diff --git a/compiler/packages/babel-plugin-react-compiler/src/Entrypoint/Pipeline.ts b/compiler/packages/babel-plugin-react-compiler/src/Entrypoint/Pipeline.ts
index e0b0536f28cc6..1085d4c69e061 100644
--- a/compiler/packages/babel-plugin-react-compiler/src/Entrypoint/Pipeline.ts
+++ b/compiler/packages/babel-plugin-react-compiler/src/Entrypoint/Pipeline.ts
@@ -276,7 +276,7 @@ function runWithEnvironment(
     }
 
     if (env.config.validateNoSetStateInEffects) {
-      env.logErrors(validateNoSetStateInEffects(hir));
+      env.logErrors(validateNoSetStateInEffects(hir, env));
     }
 
     if (env.config.validateNoJSXInTryStatements) {
diff --git a/compiler/packages/babel-plugin-react-compiler/src/HIR/Environment.ts b/compiler/packages/babel-plugin-react-compiler/src/HIR/Environment.ts
index 8e6816a3d5128..0ef41866a51c2 100644
--- a/compiler/packages/babel-plugin-react-compiler/src/HIR/Environment.ts
+++ b/compiler/packages/babel-plugin-react-compiler/src/HIR/Environment.ts
@@ -660,6 +660,13 @@ export const EnvironmentConfigSchema = z.object({
    * while its parent function remains uncompiled.
    */
   validateNoDynamicallyCreatedComponentsOrHooks: z.boolean().default(false),
+
+  /**
+   * When enabled, allows setState calls in effects when the value being set is
+   * derived from a ref. This is useful for patterns where initial layout measurements
+   * from refs need to be stored in state during mount.
+   */
+  enableAllowSetStateFromRefsInEffects: z.boolean().default(true),
 });
 
 export type EnvironmentConfig = z.infer<typeof EnvironmentConfigSchema>;
diff --git a/compiler/packages/babel-plugin-react-compiler/src/Validation/ValidateNoRefAccessInRender.ts b/compiler/packages/babel-plugin-react-compiler/src/Validation/ValidateNoRefAccessInRender.ts
index eb053ac4196a2..abbb7d8476981 100644
--- a/compiler/packages/babel-plugin-react-compiler/src/Validation/ValidateNoRefAccessInRender.ts
+++ b/compiler/packages/babel-plugin-react-compiler/src/Validation/ValidateNoRefAccessInRender.ts
@@ -639,12 +639,55 @@ function validateNoRefAccessInRenderImpl(
           case 'StartMemoize':
           case 'FinishMemoize':
             break;
+          case 'LoadGlobal': {
+            if (instr.value.binding.name === 'undefined') {
+              env.set(instr.lvalue.identifier.id, {kind: 'Nullable'});
+            }
+            break;
+          }
           case 'Primitive': {
             if (instr.value.value == null) {
               env.set(instr.lvalue.identifier.id, {kind: 'Nullable'});
             }
             break;
           }
+          case 'UnaryExpression': {
+            if (instr.value.operator === '!') {
+              const value = env.get(instr.value.value.identifier.id);
+              const refId =
+                value?.kind === 'RefValue' && value.refId != null
+                  ? value.refId
+                  : null;
+              if (refId !== null) {
+                /*
+                 * Record an error suggesting the `if (ref.current == null)` pattern,
+                 * but also record the lvalue as a guard so that we don't emit a second
+                 * error for the write to the ref
+                 */
+                env.set(instr.lvalue.identifier.id, {kind: 'Guard', refId});
+                errors.pushDiagnostic(
+                  CompilerDiagnostic.create({
+                    category: ErrorCategory.Refs,
+                    reason: 'Cannot access refs during render',
+                    description: ERROR_DESCRIPTION,
+                  })
+                    .withDetails({
+                      kind: 'error',
+                      loc: instr.value.value.loc,
+                      message: `Cannot access ref value during render`,
+                    })
+                    .withDetails({
+                      kind: 'hint',
+                      message:
+                        'To initialize a ref only once, check that the ref is null with the pattern `if (ref.current == null) { ref.current = ... }`',
+                    }),
+                );
+                break;
+              }
+            }
