NATIONAL NEWS

Ohio is poised to become the 2nd state to restrict gender-affirming care for adults

Jan 19, 2024, 9:02 PM

Ashton Colby is photographed in his apartment in Columbus, Ohio, on Thursday, Jan. 18, 2024. Ohio G...

Ashton Colby is photographed in his apartment in Columbus, Ohio, on Thursday, Jan. 18, 2024. Ohio Gov. Mike DeWine announced proposals this month that transgender advocates say could block access to gender-affirming care provided by independent clinics and general practitioners, leaving thousands of adults scrambling for treatment and facing health risks. Colby, 31, fears the clinic where he gets the testosterone he has taken since age 19 would no longer offer it. (AP Photo/Carolyn Kaster)
Credit: ASSOCIATED PRESS

(AP Photo/Carolyn Kaster)

Ohio Gov. Mike DeWine announced proposals this month that transgender advocates say could block access to gender-affirming care provided by independent clinics and general practitioners, leaving thousands of adults scrambling for treatment and facing health risks.

Ashton Colby, 31, fears the clinic where he gets the testosterone he has taken since age 19 would no longer offer it. The transgender Columbus man believes he could eventually be treated by another provider that would meet the new requirements. But even a few months’ wait could leave Colby experiencing a menstrual cycle for the first time in many years.

“My mental health has been stressed,” Colby said. “These are feelings related to being transgender that I have not felt in years, but now I’m thrown into feeling devastated about my experience as a transgender person.”

DeWine announced the proposed rules amid a whirl of activity that could push Ohio further than most other states in controlling gender-affirming care and make it just the second to set forth restrictions on adult care.

He also signed an executive order to ban gender-affirming surgery for minors but vetoed a bill that would ban all gender-affirming care for minors. One chamber of the state legislature has already overridden it and the other is voting Jan. 24 on whether to do so.

“It is a policy project that attempts to make it so onerous, so restrictive to get care, that people are functionally unable to do so,” said Kellan Baker, executive director of the Whitman-Walker Institute, a Washington-based organization focused on the health of LGBTQ+ people.

The policies focused on care for adults come in draft administrative rules released this month by the Ohio Department of Health and the state’s Department of Mental Health and Addiction Services.

They would require psychiatrists, endocrinologists and medical ethicists to have roles in creating facility-wide gender-affirming care plans for patients of all ages. Patients under 21 would have to receive at least six months of mental health counseling before starting gender-affirming medication or surgery. Providers would be barred from referring minors to treatment elsewhere, such as clinics in other states.

When he announced the measures, DeWine said they would ensure safe treatment and make it impossible to operate “fly-by-night” clinics.

The rules are not intended to stop treatment for those already receiving it and are in line with the way specialized care is generally practiced, even if the approach isn’t always state-mandated, said DeWine spokesperson Dan Tierney, who noted the administration is open to wording changes to clarify the rules.

Still, advocates say those rules go beyond the standard of care established by organizations including the World Professional Association for Transgender Health, and at any rate there are no sketchy gender clinics in the state.

“It’s bad and unnecessary bureaucracy, and we know what they’re trying to do — and they’re hoping to cut off 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 Central Outreach Wellness Center Ohio’s Columbus clinic, said clinics already successfully prescribe hormones without the involvement of endocrinologists and there aren’t enough of those specialists in the state to do the current work, plus serve an estimated 60,000 Ohioans of transgender experience.

Many transgender patients are wary of other medical settings, which they might see as unfriendly, for more routine needs like hypertension or diabetes, but clinics like hers also treat them for those conditions, she said.

“We have to behave in ways that are consistent with the oaths we’ve taken as caregivers,” Rivard said. “And these guidelines will not allow for this.”

Patients who have undergone surgery and stop hormones could be at risk for osteoporosis and extreme fatigue, she said.

Dr. Carl Streed Jr., president of U.S. Professional Association for Transgender Health, who provides gender-affirming care in Boston, noted abortion is the only other realm in which states have weighed in to bar health professionals from providing services allowed by their licenses.

“The rules are draconian. They don’t follow any standard of care,” Streed said. “It is a veil of this false sense of safety that will effectively lead to a ban.”

How the policy would affect transgender patients might depend on where they are treated. The big academic medical centers providing gender-affirming care already employ the required specialists.

Equitas Health, a Columbus-based nonprofit focused on LGBTQ+ health care, strongly opposes the regulations but also says it will fulfill the requirements to continue offering gender-affirming care if the rules are finalized.

