Counterpoint: Ohio trans youth care ban veto was a victory for a gatekeeping surveillance state targeting trans adults

On Friday, December 29, Ohio governor Mike DeWine announced a ban on gender-affirming surgeries for transgender minors as well as new restrictions on clinics providing gender-affirming care to adults. But you wouldn’t know it from the headlines, most of which simply describe Gov. DeWine’s veto of HB 68 as a victory for trans youth:

Better coverage by AP and highlights the truly significant new developments here: in his prepared remarks, Gov. DeWine outlined plans for administrative rules that could significantly limit the care available to transgender adults as well as youth. These rules, intended to “address a number of goals in House Bill 68”, could be drafted as early as the first week of the new year:

I believe we can address a number of goals in House Bill 68 by administrative rules that will have a better chance of surviving judicial review and being adopted. Today, I am directing my administration and the relevant agencies to begin work on administrative rules that will go through the full JCARR process to establish important protections. I invite the members of the General Assembly to meet with us to collaborate in the rule drafting and move this process forward, starting as early as next week.

Ban on youth gender-affirming surgeries

One of these goals pursued through administrative rulemaking is a total ban on gender-affirming surgeries for trans minors:

I adamantly agree with the General Assembly that no surgery of this kind should ever be performed on those under the age of 18. I am directing our agencies to draft rules to ban this practice in Ohio.

This is a new partial ban on gender-affirming care: any minors who would have received gender-affirming surgery in Ohio would not be able to do so under DeWine’s proposed rules. Nationally, hundreds of trans youth aged 13-17 have received masculinizing chest surgery (top surgery) in recent years, while several surgeons in the US report providing vaginoplasty to trans girls under 18 (Milrod & Karasic, 2017). To the extent that this care is provided to youth in Ohio, it would no longer be available under the new rules.

Comprehensive data reporting on care received by trans adults

DeWine then announced rules requiring that “comprehensive data” on adults and youth receiving gender-affirming care must be collected and reported “to the General Assembly and the public every six months”:

I share with the Legislature their concerns that there is no comprehensive data regarding persons who receive this care, nor independent analysis of any such data. I am today directing our agencies to immediately draft rules to require reporting to the relevant agencies and to report this data to the General Assembly and the public every six months. We will do this not only when the patients are minors, but also when the patients are adults.

Trans people and their gender-affirming care providers in Ohio were not previously subject to any state-imposed collection of data on their medical transition treatments, nor was this private medical information reported to the state or to the public. Details are currently unavailable as to the source of the state’s authority to collect and publish “comprehensive data” on the medical histories of trans people privately seeking this care, and it is not yet known how Ohio plans to protect the personal health information of its transgender residents under the proposed reporting requirement.

Restrictions on “pop-up clinics” for adults

Finally, the governor announced “restrictions that prevent pop-up clinics or fly-by-night operations”, which he accuses of “inadequate or even ideological treatments” while failing to provide “adequate counseling”:

I share the Legislature’s concerns about clinics that may pop up and try to sell patients inadequate or even ideological treatments. This is a concern shared by people I spoke with who had both positive experiences and negative experiences with their own treatments. Those who had positive experiences all noted that they received significant counseling, therapy, and consultation as a family before discussing even the possibility of other treatments. Those who had negative experiences report that they did not receive adequate counseling.

Therefore, I am directing our agencies to draft rules that establish restrictions that prevent pop-up clinics or fly-by-night operations and provide important protections for Ohio children and their families and for adults.

His remarks do not provide detail on what would be defined as a “pop-up clinic” or a “fly-by-night operation” under the proposed rules, or which treatments he regards as “ideological treatments”. However, his reference to “significant counseling, therapy, and consultation” as distinguishing between “positive experiences and negative experiences” equates counseling with adequacy of care, suggesting these rules will likely impose some form of therapy requirement on trans adults prior to accessing gender-affirming medical treatment. Ky Schevers of Health Liberation Now! assessed the overall impact of DeWine’s proposed rules:

he still plans to ban surgery for trans youth under 18, wants the state to collect data on trans youth and adults who transition, enforce counseling/therapy for children and adults before they can access transition and shut down informed consent clinics.

