'Really scary': Families brace for impact of transgender youth care ban in Ohio

Astrid Burkle, a 10-year-old transgender girl who lives in Ohio, said she wishes she "could have a normal life."

Astrid says she wishes she could just do all the things other fifth-grade girls do, baking cookies with her grandmother, singing with her friends in the local choir, and going on field trips, but instead she's said she has to spend her time on regular trips to the state house to advocate against anti-transgender legislation that may impact Astrid in the future.

"It's been really frustrating at times," Astrid told ABC News in an interview alongside her family. "Because there's just so many people out there who are just really mean."

Families across the state are bracing for the impact of a bill that would restrict certain transgender rights for minors.

Ohio House Bill 68 is comprised of two acts: the "Save Adolescents from Experimentation Act," which would ban transgender minors from receiving gender-affirming care, and the "Save Women's Sports Act," which would prevent transgender girls from taking part in girls' and women's sports.

Gender-affirming care is about supporting someone’s identity, according to medical experts. It helps align their physical appearance with their gender identity, and can include mental health services as well as medical interventions such as puberty blockers, hormone medications, and surgery. These medical options would be banned by HB 68.

Dr. Christopher Bolling, a member of the Ohio Chapter of the American Academy of Pediatrics, told ABC News in an interview that pediatricians and physicians are "extremely cautious" when it comes to gender-affirming care and often have many long conversations with people who are questioning their gender before considering age-appropriate medical interventions based on treatment guidelines. This gives patients time to explore their identity and create an individualized approach to care.

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, according to physicians interviewed by ABC News. This option would be banned by the legislation. It would also ban hormone therapy, which brings physical traits in line with gender identify.

Surgeries on adolescents are rarely done and only considered with adolescents on a case-by-case basis, physicians have told ABC News.

Astrid's mother, Alicia Burkle said Astrid has been receiving strictly mental health care services in recent years as she is too young for medical care. Therapy, Astrid said, offers a "safe space" to talk through her experiences.

However, the restrictions placed on Astrid's future choices for care have the family questioning their options.

"Just because you've said that you're not going to allow us to get the care here in Ohio doesn't mean we're suddenly going to stop getting the care for our kids," said Alicia Burkle.

She continued, "We trust the science, we trust her healthcare providers. And so we're going to do what we have to do and whether that is travel out of state to get it, whether it's leave the state and move -- that's what we'll do."

Burkle said her cisgender daughter is on hormone replacement therapy -- "But nobody's questioning that ... So I don't understand."

Physicians who provide this care will be "subject to discipline by the applicable professional licensing board." An exception in this bill allows hormone-based care and surgery for intersex and cisgender youth.

Republican Gov. Mike DeWine has yet to announce whether he will sign or veto the legislation – but more than three-fifths of legislators have voted in favor of the bill so far and can override his veto.

Supporters of gender-affirming care restrictions believe that gender transitioning is harmful to youth. Some say patients should wait until they are older to make this kind of health decision.

State Sen. Terry Johnson, who is a retired physician, argued in favor of the bill on the Senate floor.

"If you don't know if something you're doing is going to hurt someone 10, 15, 20 years down the road -- or maybe even one year down the road -- don't do it," Johnson said in a Dec. 13 debate. "The medical evidence is not there to support what we're doing in the country."

Critics of these laws say they prevent families and physicians from making decisions about their health care and will harm transgender youth.

State Sen. Paula Hicks-Hudson argued against the bill in the Dec. 13 debate.

"When we look at this legislation, let's be clear, it is not necessarily about preventing children from being exposed to these types of procedures, but it is preventing parents who are making decisions about the health care of their children," she said. "It also removes that decision for health care from professionals and parents and gives it again to government."

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 (AMA). The AMA has said this care can be medically necessary to improve the physical and mental health of transgender people.

Often because of gender-related discrimination and gender dysphoria, transgender youth are more likely to experience anxiety, depressed mood, and suicidal ideation and attempts, according to the Centers for Disease Control and Prevention. Research shows that hormone therapy can improve the mental health of transgender adolescents and teenagers, a recent study in the New England Journal of Medicine found.

The legislation has a grandfather clause that allows minors who are already on medication to continue to receive care. It's a benefit for some families in the state, including Nick Zingarelli, his wife and his teenage daughter who is already taking puberty blockers.

Zingarelli raised his daughter in Cincinnati, Ohio -- but the family moved to Missouri in 2019 to be closer to his wife's family. His daughter came out as transgender in 2020 when she was still a preteen.

He told ABC News that his daughter's coming out changed both everything and nothing about their family.

"Obviously it changed everything in terms of having to advocate for her rights," said Zingarelli in an interview. "Missouri is a deep red state."

He continued, "And when I say that nothing at all changed -- when we told friends, family, school, everybody, it was like, 'Okay, great. So these are her new pronouns. This is her name.'"

Zingarelli said he met with doctors at the time who said there was nothing they could do for his daughter at her age except for counseling.

"So this belief that doctors are just running to get prescriptions filled and everything else as soon as gender dysphoria is disclosed is nonsense," said Zingarelli.

Zingarelli and his family later moved back to Ohio in part to escape anti-transgender legislation in Missouri that restricted trans participation in sports and gender-affirming care. They did not expect to be faced with restrictive legislation in Ohio, the place they call home, he said.

For Zingarelli, the grandfather clause protecting his daughter's care is "not good enough," since it doesn't protect care in the future for children like Astrid who are not yet old enough to receive medical care.

The community has been supportive of Astrid and her family, according to Astrid's father, Aaron.

"We want to be able to support our communities and the state of Ohio, but like, people are going to leave," said Abs Burkle, Astrid's sister. "People are going to be hurt. They're not going to want to come back to Ohio."

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