+            validateNoRefValueAccess(errors, env, instr.value.value);
+            break;
+          }
           case 'BinaryExpression': {
             const left = env.get(instr.value.left.identifier.id);
             const right = env.get(instr.value.right.identifier.id);
diff --git a/compiler/packages/babel-plugin-react-compiler/src/Validation/ValidateNoSetStateInEffects.ts b/compiler/packages/babel-plugin-react-compiler/src/Validation/ValidateNoSetStateInEffects.ts
index 19c2e7bc5b9ab..656c9a671487b 100644
--- a/compiler/packages/babel-plugin-react-compiler/src/Validation/ValidateNoSetStateInEffects.ts
+++ b/compiler/packages/babel-plugin-react-compiler/src/Validation/ValidateNoSetStateInEffects.ts
@@ -11,16 +11,23 @@ import {
   ErrorCategory,
 } from '../CompilerError';
 import {
+  Environment,
   HIRFunction,
   IdentifierId,
   isSetStateType,
   isUseEffectHookType,
   isUseInsertionEffectHookType,
   isUseLayoutEffectHookType,
+  isUseRefType,
+  isRefValueType,
   Place,
 } from '../HIR';
-import {eachInstructionValueOperand} from '../HIR/visitors';
+import {
+  eachInstructionLValue,
+  eachInstructionValueOperand,
+} from '../HIR/visitors';
 import {Result} from '../Utils/Result';
+import {Iterable_some} from '../Utils/utils';
 
 /**
  * Validates against calling setState in the body of an effect (useEffect and friends),
@@ -32,6 +39,7 @@ import {Result} from '../Utils/Result';
  */
 export function validateNoSetStateInEffects(
   fn: HIRFunction,
+  env: Environment,
 ): Result<void, CompilerError> {
   const setStateFunctions: Map<IdentifierId, Place> = new Map();
   const errors = new CompilerError();
@@ -72,6 +80,7 @@ export function validateNoSetStateInEffects(
             const callee = getSetStateCall(
               instr.value.loweredFunc.func,
               setStateFunctions,
+              env,
             );
             if (callee !== null) {
               setStateFunctions.set(instr.lvalue.identifier.id, callee);
@@ -129,9 +138,42 @@ export function validateNoSetStateInEffects(
 function getSetStateCall(
   fn: HIRFunction,
   setStateFunctions: Map<IdentifierId, Place>,
+  env: Environment,
 ): Place | null {
+  const refDerivedValues: Set<IdentifierId> = new Set();
+
+  const isDerivedFromRef = (place: Place): boolean => {
+    return (
+      refDerivedValues.has(place.identifier.id) ||
+      isUseRefType(place.identifier) ||
+      isRefValueType(place.identifier)
+    );
+  };
+
   for (const [, block] of fn.body.blocks) {
     for (const instr of block.instructions) {
+      if (env.config.enableAllowSetStateFromRefsInEffects) {
+        const hasRefOperand = Iterable_some(
+          eachInstructionValueOperand(instr.value),
+          isDerivedFromRef,
+        );
+
+        if (hasRefOperand) {
+          for (const lvalue of eachInstructionLValue(instr)) {
+            refDerivedValues.add(lvalue.identifier.id);
+          }
+        }
+
+        if (
+          instr.value.kind === 'PropertyLoad' &&
+          instr.value.property === 'current' &&
+          (isUseRefType(instr.value.object.identifier) ||
+            isRefValueType(instr.value.object.identifier))
+        ) {
+          refDerivedValues.add(instr.lvalue.identifier.id);
+        }
+      }
+
       switch (instr.value.kind) {
         case 'LoadLocal': {
           if (setStateFunctions.has(instr.value.place.identifier.id)) {
@@ -161,6 +203,21 @@ function getSetStateCall(
             isSetStateType(callee.identifier) ||
             setStateFunctions.has(callee.identifier.id)
           ) {
+            if (env.config.enableAllowSetStateFromRefsInEffects) {
+              const arg = instr.value.args.at(0);
+              if (
+                arg !== undefined &&
+                arg.kind === 'Identifier' &&
+                refDerivedValues.has(arg.identifier.id)
+              ) {
+                /**
+                 * The one special case where we allow setStates in effects is in the very specific
+                 * scenario where the value being set is derived from a ref. For example this may
+                 * be needed when initial layout measurements from refs need to be stored in state.
