The 33-year-old Dayton resident, who identifies as a genderqueer transgender man, had top surgery a few years ago and began taking low-dose testosterone for his transition and other physical conditions. Last year, he and his partner made a decision: If Ohio restricts gender transition care, it’s time to go.
That time is now. As the Legislature overrides Gov. Mike DeWine’s veto of House Bill 68, the governor has proposed rules that would regulate treatment for Ohioans with gender dysphoria. House Bill 68 applies to minors, so it won’t affect Greenberg if enacted − but the administrative rules would.
Knowing that, Greenberg and his partner have started planning a move to Chicago − a decision that may cost some of their savings and retirement fund.
“I don’t think that it makes sense for me to waste a bunch of money and time and energy … on spending money on a state that doesn’t want me here,” Greenberg said in an interview. “I’d sooner put that money in someone else’s economy, thanks very much. It makes more sense for us to move to a place where I can live a normal life like everyone else.”
DeWine vetoed House Bill 68 because he believes decisions about a young person’s gender transition should be made by families and their doctors. He said the proposed rules will help the state collect data on gender transition care and ensure patients receive comprehensive treatment.
“Before anybody makes any decision about what to do, whether an adult or a child, clearly the best practice is to have that counseling,” DeWine told the USA TODAY Network Ohio Bureau. “That’s all we were trying to do with that, is to make sure that people got good care.”
But some health care providers say the rules fly in the face of current practices and could send Ohio back in time.
What are DeWine’s proposed rules?
Under one of DeWine’s proposals, providers must have a “contractual relationship” with a psychiatrist and endocrinologist to treat gender dysphoria. They would also be required to create a written, comprehensive care plan that’s reviewed by a medical ethicist. Patients under 21 would have to undergo six months of counseling before further treatment occurs.
DeWine spokesman Dan Tierney said the rule would apply to future care, not treatment that’s already taking place.
DeWine’s administration proposed a second rule that would require providers to report nonidentifying data on gender dysphoria and treatments, something the state does for flu cases and abortions.
DeWine said the first rule would prevent “fly-by-night” clinics from providing hormones or other treatment without providing mental health care. Rep. Gary Click, R-Vickery, who sponsored House Bill 68, said he appreciates the governor’s proposals and contends clinics like Planned Parenthood have lax procedures for prescribing hormones.
“Adults should be able to make their own decisions,” Click said earlier this month. “I think like anything else, there are some safety regulations that should go along with that. They need to have a doctor who’s following up with them and checking their bloodwork, things like that, to make sure that it’s safe for them to do that.”
Providers say therapy can be an important part of someone’s gender transition or necessary to ensure the patient can provide informed consent about treatment. At the same time, they emphasize that being transgender is not a mental illness.
Counseling requirements could present another barrier to care, and in some cases, therapists may not be equipped to address gender-related concerns, said Teagan Vaughn, director of gender-affirming care at Equitas Health.
Greenberg said it took him five years to find a therapist who didn’t say he “needed to learn to accept and love myself as a woman.”
“(DeWine) is acting like trans people can’t be trusted if this is the choice they want to make,” Greenberg said.
‘I have always been me’
The mental health requirements are just one piece of the puzzle.
Some of Ohio’s larger hospital systems have endocrinologists, ethicists and psychiatrists in their networks. Representatives for Cincinnati Children’s Hospital, Cleveland Clinic and Ohio State’s Wexner Medical Center declined to make someone available for an interview.
Other clinics have working relationships with those specialists, but Vaughn of Equitas Health said they rarely refer patients to an endocrinologist unless the person has hormonal abnormalities outside of their transition care. And ethicists are hard to come by.
“This mirrors the first steps in restricting abortion care that Ohio went through, as well as other places in the country,” said Adarsh Krishen, chief medical officer for Planned Parenthood of Greater Ohio. “This is a playbook that’s been used previously and creates additional barriers to health care in a state where people have challenges accessing health care anyway.”
Krishen said Planned Parenthood provides hormone treatment for adults − which involves an initial visit and follow-ups − and will address underlying health issues before starting someone on medication. The organization plans to comply with any new rules that go
into effect, but Krishen believes it will be harder for some clinics to do so.
The result, he argued, could be more expensive care that’s difficult for Ohioans to access − which DeWine said is not the goal.
“We do not want to deny care,” DeWine said. “We have an opportunity now to have input, and we’re starting to see input coming back. We want to hear from people about that, and we’re going to listen to that input. That’s the process that we are in now.”
The proposed rules won’t be enacted for some time and could change, but Greenberg isn’t waiting around for the final outcome. He and his partner plan to put their house on the market soon. It’s a hard pill to swallow: Greenberg was born in Dayton, and he said he’s been able to reconnect with his roots since moving back in 2018.
But he’s also “not willing to go back in the closet.”
“I have always been me inside,” Greenberg said. “My soul, my essence has never shifted. It is just what people made of it that shifted.”
Can I weigh in on DeWine’s proposed rules?
Ohioans can submit feedback on the data collection proposal by emailing [email protected]. The deadline is Feb. 5.
Public comment for the proposed transition care rule ended on Friday. The Ohio Department of Mental Health and Addiction Services will review the input, potentially make changes and hold public hearings, per the rulemaking process.
Haley BeMiller is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.
