Ohio Gov. Mike DeWine has vetoed Ohio House Bill 68, which is comprised of two acts: the "Save Adolescents from Experimentation Act," which would ban transgender minors from receiving gender-affirming medical care, and the "Save Women's Sports Act," which would prevent transgender girls from taking part in girls' and women's sports.
"I truly believe that we can address a number of goals in House Bill 68 by administrative rules that will have likely a better chance of surviving judicial review and being adopted," DeWine said at a Friday press conference.
He announced that he agreed with several concerns from the legislature and will draft rules for gender-affirming care moving forward -- including bans on surgeries for minors, reporting and data collection on those who receive care, as well as restrictions on "pop-up clinics" that serve the transgender community.
At least 20 states have implemented restrictions on access to gender-affirming care, many of which have faced legal challenges. A law in Arkansas was ruled unconstitutional by a federal judge and several laws have been blocked while the cases are tried.
Ohio's bill could still go into effect if 60% of the state legislature votes to override the governor’s veto.
He announced the decision on the last of 10 days he had to sign or strike down the bill once it reached his desk, using the time to speak to those who would be impacted by the restrictions on the transgender community.
When asked if he had thoughts on the sports restrictions in the bill, DeWine said he "focused on the part of the bill that I thought affected the most people and the most children by far," referring to the gender-affirming care portion of the bill.
The bill would restrict gender-affirming medical care -- including puberty blockers, hormone therapy and surgeries -- for transgender people under the age of 18. The bill includes exceptions for this kind of care for non-transgender youth.
Physicians have told ABC News that doctors, families and patients often have many long conversations together to consider age-appropriate individualized approaches to care. This often begins with mental health care, they say.
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 that may cause further stress, according to physicians interviewed by ABC News.
Hormone therapy for older teens helps align a patient's physical appearance with their gender identity. Patients are given estrogen or testosterone, and the changes from these medications occur slowly and are less reversible.
Surgeries on adolescents are rare and only considered on a case-by-case basis, physicians have told ABC News.
"None of [the families] that I talked to talked about surgery," said DeWine on Friday. "That's not where they were going in the discussion. And I think that's, frankly, a fallacy that's out there that, you know, this goes right to surgery. It just doesn't. All the children's hospitals say that we don't do surgeries."
MORE: Record number of anti-LGBTQ legislation filed in 2023Gender-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. The AMA has said this care can be medically necessary to improve the physical and mental health of transgender people.
Transgender youth are more likely to experience anxiety, depressed mood and suicidal ideation and suicide attempts due to discrimination and gender dysphoria, 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.
"These are gut-wrenching decisions that should be made by the parents and should be informed by teams of doctors who are advising them," said DeWine. "These are parents who have watched the child suffer sometimes for years and have real concerns that their child may not survive."
Physicians who provide this care for trans youth would be "subject to discipline by the applicable professional licensing board" if this bill passes.
A grandfather clause allows people already receiving care to continue doing so.
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.
"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," state Sen. Terry Johnson, who is a retired physician, said in a Dec. 13 debate on the bill. "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.
"Instead of protecting children, we're doing the exact opposite," said state Sen. Nickie Antonio on Dec. 13. "We're putting ourselves one more time between patients, families and medical professionals in making decisions about what's best for children."
Currently, under its transgender policy, the Ohio High School Athletic Association says, "Transgender student athletes should have equal opportunity to participate in sports."
As the policy currently stands, a transgender girl must either complete a minimum of one year of hormone treatment or demonstrate that she did not possess physical or physiological advantages over genetic females.
MORE: Federal judge blocks Idaho gender-affirming transgender care banFor a transgender male to participate, he must demonstrate that his muscle mass developed as a result of testosterone treatment and does not exceed muscle mass typical of adolescent genetic males. Hormone levels are then monitored every three to six months.
House Bill 68 would have made it so transgender girls could not play on girls' or women's teams.
A bill that would have banned transgender athletes from sports that correspond with their gender identity, which also included an overhaul of the state Board of Education's powers, failed in the Ohio legislature last year. The Senate amended and passed the bill, but House representatives voted against it.