Ohio Is Poised To Become 2nd State To Restrict Transgender Health Care For Adults

This month, Ohio Gov. Mike DeWine announced proposals that transgender advocates say could block access to gender-affirming care provided by independent clinics and primary care doctors, leaving thousands of adults struggling for treatment and at risk .

Read more: Efforts to limit transgender health care to continue in 2024, targeting more adults

Ashton Colby (31) is concerned that the clinic where he has been receiving the testosterone he has been taking since he was 19 no longer offers it. A transgender man from Columbus believes he will finally be able to receive treatment from another provider that meets the new requirements. But even waiting a few months could result in Colby getting her first period in years.

"My mental health is under stress," Colby said. "It's a transgender feeling that I haven't felt in years, but now I feel empty because of my transgender experience."

DeWine announced the proposed rules in a series of actions that could push Ohio further than other states to regulate gender-specific care and make it the second state to impose restrictions on adult care.

He signed an executive order banning gender-affirmation surgery for minors, but vetoed a bill that would have banned any gender-affirmation care for minors. One house of the state legislature has already repealed it, and the other will vote Jan. 24 on whether to do so.

Read more: Trans youth fear what Louisiana's new health care ban will mean

"It's a policy project that's trying to make access to health care so expensive and so limited that people can't access it effectively," said Kellan Baker, executive director of the Whitman-Walker Institute, a Washington-based health organization. . departure for health problems. . The health of LGBT+ people.

The policy, aimed at caring for adults, is contained in proposed administrative rules released this month by the Ohio Department of Public Health and the Department of Mental Health and Addiction Services.

They will need psychiatrists, endocrinologists and medical ethicists to play a role in developing common treatment plans for gender confirmation patients of all ages. Patients under the age of 21 must complete at least six months of mental health counseling before undergoing gender confirmation treatment or surgery. Providers will not be allowed to refer minors for treatment elsewhere, such as clinics in other states.

In announcing the measures, DeWine said they would ensure safe treatment and make it impossible for underground clinics to operate.

The rules are not intended to prevent treatment for those already receiving it and are consistent with how specialty care is typically practiced, even if the practice is not always approved by the state, said DeWine spokesman Dan Tierney, who noted the administration has been open. . Change the wording to clarify the rule.

However, advocates say the rules go beyond the standards of care set by organizations such as the World Professional Transgender Health Association, and there are no gender clinics in the state anyway.

"This is bad and unnecessary red tape, and we know what they're trying to do -- and they're hoping to undermine health care for as many people as possible," said Dara Adkisson, board secretary for the advocacy group TransOhio. "It's not subtle."

Mimi Rivard, a nurse practitioner and clinical director of Ohio Central Health Center's Columbus Clinic, said clinics have already had success prescribing hormones without endocrinologists, and the state lacks specialists to do the current work. . . Serves about 60,000 residents. Ohio has transgender experience.

Many transgender patients are wary of other medical facilities because of common problems like high blood pressure or diabetes, which they perceive as hostile, but clinics like hers also treat them for those conditions, she said.

"We have to act according to the oath we took as trustees," Rivard said. "And these recommendations do not allow it."

Patients who have undergone surgery and stopped taking hormones may be at risk for osteoporosis and severe fatigue, he said.

Dr. Carl Strid Jr., president of the American Transgender Health Care Professional Association, which provides gender-affirming care in Boston, noted that abortion is the only area where states have stepped in and barred providers from providing services permitted by their licenses.

"The rules are strict. They don't meet any standard of care," Strid said. "It is this veil of this false sense of security that will actually lead to sanctions."

The impact of this policy on transgender patients may depend on where they receive treatment. Large academic medical centers that provide gender-affirming care already have the necessary specialists on staff.

Equitas Health, a Columbus-based nonprofit that specializes in LGBTQ+ health care, strongly opposes the rules, but also says it will and will continue to provide gender-affirming care if the rules are finalized.

Advocates warn that care may not be available at small clinics or primary care physicians, creating additional barriers to care for low-income, minority and transgender people in rural areas.

Adkisson, who lives in Cleveland, hopes his own treatment will continue.

"I'm a white male living in a city near several major hospitals," they say. "I'm definitely not as nervous as a lot of my friends."

GOP-controlled governments in 22 other states have already enacted bans or restrictions on gender-affirming care for minors. But policies aimed at adults are still rare.

The only other restriction currently in place at the state level is in Florida, where a law that went into effect last year requires doctors to oversee all transition-related treatment and make such appointments in person. These rules were stricter for people who received care from nurses or used telemedicine.

Read more: Florida's ban on gender-affirming care for minors also limits access to transgender adults

It's unclear when Ohio's rules might go into effect or what form they will take. The Department of Health is asking for public input until February 5; Public consultation on the proposal by the Department of Mental Health and Addiction is open only until January 26.

Rhea Debussy, a spokeswoman for Equitas Health, said the rules are being reviewed by a legislative committee tasked with reviewing whether they exceed the authority of the administration, which is what DeWine is proposing.

"He's done a very impressive job over the last few weeks of angering a lot of Democrats, a lot of progressives, a lot of conservatives and a lot of Republicans across the state of Ohio," he said.

The measures were announced on Jan. 5, the same day DeWine signed an executive order banning gender-affirmation surgery on anyone under 18. Lawyers expect that the decision will not have a practical effect, since such operations are rarely performed on minors.

"It's so brutal," said Erin Upchurch, executive director of the Kaleidoscope Youth Center, a Columbus-based organization that serves LGBTQ+ youth. "It's vindictive, it's evil and it's unnecessary."

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