+                 */
+                return null;
+              }
+            }
             /*
              * TODO: once we support multiple locations per error, we should link to the
              * original Place in the case that setStateFunction.has(callee)
diff --git a/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/allow-ref-initialization-undefined.expect.md b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/allow-ref-initialization-undefined.expect.md
new file mode 100644
index 0000000000000..c355819320af0
--- /dev/null
+++ b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/allow-ref-initialization-undefined.expect.md
@@ -0,0 +1,42 @@
+
+## Input
+
+```javascript
+//@flow
+import {useRef} from 'react';
+
+component C() {
+  const r = useRef(null);
+  if (r.current == undefined) {
+    r.current = 1;
+  }
+}
+
+export const FIXTURE_ENTRYPOINT = {
+  fn: C,
+  params: [{}],
+};
+
+```
+
+## Code
+
+```javascript
+import { useRef } from "react";
+
+function C() {
+  const r = useRef(null);
+  if (r.current == undefined) {
+    r.current = 1;
+  }
+}
+
+export const FIXTURE_ENTRYPOINT = {
+  fn: C,
+  params: [{}],
+};
+
+```
+      
+### Eval output
+(kind: ok) 
\ No newline at end of file
diff --git a/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/allow-ref-initialization-undefined.js b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/allow-ref-initialization-undefined.js
new file mode 100644
index 0000000000000..886f025287bbf
--- /dev/null
+++ b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/allow-ref-initialization-undefined.js
@@ -0,0 +1,14 @@
+//@flow
+import {useRef} from 'react';
+
+component C() {
+  const r = useRef(null);
+  if (r.current == undefined) {
+    r.current = 1;
+  }
+}
+
+export const FIXTURE_ENTRYPOINT = {
+  fn: C,
+  params: [{}],
+};
diff --git a/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/error.invalid-ref-access-render-unary.expect.md b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/error.invalid-ref-access-render-unary.expect.md
new file mode 100644
index 0000000000000..ce1be800a13bb
--- /dev/null
+++ b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/error.invalid-ref-access-render-unary.expect.md
@@ -0,0 +1,78 @@
+
+## Input
+
+```javascript
+//@flow
+import {useRef} from 'react';
+
+component C() {
+  const r = useRef(null);
+  const current = !r.current;
+  return <div>{current}</div>;
+}
+
+export const FIXTURE_ENTRYPOINT = {
+  fn: C,
+  params: [{}],
+};
+
+```
+
+
+## Error
+
+```
+Found 4 errors:
+
+Error: Cannot access refs during render
+
+React refs are values that are not needed for rendering. Refs should only be accessed outside of render, such as in event handlers or effects. Accessing a ref value (the `current` property) during render can cause your component not to update as expected (https://react.dev/reference/react/useRef).
+
+  4 | component C() {
+  5 |   const r = useRef(null);
+> 6 |   const current = !r.current;
+    |                    ^^^^^^^^^ Cannot access ref value during render
+  7 |   return <div>{current}</div>;
+  8 | }
+  9 |
+
+To initialize a ref only once, check that the ref is null with the pattern `if (ref.current == null) { ref.current = ... }`
+
+Error: Cannot access refs during render
+
+React refs are values that are not needed for rendering. Refs should only be accessed outside of render, such as in event handlers or effects. Accessing a ref value (the `current` property) during render can cause your component not to update as expected (https://react.dev/reference/react/useRef).
+
+  4 | component C() {
+  5 |   const r = useRef(null);
+> 6 |   const current = !r.current;
+    |                   ^^^^^^^^^^ Cannot access ref value during render
+  7 |   return <div>{current}</div>;
+  8 | }
+  9 |
+
+Error: Cannot access refs during render
+
+React refs are values that are not needed for rendering. Refs should only be accessed outside of render, such as in event handlers or effects. Accessing a ref value (the `current` property) during render can cause your component not to update as expected (https://react.dev/reference/react/useRef).