Advocates warn the care might not be available via smaller clinics or general practitioners, creating more hurdles to care for lower-income, minority and rural transgender people.

Adkison, who lives in Cleveland, expects their own treatment to continue.

“I’m a white person living in the city near multiple major hospital systems,” they said. “I’m definitely not as concerned as many of my friends.”

GOP-controlled governments in 22 other states already have passed bans or restrictions on gender-affirming care for minors. So far, though, adoption of policies aimed at adults is rare.

The only other restriction currently in force at the state level is in Florida, where a law took effect last year requiring physicians to oversee any health care related to transitioning, and for those appointments to be in person. Those rules have been onerous for people who have received care from nurse practitioners or used telehealth.

It’s not clear when the Ohio rules might take effect, or in what form if they are finalized. The health department is taking public comment until Feb. 5; for the Department of Mental Health and Addiction Services proposal, public comment is open only until Jan. 26.

The rules also are subject to review of a legislative committee looking at whether rules exceed the administration’s power, something DeWine’s proposals do, said Rhea Debussy, spokesperson for Equitas Health.

“He’s really done an impressive job in the last two weeks, making a lot of Democrats, a lot of progressives, a lot of conservatives and Republicans across the state of Ohio very mad at him,” she said.

The measures were unveiled Jan. 5, the same day DeWine signed an executive order banning gender-affirming surgery for those under 18. Advocates expect the move will have little practical impact because such surgeries are almost never performed on minors.

“It’s very cruel,” said Erin Upchurch, executive director of Kaleidoscope Youth Center, a Columbus-based organization serving young LGBTQ+ people. “It’s vindictive, it’s mean and it’s unnecessary.”

National News

FILE - An Amazon worker delivers packages in Los Angeles on Oct. 1, 2020. July sales events have be...

Associated Press

Amazon Prime Day deals are almost here. Should you take advantage of them?

NEW YORK (AP) — It’s summertime, and the bargains seem easy at a time when many consumer prices are high. July sales events have become a seasonal revenue driver for the retail industry since Amazon launched its first Prime Day back in 2015. While consumers may be enticed by the advertised can’t-miss savings on some […]

3 hours ago

Associated Press

Shooting kills 3 people including a young child in a car on an Alabama street

Three people including a young child were killed when their car was targeted with multiple gunshots outside a residence in Birmingham, Alabama, on Saturday evening. The Birmingham Police Department said in a social media post that a triple homicide investigation was underway in the 3400 Block of 27th Street North. The police said officers responded […]

5 hours ago

Carlton Smith, left, and Justin Nimmo pose in from of the console of the Barton Opus 234 theater or...

Associated Press

Reviving Hollywood glamor of the silent movie era, experts piece together a century-old pipe organ

DETROIT (AP) — A massive pipe organ that underscored the drama and comedy of silent movies with live music in Detroit’s ornate Hollywood Theatre nearly a century ago was dismantled into thousands of pieces and stashed away. The Barton Opus, built in 1927, spent four decades stored in a garage, attic and basement in suburban […]

7 hours ago

FILE - Georgia Gov. Brian Kemp, left, and Centers for Medicare and Medicaid Services Administrator ...

Associated Press

Can a Medicaid plan that requires work succeed? First year of Georgia experiment is not promising

ATLANTA (AP) — By now, Georgia officials expected their new Medicaid plan, the only one in the nation with a work requirement, to provide health insurance to 25,000 low-income residents and possibly tens of thousands more. But a year since its launch, Pathways to Coverage has roughly 4,300 members, much lower than what state officials […]

7 hours ago

Catherine Ward, owner of One Acre Farms, a functioning educational farm to help special needs kids,...

Associated Press

After Beryl, Houston-area farmers pull together to face unique challenges

PORTER, Texas (AP) — Hurricanes cause trouble for everyone, but farmers have a whole other list of problems. Beryl has been no exception: Over the past week, the storm damaged crops, soaked rabbits and chickens, terrified goats, put horses at risk of developing colic and left cows without fences to keep them penned in. And […]

8 hours ago

Debris from the Titan submersible, recovered from the ocean floor near the wreck of the Titanic, is...

Associated Press

The first Titanic voyage in 14 years is happening in the wake of submersible tragedy. Hopes are high

PORTLAND, Maine (AP) — The company that owns the salvage rights to the Titanic is undertaking its first expedition to the ship’s wreckage in years, and those involved in the mission said they have both heavy hearts and lofty goals for a trip happening a year after a submersible disaster involving another firm killed five […]

8 hours ago

Ohio is poised to become the 2nd state to restrict gender-affirming care for adults