Ohio Gov. Mike DeWine earned plaudits just before the new year when he vetoed a ban on gender-affirming care for trans minors that the state Legislature had passed. Political pundits and onlookers portrayed DeWine as a compassionate Republican who was willing to step in to limit conservative extremism. But late Friday, the governor announced a new executive order and a set of rules from the state’s health department that could threaten access to gender-affirming care across the state, even for trans adults.
The governor announced a new executive order and a set of rules that could threaten access to gender-affirming care across the state, even for trans adults.
The new rules are designed to dramatically increase the administrative costs of providers of transition care throughout the state, by requiring providers to have a multidisciplinary team, including an endocrinologist and a psychiatrist, on staff or under contract. Further, the rules would require providers to notify the state of every gender dysphoria diagnosis along with some personal details of every patient.
Those under 21 would need to undergo a mandatory six-month waiting period and state-mandated psych evaluations before undergoing care.
All in all, the new rules could threaten the vast majority of the state’s gender care providers from providing such care. In a statement, the ACLU of Ohio said the executive order “could amount to a de facto ban on care for transgender youth and adults.”
The new state rules are subject to a public comment period, though DeWine has declared this issue so important that it deserves “emergency” status, meaning he seeks to forgo the usual state administrative rulemaking process.
Implementing the new rules would put Ohio right next to Florida on a list of most anti-trans states. Florida has similarly implemented rules over the last year that have served to cut even trans adults off gender-affirming care.
But to truly understand the moves the governor is making against transition care, you have to understand where these rules were first developed: the anti-abortion movement.
These new anti-trans rules in Ohio are very similar to the so-called TRAP laws utilized by anti-abortion politicians.
These new anti-trans rules in Ohio are very similar to the so-called TRAP laws utilized by anti-abortion politicians. “TRAP” stands for Targeted Restrictions on Abortion Providers.
TRAP laws are hyper-specific and designed to make it untenable for health care providers to stay open. Years ago, on a media tour held after-hours at an abortion provider in Philadelphia, a member of the staff pointed out to us their expensive new ventilation system.
They didn’t need a new ventilation system. They were forced to install it by the state of Pennsylvania, whose lawmakers had attempted to shut down abortion providers by requiring only abortion providers among medical providers to have an expensive class of ventilation system, even though it wasn’t needed in order to continue operations.
The ventilation requirement was a TRAP law. Lawmakers weren’t expecting the clinic to raise the funds and be able to install the system in their multistory office building.
These laws are typically hyper-focused and designed to shut down individual providers, often with the false claim that the laws will improve the quality of care or give added protections to patients. The tell in Ohio was DeWine saying, as he signed his executive order, that he hoped trans people would see an increased quality of care.
Gov. DeWine is inserting himself into the private medical lives of all the trans people in his state, while also portraying himself as some great compromiser because of his veto. It’s incredibly cynical. The governor has shown himself to be perfectly willing to put conservative politicians in charge of parts of the health care system they don’t like, like abortion care, and now he’s doing the same with transition care. Abortion bans and transition bans are political cousins, both being targeted by the birthrate-obsessed conservatives. For politicians like DeWine, abortion and transition care are inherently linked. Conservatives falsely see transition care as medically removing the ability to have biological children in heterosexual relationships even though recent studies have shown its possible to become fertile again if trans people temporarily take themselves off cross-sex hormone treatment. Abortion bans and transition bans are political cousins, both being targeted by the birthrate-obsessed conservatives in charge of Ohio and other red states. But their prescription for this issue causes more harm than good. Shutting down the vast majority of the state’s gender-affirming care providers, as this executive order would do, will in no way benefit the quality of life of the state’s trans patients. If the choice is using illegal means to access care or having no care at all, trans people will choose the black market. At some point, we need to have a national, or perhaps international, conversation about the potential harms of do-it-yourself transition care as a result of all these increased restrictions and bans on our care. DIY transitioning has been a thing for as long as medically transitioning has been a thing, and it used to be much more common within the trans community before insurance companies started covering transition care around 2016. Anti-trans campaigners envision a future world where the entire trans population is unable to ever medically transition. They see it as the easiest way to get rid of the people they’re bigoted against, and they’ve weaponized conservative lawmakers against the tiny portion of the population that is trans. But in reality, the world they want to create would still have trans people, just trans people who get their hormones or surgeries from outside the medical system. Trans people used to die from secretive, underground bottom surgeries, and health issues frequently popped up among those who got black-market hormones with self-prescribed dosages. We must avoid returning to a world where trans people are forced to turn to dark-market providers for their lifesaving medical needs, and that means we must vigorously and vocally oppose DeWine’s onerous government overreach into the private lives of trans people. The quality of transition care depends on it.
Katelyn Burns is a freelance journalist based in New England. 
