Gov. Mike DeWine speaks with reporters at the Greater Columbus Convention Center on Nov. 13, 2023. (Jeremy Pelzer, cleveland.com)

New rules regulating how minors and adults receive transition care are in effect following Gov. Mike DeWine’s contested veto of a bill concerning transgender care and athletic eligibility.

One week after DeWine vetoed House Bill 68, which prevents doctors from prescribing medical treatments to minors for gender dysphoria and prohibiting transgender girls or women from participating in high school and college sports, he issued an executive order on the matter, banning gender reassignment surgery for minors and proposing new administrative rules to govern transgender health care for adults.

Eyes have returned to House Bill 68 as a Wednesday vote in the Ohio House of Representatives to override DeWine’s veto prevailed, leaving the bill’s fate in the hands of the Ohio Senate and a Jan. 24 session.

If overridden in the Senate, the bill will go into effect within 90 days of the vote. 

In the meantime, DeWine’s proposal of rules, filed within the Ohio Department of Mental Health and Addiction Services, is subject to public comment until Friday and will go into effect afterward. It requires that patients under 21 receive a mental health evaluation and at least six months of mental health counseling before moving on to treatment. Medical providers must have a contractual relationship with a board-certified psychiatrist and an endocrinologist, a doctor who specializes in hormone-related conditions.

Similarly, doctors are required to have a care plan reviewed by a medical ethicist. Additionally, patients or their parents must give informed consent after receiving information about treatments that “can and cannot be fully or partially undone or reversed.”

DeWine also announced that the Ohio Department of Health has filed rules that will require medical providers to report data on cases of gender dysphoria and related treatments without recognizable personal information. The public comment for this proposal is open until Feb. 5.

Gender dysphoria is the psychological distress that comes from incongruence between a person’s sex assigned at birth and their gender identity, according to the American Psychiatric Association.

Calliope Mackowski, a first-year in English and a member of Trans*Mission, a student organization for transgender and gender non-conforming students, said these new rules will harm the transgender community.

“In a day and age where trans people are still a minority group that is vitally hated by conservatives and by a large number of people in power, any step to oppress our ability to access health care that we need is a step in the wrong direction,” Mackowski said.

DeWine’s press secretary, Dan Tierney, said the governor had determined counseling should be comprehensive because two-thirds of those who receive therapy for gender dysphoria do not go on with further treatment, according to data from the Ohio Children’s Hospital Association.

According to excerpts from the Ohio Senate Government Oversight Committee’s Dec. 6, 2023, legislative testimony, the association’s President and CEO Nick Lashutka said this data comprised 3,300 individuals under the age of 18.

Jian Neo Chen, associate professor of women’s, gender and sexuality studies and a member of the transgender community, said medical establishments already have protocols in place to assist transgender youth, which makes counseling restrictions unnecessary.

“This added requirement is an effort to further police trans youth, ultimately, and to exert even more pressure and restrictions on their lives, their survival, their autonomy,” Chen said.

Those under 21 who are already receiving medical treatment will not have to halt their plans, Tierney said.

“The purpose of the rules is to address what should happen before other treatments are even considered,” Tierney said.

Chen said he is also concerned about how requiring providers to work with psychiatrists, endocrinologists and medical ethicists might impact accessibility to care.

“It’s gonna take it back decades and decades to a really primitive way where it’s not really going to be care at all,” Chen said. “It’s actually just erecting not only barriers, but folks are really trying to shut down folks’ ability to access care.”

According to Tierney, accessibility to transgender care will not be impacted heavily by the administrative rules, as the government is “not aware of it being provided in the state in other fashions.”

“[Gender dysphoria] that is sought to be treated by the family and by the patient does involve these specialty practitioners by nature,” Tierney said.

In terms of the data to be provided to policymakers regarding gender dysphoria care, Tierney said patients should not worry about their identity being revealed as the de-identification practice is the “classic public health model.”

“We’re not reporting on individual people here,” Tierney said.