Ohio Gov. Mike DeWine this month announced a proposal that transgender advocacy groups say could impede access to gender-affirming care provided by independent clinics and general practitioners. Thousands of adults will have to fight for treatment and face health risks, it said.
read more: Efforts to restrict medical care for transgender people will continue until 2024, targeting more adults
Ashton Colby, 31, is concerned that the clinic that administers the testosterone he has been taking since he was 19 will no longer offer it. Transgender men in Columbus believe they will eventually be able to be treated by another health care provider who meets the new requirements. But even if she waits just a few months, Colby could experience her first menstrual cycle in years.
“My mental state is stressed,” Colby said. “These feelings associated with being transgender are something I haven't felt in years, but now I feel defeated by my experience as a transgender person.”
DeWine's proposed rule comes amid a whirlwind of activity that would push Ohio toward more gender-affirming care regulations than most other states, making it the second state to place restrictions on adult care. announced.
He also signed an executive order banning gender reassignment surgery for minors, but vetoed a bill that would ban all gender reassignment care for minors. One chamber of the state Legislature has already killed the bill, and the other chamber is voting on whether to do so on January 24th.
read more: Transgender youth 'afraid' of what Louisiana's new medical ban means
“This is a policy project that seeks to make access to care so onerous and restrictive that people are unable to functionally access care,” said Whitman, a Washington-based organization. – Kellan Baker, executive director of the Walker Institute. Health of LGBTQ+ people.
The adult care-focused policy is included in a draft administrative rule released this month by the Ohio Department of Health and the state Department of Mental Health and Addiction Services.
Psychiatrists, endocrinologists, and medical ethicists will be asked to play a role in developing facility-wide gender-affirming care plans for patients of all ages. Patients under the age of 21 must undergo at least six months of mental health counseling before beginning gender-affirming medications or surgery. Health care providers would be prohibited from referring minors for treatment elsewhere, including clinics in other states.
When DeWine announced the move, he said it would ensure safe care and make it impossible for “night-time” clinics to operate.
DeWine spokesman Dan Tierney said the rule is not intended to halt treatment for people already receiving treatment, even though that approach is not necessarily mandated by the state. He noted that the administration is open, saying that it is consistent with how professional treatment is generally practiced. Change the wording to clarify the rule.
Still, advocates say these rules go beyond the standard of care set by groups such as the World Professional Association for Transgender Health, and that there are no opaque gender clinics in the state anyway.
“This is egregious and unnecessary bureaucracy, and we know what they're trying to do, and they're trying to improve health care for as many people as possible,” said Dara Adkison, executive director of the advocacy group TransOhio. I hope that it will be discontinued.” “It's not subtle.”
Mimi Rivard, a nurse and clinical director at Ohio Central Outreach Wellness Center's Columbus clinic, said the clinic has already been successful in prescribing hormones without the involvement of an endocrinologist, and the state He said there were not enough professionals within the country to provide medical services in addition to their current jobs. An estimated 60,000 Ohioans have a transgender background.
Many transgender patients have everyday needs like high blood pressure or diabetes that make them wary of other medical settings as unfriendly, but clinics like hers also treat those conditions. She said there was.
“We must live up to our oath as caregivers,” Rivard said. “And these guidelines do not allow this.”
Patients who have surgery and stop taking hormones may be at risk for osteoporosis and extreme fatigue, she said.
Dr. Carl Street Jr., president of the American Association of Transgender Health Professionals, which provides gender-affirming care in Boston, said the state would seek to prohibit health care professionals from providing services recognized by their licenses. He noted that the only other area being considered is abortion.
“The rules are strict. They don't follow any standard of care,” Streed said. “It is this veil of false security that leads to a de facto ban.”
How this policy affects transgender patients may vary depending on where they receive care. Large academic medical centers that provide gender-affirming care are already hiring the professionals they need.
Equitas Health, a Columbus-based nonprofit focused on LGBTQ+ health care, strongly opposes the regulation but would like to see requirements to continue providing gender-affirming care if the rule is finalized. It also states that it satisfies the requirements.
Advocates warn that this care may not be available in small clinics or general practitioners, creating additional hurdles to care for low-income, minority and rural transgender people. There is.
Adkisson, who lives in Cleveland, is hopeful that their treatment will continue.
“I am a white man who lives near several major hospital systems in the city,” they said. “I'm not as worried as many of my friends.”
Republican-controlled governments in 22 other states have already passed bans or restrictions on gender-affirming care for minors. However, to date, policies aimed at adults have rarely been adopted.
The only state-level restrictions currently in place are in Florida, where a law enacted last year requires doctors to oversee transition-related medical care and that appointments must be in-person. These rules were onerous for people who received care from nurses or used telemedicine.
read more: Florida's ban on gender-affirming care for minors also limits access for trans adults
It's unclear when Ohio's rules will go into effect or how they would be enforced if finalized. The health department is accepting public comments until February 5th. Public comments will only be accepted until Jan. 26 on the Department of Mental Health and Addiction Services proposal.
The rule, like DeWine's proposal, will also be subject to review by a legislative committee that considers whether the rule exceeds the administration's authority, said Lea Debussy, a spokeswoman for Equitas Health. That's what it means.
“He's done a really great job the last two weeks and made a lot of Democrats, a lot of progressives, a lot of conservatives, Republicans across the state of Ohio very angry at him,” she said.
The measure was announced on Jan. 5, the same day DeWine signed an executive order banning gender reassignment surgery for people under 18. Supporters predict the measure will have little practical impact because such surgeries are rarely performed on minors.
“This is so cruel,” said Erin Upchurch, executive director of Kaleidoscope Youth Center, a Columbus-based organization that serves LGBTQ+ youth. “It’s vindictive, mean and unnecessary.”