+
+   5 |   const r = useRef(null);
+   6 |   const current = !r.current;
+>  7 |   return <div>{current}</div>;
+     |                ^^^^^^^ Cannot access ref value during render
+   8 | }
+   9 |
+  10 | export const FIXTURE_ENTRYPOINT = {
+
+Error: Cannot access refs during render
+
+React refs are values that are not needed for rendering. Refs should only be accessed outside of render, such as in event handlers or effects. Accessing a ref value (the `current` property) during render can cause your component not to update as expected (https://react.dev/reference/react/useRef).
+
+   5 |   const r = useRef(null);
+   6 |   const current = !r.current;
+>  7 |   return <div>{current}</div>;
+     |                ^^^^^^^ Cannot access ref value during render
+   8 | }
+   9 |
+  10 | export const FIXTURE_ENTRYPOINT = {
+```
+          
+      
\ No newline at end of file
diff --git a/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/error.invalid-ref-access-render-unary.js b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/error.invalid-ref-access-render-unary.js
new file mode 100644
index 0000000000000..8d99008f805b3
--- /dev/null
+++ b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/error.invalid-ref-access-render-unary.js
@@ -0,0 +1,13 @@
+//@flow
+import {useRef} from 'react';
+
+component C() {
+  const r = useRef(null);
+  const current = !r.current;
+  return <div>{current}</div>;
+}
+
+export const FIXTURE_ENTRYPOINT = {
+  fn: C,
+  params: [{}],
+};
diff --git a/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/error.invalid-ref-initialization-unary-not.expect.md b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/error.invalid-ref-initialization-unary-not.expect.md
new file mode 100644
index 0000000000000..516d006c205a9
--- /dev/null
+++ b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/error.invalid-ref-initialization-unary-not.expect.md
@@ -0,0 +1,43 @@
+
+## Input
+
+```javascript
+//@flow
+import {useRef} from 'react';
+
+component C() {
+  const r = useRef(null);
+  if (!r.current) {
+    r.current = 1;
+  }
+}
+
+export const FIXTURE_ENTRYPOINT = {
+  fn: C,
+  params: [{}],
+};
+
+```
+
+
+## Error
+
+```
+Found 1 error:
+
+Error: Cannot access refs during render
+
+React refs are values that are not needed for rendering. Refs should only be accessed outside of render, such as in event handlers or effects. Accessing a ref value (the `current` property) during render can cause your component not to update as expected (https://react.dev/reference/react/useRef).
+
+  4 | component C() {
+  5 |   const r = useRef(null);
+> 6 |   if (!r.current) {
+    |        ^^^^^^^^^ Cannot access ref value during render
+  7 |     r.current = 1;
+  8 |   }
+  9 | }
+
+To initialize a ref only once, check that the ref is null with the pattern `if (ref.current == null) { ref.current = ... }`
+```
+          
+      
\ No newline at end of file
diff --git a/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/error.invalid-ref-initialization-unary-not.js b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/error.invalid-ref-initialization-unary-not.js
new file mode 100644
index 0000000000000..b9b5d41295cdb
--- /dev/null
+++ b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/error.invalid-ref-initialization-unary-not.js
@@ -0,0 +1,14 @@
+//@flow
+import {useRef} from 'react';
+
+component C() {
+  const r = useRef(null);
+  if (!r.current) {
+    r.current = 1;
+  }
+}
+
+export const FIXTURE_ENTRYPOINT = {
+  fn: C,
+  params: [{}],
+};
diff --git a/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-set-state-in-useEffect-from-ref.expect.md b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-set-state-in-useEffect-from-ref.expect.md
new file mode 100644
index 0000000000000..e60888bafc647
--- /dev/null
+++ b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-set-state-in-useEffect-from-ref.expect.md
