Ohio’s Republican Governor Seeks Harsh New Restrictions on Adult Transition
There’s no evidence that requiring six months of therapy for adults under age 21 is necessary, nor that requiring all clinics to have a multidisciplinary team will improve patient outcomes.
by Evan Urquhart
On Friday, Ohio Governor Mike DeWine followed up his veto of the legislature’s ban on all gender-affirming care for minors in the state with an announcement of a spate of tough new regulations that would impact healthcare for all trans people in the state, with particularly tough requirements for young adults in the 18-21 age group. The result, if the regulations go into effect, would likely be a dramatic loss of access to hormone therapy for adult trans people in Ohio.
The regulations impact hospitals and healthcare facilities in Ohio, and bar them from diagnosing or treating gender dysphoria unless they meet a number of conditions. These include involving both a psychiatrist and an endocrinologist in the treatment of every patient, and a 6-month therapy requirement for adult patients under the age of 21.
These regulations are concerning to members of the trans community in Ohio and beyond because they represent a much higher set of requirements for treating gender dysphoria than exists for other treatments, and many clinics where patients access affordable care would not currently meet these standards. In addition, there’s no evidence that requiring two different doctors with two completely different specialties is necessary for the vast majority of patients. Hormonal treatments are not new or experimental, and their effects have been well studied in both transgender and cisgender individuals, so an endocrinologist’s specialized knowledge would only be required in cases that deviated from the standard outcome. A psychiatrist is perhaps even more unnecessary: Psychiatry is concerned primarily with prescribing and monitoring psychoactive medications for people suffering with mental illness. Trans identity is not considered a mental illness and specialists in treating typically come from endocrinology. For trans patients not suffering from any major mental illness it’s unclear what role a psychiatrist could even play in their treatment.
The therapy requirement for those under 21 is also quite concerning, though not because therapy isn’t a useful thing for people seeking to transition to access. However, therapists specializing in treating the transgender community are rare, and waiting lists to see them are already lengthy in Ohio, according to local members of the community.
For those who have not experienced gender dysphoria it can be difficult to understand how urgently treatment for it is needed because many cisgender people still implicitly think of gender-affirming care as optional or cosmetic. Instead it is much like other forms of healthcare, where a long wait to address an issue means additional discomfort and, potentially, a worsening crisis.
A large number of trans adults in America receive care from nurse practitioners in clinics that would likely struggle to meet the guidelines proposed in Ohio. One estimate suggests that as many as 80 percent of trans adults get their care from a nurse practitioner. Some trans people who have had a surgery that impacts their bodies ability to produce hormones would face severe side effects from being without their medication. Others would face forced detransition. As the trans community watches restrictions on adult treatment expand beyond Florida fear and uncertainty are widespread as access to hormone therapy looks increasingly threatened.
