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The rules would collect data on transgender medical care and modify the treatment of those with gender dysphoria, requiring medical consent from a psychiatrist, an endocrinologist and a bioethicist before moving forward with treatment.

BY: MEGAN HENRY –  Ohio Capital Journal

Ohio transgender adults are deeply concerned Gov. Mike DeWine’s proposed administrative rules would make it harder for them to access gender-affirming care.

DeWine announced two proposed rules earlier this month that would collect data on transgender medical care and modify the treatment of those with gender dysphoria, including requiring patients under 21 undergo six months of counseling before receiving more treatment.

“Anytime the government is telling its citizens what they can and cannot do with their own bodies, it sets a very, very, very dangerous precedent,” said Vincent-Natasha Gay, a transgender adult who lives in central Ohio.

The rules are just proposals at this point and have not gone into effect. Ohioans still have time to submit comments regarding the proposed rules.

“They need to not be implemented,” said Lis Regula, a transgender man living in Columbus. “It would make us the worst state in the entire nation for adults and children who want to obtain gender-affirming care.”

A major issue Terry Brown has with the administrative rules is that they deal with adults.

“You’re talking about restricting people who are classified as adults in the eyes of the law,” Brown, a trans man, said.

The Ohio Senate Democratic Caucus recently sent a letter to DeWine expressing their concerns about how the proposed rules could get in the way of adults accessing gender-affirming care.

“While these rules may have been drafted with the intention of taking a more pragmatic approach than the legislature, in reality, this proposal could make it more difficult for trans Ohioans to receive the life-saving medical care that they need,” the letter said. “The proposed rules go even further than House Bill 68 by interfering with the lives and medical care of both trans children and trans adults.”

House Bill 68 would ban gender-affirming care for trans youth. DeWine vetoed HB 68, but the House voted to override his veto last week. The Senate will vote to override the veto on Wednesday next week.

One of the proposed administrative rules would require obtaining medical consent from a psychiatrist, an endocrinologist, and a bioethicist before moving forward with treatment.

DeWine’s spokesperson Dan Tierney said this rule would only apply to people who start receiving treatment after the rule takes effect.

“It’s the Department of Health’s intention that it applies to treatment that starts moving forward after the enactment of the rule,” Tierney said. “That’s the way House Bill 68 was written. We intend this to be consistent with that.”

Lawmakers added a grandfather clause to HB 86 that would allow doctors who already started treatment on patients to continue.

But transgender adults argue the language of the proposed rules is vague and ambiguous.

“I feel like that was not very clear at all,” Brown said. “Because of that vagueness, we really still don’t know how it’s going to be applied.”

This just leaves Regula with more questions about continuing care.

“That doesn’t address if someone has to put a pause on things for some reason if they’re going to be able to get back to their treatment,” Regula said.

Vincent-Natasha Gay is currently receiving gender-affirming care and would be considered grandfathered in under the proposed administrative rules.

“But that shouldn’t matter,” Gay said. “There are so many people out there who are trans and just don’t know they’re trans yet, or are in the closet and hiding because they’re afraid for their life. And my goodness, with these proposed rule changes, that’s just going to make that even worse.”

Health experts say it would be harmful if someone who’s already receiving treatment abruptly stopped, Tierney said.

“That could have some negative health consequences,” he said. “That’s certainly not the intent for anything along those lines.”

Instead, Tierney said these rules are meant to prohibit health care providers from giving treatment without consultation.

“Most of the providers are doing this in the comprehensive, multidisciplinary way, anyways, so they would likely be in compliance with the rule,” he said.

The proposed rule doesn’t mean people have to sit down with a psychiatrist, an endocrinologist, and a bioethicist, Tierney said

“The bioethicist helps develop how each facility is going to deal with cases of how the treatments occur at that particular facility,” he said. “At the very least, mental health care is generally provided by the psychiatrist, not the endocrinologist, and endocrinology is generally provided by the endocrinologist, not by the psychiatrist.”

But Ares Page is concerned about adding people to the medical team that might not have proper training in treating transgender patients.

“I don’t see where that’s going to be safe, and where that’s going to help us improve our safety,” said Page, a transgender adult living in Akron.

Page is also worried how much extra it will cost to add these specialists to a person’s medical team.

“Some people’s insurance companies may not allow them, or approve them for these specialists,” Page said.

Ohioans have until 5 p.m. Friday to give feedback on the proposed transition care rule by emailing out to MH-SOT-rules@mha.ohio.gov with the subject line, “Comments on Gender Transition Care Rules.”

Data Collection

The second proposed administrative rule would require data collection around gender-affirming care, including requiring a health care provider to report non-identifying treatment for “gender-reassignment surgery, gender-transition services, genital gender reassignment surgery,” according to the proposed administrative rules.

Under the proposed administrative rules, the Ohio Department of Health would share the aggregate data collected with Ohio lawmakers starting Jan. 31, 2025.

But many transgender adults question why the data collection is necessary.

“You can assign a code …  But there always has to be a place where my name goes back to the code,” Brown said.  “That is a problem.”

Having a common data set on medical treatment will help people make an informed decision, Tierney said, who explained ODH collects data on things like pediatric flu deaths, food poisoning and abortion.

“It’s all de-identified, it’s all aggregate,” Tierney said. “There’s really no way you could identify any patient from the data.”

But people are concerned it would be hard to have the data be completely anonymous, especially for folks who live in a small community.

“If it’s a matter of three (trans) people in a community and a doctor’s office or hospital system is treating all three of those people, how do you really anonymize three folks?” Regula said.

Feedback for the data collection proposal must be sent to ODHrules@odh.ohio.gov by Feb. 5.

Despite these proposed rules and ongoing legislation targeting trans youth, most people interviewed for this story say they would like to stay in Ohio if they can.

“This is my home,” Regula said. “I’m an Ohio boy born and bred. I was raised here, my family is here. … I can’t imagine leaving home …  I also want to be able to make sure that my daughter and I have the medical care that we need.”

But Page has contemplated leaving the country altogether.

“(The government) has no right to tell me what to do with my body,” Page said.

Follow OCJ Reporter Megan Henry on X.