The Ohio Senate has voted to override Gov. Mike DeWine’s veto against Ohio House Bill 68 in a 23-9 vote. This bill would ban transgender minors from receiving gender-affirming medical care and prevent transgender girls from taking part in girls' and women's sports.
The Ohio House voted to override the veto on Jan. 10.
The bill restricts the use of puberty blockers, hormone therapy or surgeries for transgender youth. The bill does not restrict the use of this care on non-transgender youth, and specifically includes an exception for intersex youth with ambiguous or abnormal sex characteristics.
A grandfather clause allows transgender people already receiving care to continue doing so.
Physicians have told ABC News that doctors, families and patients often have many long conversations together to consider age-appropriate individualized approaches to care. This often begins with mental health care, they say.
For youth approaching puberty, puberty blockers are a reversible form of gender-affirming care that allows children to pause puberty and explore their gender identity without the growth of permanent sex characteristics (e.g., breasts, genitalia) that may cause further stress, according to physicians interviewed by ABC News.
Hormone therapy for older teens helps align a patient's physical appearance with their gender identity. Patients are given estrogen or testosterone, and the changes from these medications occur slowly and are partially reversible.
Surgeries on adolescents are rare and only considered on a case-by-case basis, physicians have told ABC News.
DeWine vetoed the bill in December 2023, saying he believed the bill as written would harm transgender youth and impede on families' ability to make decisions after speaking with those who would be impacted by the legislation.
"The decisions that parents are making are not easy decisions," DeWine said in the Dec. 29 press conference. "These tough, tough decisions should not be made by the government. They should not be made by the state of Ohio. They should be made by the people who love these kids the most. And that's the parents, the parents who raised the child, the parents who have seen that child go through agony."
However, he agreed with several concerns highlighted by the legislature.
He proposed rules to regulate gender-affirming care instead that would be less likely to be challenged in court -- including bans on surgeries for minors.
"None of [the families] that I talked to talked about surgery," said DeWine in a Dec. 29 statement. "That's not where they were going in the discussion. And I think that's, frankly, a fallacy that's out there that, you know, this goes right to surgery. It just doesn't. All the children's hospitals say that we don't do surgeries."
At least 21 states have implemented restrictions on access to gender-affirming care, many of which have faced legal challenges.
A law banning gender-affirming care for minors in Arkansas was ruled unconstitutional by a federal judge and similar laws have been blocked in Georgia, Indiana, Idaho, Texas and Montana while lawsuits are considered.
DeWine also proposed reporting and data collection on those who receive care to better monitor quality of care, as well as implementing restrictions on "pop-up clinics" that serve the transgender community.
"I truly believe that we can address a number of goals in House Bill 68 by administrative rules that will have likely a better chance of surviving judicial review and being adopted," DeWine said.
Gender-affirming care has been called safe and effective by more than 20 major national medical associations, including the American Academy of Pediatrics and the American Medical Association. The AMA has said this care can be medically necessary to improve the physical and mental health of transgender people.
Transgender youth are more likely to experience anxiety, depressed mood and suicidal ideation and suicide attempts due to discrimination and gender dysphoria, according to the Centers for Disease Control and Prevention.
Research shows hormone therapy can improve the mental health of transgender adolescents and teenagers, a recent study in the New England Journal of Medicine found.
When asked if he had thoughts on the sports restrictions in the bill, DeWine said he "focused on the part of the bill that I thought affected the most people and the most children by far," referring to the gender-affirming care portion of the bill.
The bill also would ban transgender girls from participating in sports. It would replace the state's current transgender sport participation policies, which require a transgender girl to complete a minimum of one year of hormone treatment or demonstrate that she did not possess physical or physiological advantages over genetic females.
For a transgender male to participate in sports, he currently must demonstrate that his muscle mass developed as a result of testosterone treatment and does not exceed muscle mass typical of adolescent genetic males. Hormone levels are then monitored every three to six months.
However, as Rep. Richard D. Brown pointed out during House debate on the bill, the Ohio Constitution states that "no bill shall contain more than one subject, which shall be clearly expressed in its title." It is unclear if this will complicate the bill's path forward.
Physicians who provide any gender-affirming medical care for trans youth in Ohio under this law would be "subject to discipline by the applicable professional licensing board" under this legislation.
ABC News' Mary Kekatos contributed to this report.
Ohio Senate overrides governor veto of trans care, sports ban HB 68 originally appeared on abcnews.go.com