OHIO LEGISLATIVE SERVICE COMMISSION
Office of Research Legislative Budget
www.lsc.ohio.gov and Drafting Office
H.B. 68 Final Analysis
135th General Assembly
Click here for H.B. 68’s Fiscal Note
Primary Sponsor: Rep. Click
Effective date: April 24, 2024
Effective date:
Emma Carroll, Research Analyst
SUMMARY
SAFE Act
 Prohibits a physician from knowingly performing gender reassignment surgery on a minor.
 Prohibits a physician from knowingly prescribing a cross-sex hormone or puberty-
blocking drug to a minor for the purpose of assisting with gender transition.
 Prohibits a physician from aiding or abetting those prohibited practices.
 Permits a physician to continue to prescribe a cross-sex hormone or puberty-blocking
drug to a minor after the act’s effective date under specified circumstances.
 Prohibits a mental health professional from diagnosing or treating a minor for a gender-
related condition without first obtaining the consent of at least one parent or legal
custodian, or the minor’s guardian.
 Prohibits a mental health professional from diagnosing or treating a minor for a gender-
related condition without screening the minor for other comorbidities, abuse, and
traumas during the course of treatment.
 Establishes penalties for physicians and mental health professionals who engage in
conduct the act prohibits.
 Prohibits Medicaid coverage of gender transition services for minors.
 Prohibits a court from denying or limiting parental rights and responsibilities or
parenting time due to certain parental decisions regarding their child’s gender identity
and gender transition.
 Expresses the General Assembly’s findings regarding gender transition services,
particularly for minors.
 Entitles these provisions of the act the Ohio Saving Adolescents from Experimentation
(SAFE) Act.
February 6, 2024
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Save Women’s Sports Act
 Requires each school that participates in athletic competitions or events administered
by an organization that regulates interscholastic athletic conferences or events to
designate separate single-sex athletic teams based on the sex of the participants.
 Requires each state institution of higher education or private, nonprofit college or
university that is a member of the NCAA, NAIA, or NJCAA to designate separate
single-sex athletic teams and sports based on the sex of the participants.
 Prohibits a state institution, private college, school, interscholastic conference, or
organization that regulates interscholastic athletics from knowingly permitting a male
athlete to participate in a female athletic competition.
 Authorizes an athletic participant to file a civil action if the participant is deprived of an
athletic opportunity or suffers harm as a result of a violation of the act’s single-sex
participation requirements or if the participant is subject to retaliation for reporting
such a violation.
 Prohibits a state agency or political subdivision, accrediting organization, or athletic
association that operates or has business activities in Ohio from taking adverse action
against a school, school district, or college or university that complies with the act’s
single-sex participation requirements.
 Entitles these provisions of the act the “Save Women’s Sports Act.”
TABLE OF CONTENTS
SAFE Act ................................................................................................................................ 3
Prohibition on certain gender transition services for minors ..................................................... 3
Grandfather clause ................................................................................................................. 3
Permissible medical treatment .............................................................................................. 3
Mental health care ...................................................................................................................... 4
Enforcement ................................................................................................................................ 4
Medicaid ...................................................................................................................................... 5
Parental rights and responsibilities ............................................................................................. 5
Designation.................................................................................................................................. 5
Legislative findings ...................................................................................................................... 5
Save Women’s Sports Act ...................................................................................................... 7
Interscholastic and intercollegiate single-sex athletic teams ..................................................... 7
Civil action authorized ................................................................................................................. 8
Statute of limitations .............................................................................................................. 9
Designation.................................................................................................................................. 9
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DETAILED ANALYSIS
SAFE Act
Prohibition on certain gender transition services for minors
The act regulates the provision of gender transition services to minors by addressing
several facets of gender transition – defined as the process in which an individual goes from
identifying with and living as a gender that corresponds to his or her biological sex to identifying
with and living as a gender different from his or her biological sex, including social, legal, or
physical changes.
The act prohibits physicians from knowingly doing any of the following: 1
 Performing genital or nongenital gender reassignment surgery on a minor;
 Prescribing a cross-sex hormone or puberty-blocking drug for a minor for the purpose of
assisting the minor with gender transition; and
 Engaging in conduct that aids or abets the performance of gender reassignment surgery
on a minor or the prescription of a cross-sex hormone or puberty-blocking drug to a
minor for the purpose of gender transition, provided that this prohibition may not be
construed to impose liability on any protected speech.
Grandfather clause
A physician who began treating a minor with a cross-sex hormone or puberty blocking
drug for the purpose of assisting the minor with gender transition before the act’s effective
date may continue to prescribe a hormone or drug to the minor if (1) the minor has been a
continuous Ohio resident since the act’s effective date and (2) the physician determined and
documented that terminating the minor’s prescription would cause harm to the minor.2
Permissible medical treatment
The act specifies that it does not prohibit a physician from treating, including by
performing surgery on or prescribing drugs or hormones for, a minor in the following
circumstances:3
 The minor was born with a medically verifiable disorder of sex development, including
ambiguous external biological sex characteristics;
 The minor was diagnosed with a chromosomal or hormonal disorder of sexual
development, which a physician has determined through genetic or biochemical testing;
or
1 R.C. 3129.02(A).
2 R.C. 3129.02(B).
3 R.C. 3129.04.
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 The minor needs treatment for a complication of a previous gender transition service.
