Ohio’s HB 68 gender-affirming care ban prohibits doctors from providing gender-transition surgery, puberty blockers, or cross-sex hormones to anyone under 18, and it restricts transgender athletes from competing on female-designated teams in K-12 schools and colleges. The law took effect on April 24, 2024, after the legislature overrode Governor Mike DeWine’s veto. As of early 2026, it is enforceable statewide while the Ohio Supreme Court reviews a state constitutional challenge.
What the Medical Ban Covers
The medical restrictions live in Ohio Revised Code Chapter 3129. Section 3129.02 bars a physician from knowingly performing gender-reassignment surgery on a minor.1Ohio Legislative Service Commission. Ohio Revised Code 3129.02 – Physician Prohibitions The same section bans prescribing puberty-blocking drugs or cross-sex hormones — testosterone, estrogen, or progesterone in amounts exceeding what the body would naturally produce — when the purpose is to help a minor transition.2Ohio Legislative Service Commission. Ohio Revised Code Chapter 3129 – Gender Transition Services for Minors
The word “knowingly” does real work. A physician who prescribes testosterone for an unrelated condition, or treats a hormonal disorder, is not violating the statute. The prohibition targets treatments specifically intended to help a minor transition.
Ohio Medicaid will not cover gender-transition services for minors, so even care that might fit a statutory exception cannot be billed to the state program.3Ohio Legislative Service Commission. Ohio Revised Code 3129.06
The Narrow Exceptions
Section 3129.04 creates three exceptions, all narrow:
- Treatment of a minor born with medically verifiable ambiguous sex characteristics, such as atypical chromosome structures or both ovarian and testicular tissue.
- Treatment where genetic or biochemical testing shows the minor does not have typical sex chromosome structure or hormone production.
- Treatment of an infection, injury, disease, or disorder caused or worsened by gender-transition services performed earlier, whether or not that earlier care was legal at the time.
Note what the third exception is not. It does not let a physician continue prescribing hormones or puberty blockers to a patient who was already on them. It permits treatment only for medical problems that resulted from prior transition care.4Ohio Legislative Service Commission. Ohio Revised Code 3129.04 Families who expected a grandfather clause protecting ongoing therapy will not find one in the statute.
Mental Health Care Rules
Mental health treatment for gender-related distress is not banned, but Section 3129.03 attaches two conditions. A mental health professional cannot diagnose or treat a minor presenting with a gender-related condition without consent from at least one parent, legal custodian, or guardian.5Ohio Legislative Service Commission. Ohio Revised Code 3129.03 – Mental Health Care
The professional must also screen the minor for other conditions that could be influencing the distress. The statute names depression, anxiety, ADHD, and autism spectrum disorder, along with physical, sexual, mental, and emotional abuse or trauma. These screenings must run through the course of diagnosis and treatment, not as a one-time checkbox.5Ohio Legislative Service Commission. Ohio Revised Code 3129.03 – Mental Health Care A therapist who skips comorbidity screening, or proceeds without parental consent, is out of compliance.
Sports Restrictions in Schools and Colleges
The Save Women’s Sports Act is the other half of HB 68. K-12 schools must designate athletic teams by biological sex, and teams designated for girls or women are limited to students who are biologically female. Any private school that competes against public institutions is covered.6Ohio Legislature. House Bill 68
Section 3345.562 extends the same framework to intercollegiate athletics. State institutions of higher education and NCAA-member private colleges must designate single-sex teams, and women’s teams are limited to biologically female athletes. Men’s teams remain open to all eligible athletes.
As of February 2025, the NCAA updated its own transgender participation policy to restrict women’s-team competition to athletes assigned female at birth. Athletes assigned male at birth may practice with women’s teams and receive medical care and benefits but cannot compete. The NCAA has also stated that state and federal laws supersede its rules, so Ohio’s restrictions apply regardless of any future NCAA change.7NCAA. NCAA Announces Transgender Student-Athlete Participation Policy Change
One practical consequence for athletes assigned female at birth: starting testosterone therapy ends eligibility to compete on a women’s team.7NCAA. NCAA Announces Transgender Student-Athlete Participation Policy Change
Custody and Parenting Time
HB 68 added Section 3109.054 to the Revised Code. When a court decides custody or parenting time, it cannot penalize a parent for raising a child consistent with the child’s biological sex, for declining to consent to gender-transition services, or for declining to consent to mental health services aimed at affirming a gender identity that differs from the child’s biological sex.8Ohio Legislative Service Commission. Ohio Revised Code 3109.054 – Parental Decisions Regarding Child’s Gender Identity and Gender Transition
If parents disagree about gender-affirming care during a custody dispute, the parent who opposes it cannot lose custody or parenting time on that basis alone.
Where the Law Stands in Court
The ACLU of Ohio, the national ACLU, and the law firm Goodwin sued on behalf of two families with transgender children in March 2024. The case, Moe v. Yost, argues that HB 68 violates the Ohio Constitution.9American Civil Liberties Union. Moe v. Yost
The rulings so far:
- April 16, 2024: A Franklin County judge granted a temporary restraining order, blocking the law from taking effect.
- August 6, 2024: The trial court ruled against the families, vacating the restraining order and allowing HB 68 to take immediate effect.10American Civil Liberties Union. Ohio Judge Rules Against Families and Doctors, Allowing Ban on Gender-Affirming Care to Take Immediate Effect
- March 18, 2025: The Tenth District Court of Appeals reversed and blocked the ban on gender-affirming care for minors.
- April 29, 2025: The Ohio Supreme Court stayed the appellate ruling, putting HB 68 back into effect while the state’s highest court reviews the case.9American Civil Liberties Union. Moe v. Yost
The Ohio Supreme Court has accepted the case for review. Until it issues a final decision, HB 68 is binding on families, physicians, schools, and colleges across the state.
Why a Federal Challenge Is Unlikely to Help
In June 2025, the U.S. Supreme Court ruled 6-3 in United States v. Skrmetti that Tennessee’s ban on gender-affirming medical care for minors does not violate the Equal Protection Clause. The Court applied rational-basis review rather than the heightened scrutiny that would apply to laws targeting a suspect class.11Oyez. United States v. Skrmetti Ohio’s law is structured similarly to Tennessee’s, so a federal equal-protection challenge to HB 68 has little room to run. The state constitutional argument in Moe v. Yost is a separate avenue and is where the fight over the law now sits.