COLUMBUS (TNS) — Gov. Mike DeWine signed an emergency order Friday morning banning minors with gender dysphoria from getting surgeries, after vetoing a bill that would ban all gender-affirming medical treatments of minors that included hormones, puberty blockers and surgeries.

The order goes into effect immediately while it undergoes the administrative rulemaking process that requires public comment and clearance of two panels. As a result of that process, the rule could be altered before it becomes final.

DeWine, who addressed reporters from his downtown Columbus office, said the Ohio Department of Health and the Ohio Department of Mental Health and Addiction Services submitted for the rule making process additional provisions related to transgender care that are not emergency orders and do not go into effect immediately. The rules require extensive counseling before treatments begin, informed consent and reporting requirements of clinics.

But there are also rules that will be subject to public comment and clearance by panels.

Last week, DeWine outlined his plan to regulate care for transgender minors after vetoing House Bill 68, which would have banned all forms of medical care to transgender minors and banned trans girls and women from female scholastic sports.

The non-emergency rules regarding transgender care that DeWine’s administration has proposed are:

-To require a multidisciplinary team to support individuals receiving gender-affirming care, including but not limited to a bioethicist, a psychiatrist and an endocrinologist.

-To require a comprehensive care plan that includes sufficient informed consent from patients and, when the patient is a minor, their parents. This includes discussions of potential risks associated with the treatment and comprehensive and lengthy mental health counseling prior to being considered for any treatment.

-Clinics that offer gender-affirming care must report cases of gender dysphoria and any subsequent treatments received by the patient. Cases of the flu, the coronavirus, food poisoning cases, abortions and other health data are submitted to the state. DeWine said there needs to be aggregated data on gender-affirming care submitted to the state in a way that conforms with patient privacy laws. The data can be used by policymakers and the public to make informed decisions about care.

The Endocrine Society’s Clinical Practice Guidelines say that taking medicine to suppress puberty is fully reversible and gives youth experiencing gender incongruence time to explore their options before undergoing other treatments. Research shows that puberty suppression improves their mental health and prevents a teen from developing characteristics such as facial hair and breast growth, the society said.

When adolescents enter puberty and have sufficient mental capacity to give informed consent – usually around age 16 – clinicians may add hormones, the Endocrine Society states. Feminizing hormone therapy includes medications to reduce the level of testosterone, while providing enough estrogen to allow feminizing to occur. Masculinizing hormone therapy includes medications that will increase testosterone levels to cause masculinizing changes to occur. These medicines are only partially reversible, the society said.

The Endocrine Society’s guidelines say that families should work with a therapist throughout the process.

DeWine said that his executive order affects fly-by-night clinics. He said he’s aware of ads in Cincinnati promoting such places.

“I’m concerned that there could be fly-by-night providers, clinics that might be dispensing medication to adults with no accountability,” he said. “With what we are announcing today, that will take care of that.”