Ohio House Bill 68 is a 2024 state law that bans most gender-transition medical treatment for anyone under 18 and requires school and college sports teams to be organized by biological sex. It took effect on April 24, 2024, after the General Assembly overrode Governor Mike DeWine’s veto, and it remains in force today while court challenges continue. The law has two parts: the Saving Ohio Adolescents from Experimentation (SAFE) Act, covering medical care, and the Save Women’s Sports Act, covering athletics.
What Medical Treatments Are Banned
Ohio Revised Code Section 3129.02 prohibits physicians from knowingly performing gender reassignment surgery on a minor or prescribing puberty blockers or cross-sex hormones to help a minor transition. The surgical ban is absolute. It reaches both genital procedures, such as vaginoplasty, phalloplasty, hysterectomy, and orchiectomy, and non-genital ones, such as chest surgery, facial feminization, and voice surgery, when done to assist gender transition.
Physicians also cannot aid or encourage the delivery of any banned treatment. The statute says it cannot be used to punish speech that is protected under state or federal law.
The Grandfather Clause for Hormones
Section 3129.02(B) lets a physician keep prescribing puberty blockers or cross-sex hormones to a minor who was already receiving them before April 24, 2024. Two conditions apply. The minor must have been a continuous Ohio resident since that date, and the physician must determine and document in the medical record that stopping the prescription would cause harm. This exception does not cover surgery. Surgical procedures are banned regardless of when treatment started.
Exceptions for Other Conditions
Section 3129.04 preserves three situations where otherwise prohibited treatment is still allowed:
- A minor born with a medically verifiable disorder of sex development, such as ambiguous external anatomy, atypical sex chromosome structures (for example, 46,XX with virilization or 46,XY with undervirilization), or both ovarian and testicular tissue.
- A minor whose genetic or biochemical testing shows abnormal sex chromosome structure or abnormal sex hormone production or function, even if the condition was not apparent at birth.
- A minor who develops an infection, injury, disease, or other disorder caused or worsened by gender transition services, whether those services were legal or not. Treatment to address those complications is permitted.
Rules for Mental Health Care
Section 3129.03 requires a mental health professional to get consent from at least one parent, legal custodian, or guardian before diagnosing or treating a minor for any gender-related condition. This applies regardless of the minor’s age, overriding the general rules that would otherwise let some older minors consent on their own.
The same section requires the practitioner to screen, throughout diagnosis and treatment, for comorbid conditions such as depression, anxiety, ADHD, and autism spectrum disorder, and for a history of physical, sexual, mental, or emotional abuse or other trauma. Failing to meet the consent and screening requirements is unprofessional conduct and exposes the practitioner to discipline from their licensing board.
Protection for Parents in Custody Cases
Section 3109.054 says no Ohio court can reduce a parent’s custody time or parental rights because that parent chose to raise the child consistent with the child’s biological sex, declined to consent to gender transition services, or declined to consent to counseling aimed at affirming a gender identity different from the child’s biological sex. A parent who refuses to authorize hormones or puberty blockers cannot lose custody on that basis alone. The provision applies to allocating parental rights and parenting time, not to parental fitness questions outside gender-related decisions.
Medicaid Will Not Pay
Section 3129.06 bars Ohio’s Medicaid program from covering gender transition services for minors. The Medicaid prohibition does not reach the Section 3129.04 exceptions, and it does not affect mental health services for gender-related conditions or any services unrelated to gender transition.
Sports Teams and Transgender Athletes
The Save Women’s Sports Act, now codified at Section 3313.5320 for interscholastic sports and Section 3345.562 for intercollegiate athletics at state institutions, requires schools to designate teams as female, male, or coed and prohibits athletes of the male sex from competing on teams designated for females. The rule runs one direction only. Female athletes can still compete on male or coed teams. Both public and private schools that take part in interscholastic competition are covered.
No state agency, political subdivision, accrediting organization, or athletic association can investigate or take adverse action against a school for maintaining sex-separated teams. An athlete who loses a competitive opportunity because a school violates the sex-designation rules can sue for damages, injunctive relief, and attorney’s fees. The same right applies to anyone who faces retaliation for reporting a violation. Lawsuits must be filed within two years.
Penalties for Providers
Section 3129.05 treats any violation of the physician prohibitions, the mental health requirements, or the Medicaid ban as unprofessional conduct, with discipline up to and including license revocation. The statute preserves common-law causes of action, so malpractice and other civil claims by patients and families are not blocked. The Ohio Attorney General can also bring enforcement actions to compel compliance, separate from anything a licensing board does.
Where the Court Fights Stand
In Moe v. Yost, brought on behalf of two transgender minors and their families, a Franklin County trial court granted a temporary restraining order in April 2024 but ruled against the plaintiffs in August 2024. The Tenth District Court of Appeals blocked the ban in March 2025. The Ohio Supreme Court then stayed that appellate ruling in April 2025, so HB 68 remains in effect while the appeal continues.
In June 2025, the U.S. Supreme Court decided United States v. Skrmetti, holding that Tennessee’s similar ban on gender-affirming medical care for minors does not violate the Equal Protection Clause and is subject to rational-basis review rather than heightened scrutiny. That ruling makes federal constitutional challenges to Ohio’s medical restrictions considerably harder to win. State constitutional arguments, like those in Moe v. Yost, remain a separate question.
On the athletics side, the U.S. Supreme Court heard oral arguments in January 2026 in West Virginia v. B.P.J., which asks whether Title IX or the Fourteenth Amendment prevents states from assigning sports teams based on biological sex at birth. A ruling is expected by mid-2026 and could either reinforce or undermine the legal foundation of the Save Women’s Sports Act. A companion case, Little v. Hecox, raises similar equal-protection questions about Idaho’s comparable law.