Whichever clinics Ohio chooses to target, trans adults receiving their care through these clinics may face disruptions to their ongoing treatment:

  • Any requirements for a minimum number or frequency of therapy appointments, such as those imposed by now-withdrawn rules in Missouri and Florida, would needlessly delay adults’ access to this medically necessary care as determined by their healthcare provider.
  • A one-size-fits-all requirement of several appointments for each patient would drastically increase the workload of gender-affirming care providers and impair their ability to deliver this care in a timely fashion. Ballooning waitlists have been associated with suicides of trans patients waiting for assessment in the UK.
  • These unnecessary appointments will increase the expenses incurred by trans people, already an economically disadvantaged group. Some trans adults who were previously able to afford this care may not be able to afford it now.

In many ways, this outcome is even worse than the lack of a veto. While this was previously a question of whether gender-affirming medical care for youth would be banned or not, this veto has instead been used as an opportunity to target and restrict care for transgender adults, a vastly larger segment of the trans population than youth. The Williams Institute estimates that Ohio is home to 8,500 trans youth aged 13-17, compared to 46,500 trans adults – the eighth-largest adult transgender population in the US.

Under the proposed rules, thousands of adults in Ohio who’ve made the private medical decision to transition would now have their health information routinely reported to lawmakers and the public. Menopausal cis women in Ohio receiving hormone replacement therapy prescribed by their family doctor, and middle-aged cis men receiving testosterone at “low T clinics”, will not have their “comprehensive data” regularly collected and reported to the government. Only trans people are treated as though our embodied genders are a matter of ongoing state interest, so allegedly compelling that it overrides any concern for respecting or protecting our medical histories as private citizens.

This is intrusive, completely unwarranted, and an alarming escalation in the ongoing targeting of trans lives by right-wing administrations. The government has no business creating a list of who has transitioned, and transitioning in Ohio should not come at the cost of one’s medical privacy. Trans people have no reason to assume that their data and personal safety will be meaningfully protected or that the state will always use this information for benign purposes. And regardless of the many ways this could go horribly wrong, the government’s sanctioning of the intrusion itself is inherently a harm to trans people and strips us of the dignity afforded to people who do not transition: it tells the public that any trans person they see is likely doing something so unusual and suspicious that it must be urgently monitored by the state.

Inside the Collective

So where did this come from? How did a trans youth care ban turn into a comprehensive threat to adults’ healthcare and privacy? Some clues to DeWine’s inspiration may be found among the “people I spoke with who had both positive and negative experiences with their own treatments” – particularly “[t]hose who had negative experiences” and “report that they did not receive adequate counseling.”

A Washington Post story from December 27 details the work of detransitioner Carey Callahan in an unusual effort to mobilize detransitioners against Ohio’s trans youth care ban. 2023’s wave of red state trans youth care bans was accompanied and facilitated by a traveling troupe of about a dozen anti-trans detransitioners repetitively testifying in favor of bans and against gender-affirming care broadly. The Post profiles the emergence of an even larger contingent of anti-ban detransitioners and their coordinated efforts in Ohio:

As they strode into the Statehouse, Callahan beamed. Callahan had contacted dozens of detransitioners, and asked whether they would join her in testifying against Ohio’s ban. Nineteen submitted testimony — nearly triple the number who’d testified in favor of Ohio’s bill. It was more than had ever testified in one state.

However, Callahan’s arguments appear to be more pro-regulation than anti-ban. In her December testimony, Callahan praised Ohio’s gender clinics for minimizing the number of youth who pursue transition, which she considers superior to other states with “lower quality programs and higher risk of regret”:

The majority of children being provided care in these 6 programs do not receive any hormonal treatment. None of Ohio’s programs will perform surgeries on minor patients. …

I am particularly concerned that an impact of this bill will be to shut down Ohio’s gender-affirming clinics where healthcare leaders are modeling what cautious, considered care looks like. Other states which follow less cautious approaches will continue to promote those approaches, and our Ohio families will have to go to those states with lower quality programs and higher risk of regret to access help. The detransitioners who had negative experiences as minors in other states would probably have been served by those programs learning from the successful processes of Ohio’s clinicians. The success of our pediatric programs at preventing detransition through guiding youth through a careful discernment process is an achievement of our state we should be proud of. The rest of the country should be more like Ohio in this regard.

