ODMH –  the public comment deadlines are February 5 and January 19, respectively – as well as the committee that’ll be reviewing the proposed rule changes.

“People can submit public comment, raise trans voices, amplify messages from advocacy organizations, and donate to mutual aid and emergency funds such as the Trans Ohio Emergency Fund,” says Hartlage.

If you care about trans lives, please say something. We need all hands on deck to make it clear that this is not something people want, that this will needlessly hurt so many trans people and uproot so many lives. We can’t let draconian, anti-trans laws strike another state.

Editor’s Note: This article initially stated there was no grandfather clause for those currently transitioning in regard to the proposed rule requiring 6 months of therapy before transitioning. It has been updated to reflect that a small grandfather clause is included for those currently transitioning.