Ohio Gov. Mike DeWine issued an executive order Friday that will ban all gender-affirming surgeries for minors. The Republican also announced new administrative rules for transgender youth and adults seeking care in the state.
DeWine’s order comes a week after he vetoed House Bill 68, which would have banned all gender-affirming care for minors, including puberty blockers and hormone therapy. Those treatments are the most common forms of care for transgender youth. The governor initially said that if he were to sign the bill, which also would bar trans students from participating in sports, the state would be interfering with parents’ medical decisions for their children.
“A week has gone by, and I still feel just as firmly about that as I did that day,” he said at a news conference Friday morning. “I believe that parents, not the government, should be making these crucial medical decisions for the children.”
Gender-affirming surgery for minors is extremely rare and usually comes in the form of a double mastectomy, also known as top surgery, to relieve chest dysphoria for transmasculine youth.
The president of the Ohio Children’s Hospital Association, Nick Lashutka, who testified before the state legislature, told WCMH-TV, an NBC affiliate in Columbus, that the state’s children’s hospitals never perform any surgeries on minors for gender dysphoria.
DeWine’s executive order makes Ohio the second state to specifically ban surgeries for transgender youth. Arizona passed a similar law in 2022.
While the Ohio General Assembly has signaled that it may overturn the governor’s veto next week, DeWine’s administrative rules extend beyond the scope of House Bill 68 to include new provisions for trans adults as well as trans youth.
DeWine said he is concerned about “fly-by-night” clinics that offer hormone therapy to adults “without the lead-in psychiatric care that we know is so very, very important.”
The rules would require patients to work with a multidisciplinary team of health providers, including endocrinologists, bioethicists and psychiatrists; require patients to receive information about the risks of gender-affirming care and to give their informed consent before treatment; and require patients to undergo counseling before receiving hormone therapy or other treatments for gender dysphoria.
DeWine said the Ohio Department of Health and the Ohio Department of Mental Health and Addiction Services would adopt and enforce these rules after a public comment period. The agencies would also collect aggregated “de-identified data” on cases of gender dysphoria and treatments.
These new rules create administrative burdens not only for transgender youth but also adults, and they fall in line with emergency orders and administrative rules that other Republican officials enacted last year to curb access to gender-affirming care. More than 20 states enacted bans on gender-affirming care for youth in 2023.
Last spring, Missouri Attorney General Andrew Bailey issued an emergency order that required adults and minors to undergo more than a year of therapy and mental health assessments before accessing care. Though the rule was terminated in May after a St. Louis County judge blocked its enforcement, it had a chilling effect on the trans community and forced some providers to stop prescribing hormones to adult patients.
In Florida, a state law that barred trans youth from receiving gender-affirming care also saddled adults with new requirements to access care. The law required patients to not only sign informed-consent forms in person but also forced them to obtain prescriptions from physicians, and not nurse practitioners, for hormone therapy. The law also barred the use of telehealth for new prescriptions.
In practice, many advocates for the trans community have said that these restrictions impose an undue burden on transgender people.