Callahan provides no evidence that Ohio has a lower rate of detransition than other states, or that this “cautious, considered” gatekeeping actually serves to prevent detransitioning, yet her rhetoric unavoidably equates patient safety with limiting the number of people who transition. The group Are You Asking Why? Collective, containing 15 of the 19 anti-ban detransitioners, submitted a statement echoing these arguments for “moderation” and against out-of-state clinics:

Bans do not promote improvement, or encourage innovation. Shutting down clinics will not improve anyone’s quality of care. Ohio’s existing programs are known for their moderation. They do not perform surgeries on minors; many clinics out of state do.

(The remaining anti-ban detransitioners – Devin Cantu, Lucy Coelen, and Cassidy – are not affiliated with the Collective and submitted testimony defending access to gender-affirming care.) According to Ky Schevers, a medically detransitioned retrans genderqueer butch who previously worked closely with members of the Collective including Max Robinson and Iva Goldsmith, “Are You Asking Why? is made up of detransitioned radical feminists who seek to restrict or eliminate medical transition and replace it with conversion practices.” Schevers notes that while the group positions itself against healthcare bans promoted by the right wing, they do not support transgender identities or transitioning:

They’re opposed to working with right-wing groups and laws banning medical transition and try to leverage these positions to appear more “moderate” or trans-friendly than they truly are. Instead of banning medical transition, they seek to make it harder to access through more gatekeeping and for many their long term goal is to replace it with “therapy” or conversion practices. Many don’t even believe in therapy as an effective treatment for gender dysphoria either but instead promote “alternative treatments” for gender dysphoria, including radical feminist “consciousness raising” and mindfulness meditation to accept one’s assigned sex.

“Oversight Board”

Far from supporting trans Ohioans’ continued access to care, these detransitioners attack gender transition itself, and regard youth care bans as simply an inadequate approach to curtailing all gender-affirming care. An individual submission by Collective member Max Robinson emphasizes how few trans youth receive hormone therapy in Ohio, and calls on the state to determine “what strategies other than transition may represent meaningful options for people with gender dysphoria”, while criticizing the youth care ban on the grounds that it would “drive use of low quality remote gender care services online”:

Trained specialists are far better equipped to interpret it than legislators. For example, I hear it on good authority from an Ohioan that the pediatric gender clinics there prescribe hormones pretty sparingly, and don’t actually perform any underage transitional surgeries. Other states do, though.

The resources spent on pushing for these bans could have been spent exploring how best to support those who detransition or what strategies other than transition may represent meaningful options for people with gender dysphoria. Bans drive clinicians and families trying to support their children out of state, they drive use of low quality remote gender care services online, and they heighten stigma against gender nonconforming children. There are many productive ways to engage with concerns about the ethics of pediatric transition, and to end the worship of heterosexual conformity that makes transition coherent by defining the woman-hating gender roles we must move within or outside of. This isn’t one of them.

Schevers explains the group’s strategy: “They seek to infiltrate and influence trans healthcare with the long term goal of tearing it down. They have an easier time doing this because medical providers who are in favor of more gatekeeping, psychological assessments and therapy like to use detransition stories as justification for such practices.” Another submission by Collective member Ciara describes care bans as “cutting the head off a hydra”, calling for “more safety nets to save people who would be hurt by transitional care” while asserting that “race, sex, cultural background, trauma and other things can cause someone to desire transition”. Ciara appears to deny that some people are transgender as a lifelong state:

Do you want to help people who are planning on transitioning, or those who regret it? Banning transition won’t. It’s cutting the head off a hydra. We need to set high standards for the care dysphoric people are receiving, and that includes more safety nets to save people who would be hurt by transitional care. More research into the effects of hormones on people’s bodies. More therapy, more awareness of how race, sex, cultural background, trauma and other things can cause someone to desire transition as a way to ease the pain they’re in. Less ignoring the root causes of dysphoria, of medical professionals shamelessly acting like somehow we can be born hating our own bodies, or even be born in the wrong ones.

