The Ohio Senate voted Wednesday to override Gov. Mike DeWine's veto of legislation that restricts medical care for transgender minors and blocks transgender girls from female sports.

The bill prohibits doctors from prescribing hormones, puberty blockers or gender reassignment surgery before patients turn 18 and requires mental health providers to get parental permission to diagnose and treat gender dysphoria. It also bans transgender girls and women from playing on female sports teams in high school and college.

DeWine vetoed the legislation in December, arguing decisions about gender transition care should be left to families and their medical providers. But the governor's fellow Republicans disagree and say the bill is necessary to protect Ohio children.

The House voted earlier this month to overturn DeWine's decision. House Bill 68 is now poised to become law in 90 days, although opponents have signaled they could take the matter to court.

Twenty-four Republicans backed the override, with Sen. Nathan Manning, R-North Ridgeville, serving as the sole GOP vote against it. Manning voted against the bill in December.

"Despite what the liberals say, gender is not assigned at birth, but rather from the moment of conception, you are either male or you are female,” Sen. Kristina Roegner, R-Hudson. "There is no such thing as gender-affirming care. You can’t affirm something that doesn’t exist."

Gender-affirming care is a recognized medical practice encompassing different treatments, including medication, therapy and surgery, that help support someone's gender identity.

What does Ohio House Bill 68 say?

House Bill 68 does not ban talk therapy, and Ohioans already receiving hormones or puberty blockers can continue if when it becomes law, as long as doctors determine stopping the prescription would cause harm. But critics of the legislation say this isn’t enough to maintain current treatment because health care providers could be wary of legal consequences.

“It's terrorizing our children,” said Minna Zelch, who has a 19-year-old transgender daughter. “It's terrorizing transgender people. Even transgender adults in this state are now having to think, ‘Can I stay here? Can I get a job elsewhere?’”

The bill's ban of transgender girls and women in high school and college sports doesn't specify how schools would verify an athlete's gender if it's called into question. Players and their families can sue if they believe they lost an opportunity because of a transgender athlete.

Right now, the Ohio High School Athletic Association allows transgender girls to join female teams if they've completed at least one year of hormone therapy. The association approved seven transgender girls to play girls' sports for the 2023-24 school year. About 400,000 student-athletes play at the high school level, according to OHSAA.

What's next?

Opponents of House Bill 68 have said they will explore litigation, something that's played out in other states with bans on youth gender transition care. A federal judge struck down a law in Arkansas that mirrors Ohio’s new policy, but the state is appealing the decision.

“This is not the last word on this issue,” said Kelley Robinson, president of the Human Rights Campaign. “This is actually the beginning of a fight to protect our families and our kids.”

DeWine, meanwhile, is pursuing separate policies to address the issue.

DeWine signed an executive order banning Ohio hospitals and surgical facilities from performing gender transition surgery on minors. His administration also proposed rules to collect data on transgender medical care and regulate the treatment of adults and children with gender dysphoria.

Under the second proposal, providers must have a "contractual relationship" with a psychiatrist and endocrinologist to treat gender dysphoria. They would also be required to create a written, comprehensive care plan that's reviewed by a medical ethicist. Patients under 21 would have to undergo six months of counseling before further treatment occurs.

"I don't think the governor's executive order covers much of what (House Bill) 68 is about, and it covers, frankly, a pretty huge new thing that 68 did not anticipate," Senate President Matt Huffman, R-Lima, said Wednesday.

DeWine said his administration has already received an “unprecedented” number of public comments and plans to modify the rules based on that.

“We just want to make sure that people get the counseling,” DeWine said. “So, trying to get that balance so we are not interfering with what people want to do, but also making sure that good practices are followed for everybody.”

Haley BeMiller is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.