Mental health care
The act prohibits mental health professionals from diagnosing or treating a minor for a
gender-related condition without first obtaining the consent of at least one of the minor’s
parents or legal custodians or the minor’s guardian.4 A gender-related condition is any
condition where an individual feels an incongruence between the individual’s gender identity
and biological sex, including gender dysmorphia.5
Additionally, during the course of diagnosis or treatment, the mental health professional
must screen the minor for comorbidities that may be influencing the minor’s gender-related
condition (including depression, anxiety, attention deficit hyperactivity disorder, autism
spectrum disorder, and other mental health conditions) and for physical, sexual, mental, and
emotional abuse and other traumas.6 Mental health professionals include psychiatric-mental
health clinical nurse specialists, psychiatric-mental health nurse practitioners, psychiatrists,
psychologists, school psychologists, social workers, professional counselors, and marriage and
family therapists.7
Enforcement
Any physician who engages in the conduct the act prohibits is subject to discipline by
the State Medical Board for unprofessional conduct. Similarly, any mental health professional
who diagnoses or treats a minor for a gender-related condition in violation of the act is
engaging in unprofessional conduct and is subject to discipline by the appropriate licensing
board.8
Ohio’s Attorney General may bring an action to enforce compliance with the act’s
prohibitions concerning physicians and mental health professionals. The Attorney General, the
state, and any state agency, officer, or employee may act as currently authorized to file or
intervene in any proceeding.9
The act specifies that it is not to be construed to preempt any other private cause of
action arising under Ohio common law.10
4 R.C. 3129.03(A).
5 R.C. 3129.01(E).
6 R.C. 3129.03(B).
7 R.C. 3129.01(I).
8 R.C. 3129.05(A).
9 R.C. 3129.05(C).
10 R.C. 3129.05(B).
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Medicaid
The act prohibits Medicaid from covering gender transition services for minors;
however, the exclusion does not include mental health services provided for a minor’s gender-
related condition, any services that are not gender transition services, or any services described
in “Permissible medical treatment” above.11
The act defines “gender transition services” to mean:12
 Any medical or surgical service (including physician services, inpatient and outpatient
hospital services, or prescription drugs or hormones);
 Provided for the purpose of assisting an individual with gender transition; and
 That seeks to alter or remove physical or anatomical characteristics or features that are
typical for the individual’s biological sex, or to instill or create physiological or
anatomical characteristics that resemble a sex different from the individual’s birth sex,
including medical services that provide puberty-blocking drugs, cross-sex hormones, or
other mechanisms to promote the development of feminizing or masculinizing features
in the opposite sex, or genital or nongenital gender reassignment surgery.
Parental rights and responsibilities
The act prohibits a judge, when allocating parental rights and responsibilities or
parenting time, from denying or limiting a parent’s parental rights and responsibilities or
parenting time based on that parent’s decision to refer to and raise their child in a manner
consistent with the child’s biological sex, to decline to consent to their child receiving gender
transition services, or to decline to consent to their child receiving mental health services that
affirm the child’s self-perception as transgender.13
Designation
The preceding provisions are designated as the “Ohio Saving Adolescents from
Experimentation (SAFE) Act.”14
Legislative findings
The General Assembly makes the following findings:15
 This state has a compelling interest in protecting the health and safety of its citizens,
especially vulnerable children.
11 R.C. 3129.06.
12 R.C. 3129.01(G).
13 R.C. 3109.054.
14 Section 3.
15 Section 2.
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 Only a tiny percentage of the American population experiences distress at identifying
with their biological sex.
 Studies consistently demonstrate that the vast majority of children who are gender
nonconforming or experience distress at identifying with their biological sex come to
identify with their biological sex in adolescence or adulthood, thereby rendering most
medical health care interventions unnecessary.
 Scientific studies show that individuals struggling with distress at identifying with their
biological sex often have already experienced psychopathology, which indicates these
individuals should be encouraged to seek mental health care services before undertaking
any hormonal or surgical intervention.
 Suicide rates, psychiatric morbidities, and mortality rates remain markedly elevated
above the background population after inpatient gender reassignment procedures have
been performed.
 Some health care providers are prescribing puberty-blocking drugs in order to delay the
onset or progression of puberty in children who experience distress at identifying with
their biological sex. This is being done despite the lack of any long-term longitudinal
studies evaluating the risks and benefits of using these drugs for the treatment of such
distress or gender transition.
 Health care providers are also prescribing cross-sex hormones for children who
experience distress at identifying with their biological sex, despite the fact that no
randomized clinical trials have been conducted on the efficacy or safety of the use of
cross-sex hormones in adults or children for the purpose of treating such distress or
gender transition.
 The use of cross-sex hormones comes with the following serious known risks:
 For biological females, erythrocytosis (a condition where the body makes too many red
blood cells), severe liver dysfunction, coronary artery disease, cerebrovascular disease
(a group of conditions that affect blood flow in the brain), hypertension (high blood
pressure), increased risk of breast and uterine cancers, and irreversible infertility;
 For biological males, thromboembolic disease (a group of conditions where blood
clots form in a vein, and then dislodge and travel in the blood), cholelithiasis
(gallstones), coronary artery disease, macroprolactinoma (pituitary gland tumor),
cerebrovascular disease, hypertriglyceridemia (an abnormal concentration of
triglycerides in the blood), breast cancer, and irreversible infertility.
 Genital and nongenital reassignment surgeries are generally not recommended for
children, although evidence indicates referrals for children to have such surgeries are
becoming more frequent.
 Genital gender reassignment surgery includes several irreversible invasive procedures for
males and females and involves the following alterations of biologically normal and
functional body parts:
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 For biological females, surgery may involve a hysterectomy (removal of the uterus)
or oophorectomy (removal of one or both ovaries), reconstruction of the urethra,
genital reconstruction including metoidioplasty (surgical creation of a penis using
existing genital tissue) or phalloplasty (construction of a penis), vaginecto