This emphasis on trauma as a “root cause” of gender dysphoria is familiar to Schevers, who observes:

Detrans TERFs will offer their stories to such providers in order to gradually shift understandings and acceptable treatments for gender dysphoria. For example, during my own time as a detrans radical feminist, I shared my experiences with providers working in trans healthcare in order to push the idea that dysphoria can be caused by trauma and internalized misogyny/homophobia.

Worryingly, a submission by Collective member Iva Goldsmith calls on the state to create an “Oversight Board” that would “investigate detransition, reach out to people lost to followup”, with “requirements for how often such a committee publicly reports on what they’ve done”:

Why not, for instance, use your legislative powers to form a public Detransition & Innovation Oversight Board? It could be a group of some well-respected medical professionals and some neutral parties, who have a mandated charge to investigate detransition, reach out to people lost to followup, and find ways to use their experiences to inform & improve the trans healthcare process, with the goal of reducing the rate of regret and other negative outcomes, and building networks of support. Why not write up requirements for how often such a committee publicly reports on what they’ve done and what progress they’ve made?

Goldsmith’s recommendations unnervingly presage Gov. DeWine’s plans for the state to collect “comprehensive data regarding persons who receive this care”, perform “independent analysis” of this data, and “require reporting to the relevant agencies and to report this data to the General Assembly and the public every six months”.

What just happened here is that anti-trans detransitioners have found a new way to obstruct the transgender community’s timely, affordable access to transition treatment as determined by our healthcare providers. Referencing her own past activism, Schevers warns of the unique dangers posed by this contingent’s broader appeal:

I was able to influence many liberals, leftists, therapists and other medical professionals since I knew how to modify my arguments to appeal to them. I could reach people who wouldn’t have listened to right-wing detrans activists like Chloe Cole. I’ve long worried that trans people and our allies could be caught off-guard by groups like Are You Asking Why? since their views and approach are different from the right-wing groups people are more familiar with. They’ll claim they just want better healthcare outcomes when really they want to completely eliminate medical transition. … I know from my past that these activists shouldn’t be underestimated.

We know that Ohio’s governor was paying attention to people who’ve “had negative experiences” with gender-affirming care, and his announcement in many ways resembles the recommendations of this group of detransitioners. A mere 1% of people who’ve transitioned regret doing so – there is no evidence that greater gatekeeping and extended assessment prevent regret (Ashley et al., 2023), and prompt access to masculinizing hormone therapy by trans adults is associated with lower levels of depression and suicidality compared to delayed access (Nolan et al., 2023). But this handful of individuals who question whether anyone is really trans at all may soon have their way: transitioning in Ohio could cost more, access to care could take longer, and these medically necessary treatments could ultimately be available to fewer trans people.

Update, 2024-01-02 Following the publication of this article, the Ohio governor’s office responded today: “In Ohio, the adoption of administrative rules is a months long process. On Friday, the Governor directed agencies to begin drafting rules on the three subject areas he referenced in his address and veto message. No drafts existed prior to this directive, and at this early hour today, no drafts have been finalized.”

Further reading

If you come at this from the angle of preventing detransition, you’ll never actually be able to treat people as individuals who deserve dignity and respect.

In my experience, such detrans activists are often better at swaying liberals and leftists than right-wing detrans activists like Chloe Cole. Especially if they present their political agenda as a “nuanced approach” and/or a “reasonable compromise”.

If you’d like to help us with more investigations like this, you can support Gender Analysis on Ko-Fi or Patreon.

About Zinnia Jones

My work focuses on insights to be found across transgender sociology, public health, psychiatry, history of medicine, cognitive science, the social processes of science, transgender feminism, and human rights, taking an analytic approach that intersects these many perspectives and is guided by the lived experiences of transgender people. I live in Orlando with my family, and work mainly in technical writing.
This entry was posted in Adult care restrictions, Anti-trans detransitioners, Are You Asking Why? Collective, Conversion practices, Gatekeeping, Influence groups, Informed consent, News, Ohio, Ohio administrative rules, Privacy, Psychotherapy, Regret and detransition, Surveillance, TERFs, Trans youth, Transgender medicine, Transphobia and prejudice. Bookmark the permalink.

Leave a Reply

Your email address will not be published. Required fields are marked *