@@ -0,0 +1,63 @@
+
+## Input
+
+```javascript
+// @validateNoSetStateInEffects
+import {useState, useRef, useEffect} from 'react';
+
+function Tooltip() {
+  const ref = useRef(null);
+  const [tooltipHeight, setTooltipHeight] = useState(0);
+
+  useEffect(() => {
+    const {height} = ref.current.getBoundingClientRect();
+    setTooltipHeight(height);
+  }, []);
+
+  return tooltipHeight;
+}
+
+export const FIXTURE_ENTRYPOINT = {
+  fn: Tooltip,
+  params: [],
+};
+
+```
+
+## Code
+
+```javascript
+import { c as _c } from "react/compiler-runtime"; // @validateNoSetStateInEffects
+import { useState, useRef, useEffect } from "react";
+
+function Tooltip() {
+  const $ = _c(2);
+  const ref = useRef(null);
+  const [tooltipHeight, setTooltipHeight] = useState(0);
+  let t0;
+  let t1;
+  if ($[0] === Symbol.for("react.memo_cache_sentinel")) {
+    t0 = () => {
+      const { height } = ref.current.getBoundingClientRect();
+      setTooltipHeight(height);
+    };
+    t1 = [];
+    $[0] = t0;
+    $[1] = t1;
+  } else {
+    t0 = $[0];
+    t1 = $[1];
+  }
+  useEffect(t0, t1);
+  return tooltipHeight;
+}
+
+export const FIXTURE_ENTRYPOINT = {
+  fn: Tooltip,
+  params: [],
+};
+
+```
+      
+### Eval output
+(kind: exception) Cannot read properties of null (reading 'getBoundingClientRect')
\ No newline at end of file
diff --git a/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-set-state-in-useEffect-from-ref.js b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-set-state-in-useEffect-from-ref.js
new file mode 100644
index 0000000000000..e27292c0a8a85
--- /dev/null
+++ b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-set-state-in-useEffect-from-ref.js
@@ -0,0 +1,19 @@
+// @validateNoSetStateInEffects
+import {useState, useRef, useEffect} from 'react';
+
+function Tooltip() {
+  const ref = useRef(null);
+  const [tooltipHeight, setTooltipHeight] = useState(0);
+
+  useEffect(() => {
+    const {height} = ref.current.getBoundingClientRect();
+    setTooltipHeight(height);
+  }, []);
+
+  return tooltipHeight;
+}
+
+export const FIXTURE_ENTRYPOINT = {
+  fn: Tooltip,
+  params: [],
+};
diff --git a/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-setState-in-effect-from-ref-arithmetic.expect.md b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-setState-in-effect-from-ref-arithmetic.expect.md
new file mode 100644
index 0000000000000..ee19358f3fb0e
--- /dev/null
+++ b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-setState-in-effect-from-ref-arithmetic.expect.md
@@ -0,0 +1,68 @@
+
+## Input
+
+```javascript
+// @validateNoSetStateInEffects @enableAllowSetStateFromRefsInEffects
+import {useState, useRef, useLayoutEffect} from 'react';
+
+function Component() {
+  const ref = useRef({size: 5});
+  const [computedSize, setComputedSize] = useState(0);
+
+  useLayoutEffect(() => {
+    setComputedSize(ref.current.size * 10);
+  }, []);
+
+  return computedSize;
+}
+
+export const FIXTURE_ENTRYPOINT = {
+  fn: Component,
+  params: [],
+};
+
+```
+
+## Code
+
+```javascript
+import { c as _c } from "react/compiler-runtime"; // @validateNoSetStateInEffects @enableAllowSetStateFromRefsInEffects
+import { useState, useRef, useLayoutEffect } from "react";
+
+function Component() {
+  const $ = _c(3);
+  let t0;
+  if ($[0] === Symbol.for("react.memo_cache_sentinel")) {
+    t0 = { size: 5 };
+    $[0] = t0;
+  } else {
+    t0 = $[0];
+  }
+  const ref = useRef(t0);
+  const [computedSize, setComputedSize] = useState(0);
+  let t1;
+  let t2;
+  if ($[1] === Symbol.for("react.memo_cache_sentinel")) {
+    t1 = () => {
+      setComputedSize(ref.current.size * 10);
+    };
+    t2 = [];
+    $[1] = t1;
+    $[2] = t2;
+  } else {
+    t1 = $[1];
+    t2 = $[2];
+  }
+  useLayoutEffect(t1, t2);
+  return computedSize;
+}
+
+export const FIXTURE_ENTRYPOINT = {
+  fn: Component,
+  params: [],
+};
+
+```
+      
+### Eval output
+(kind: ok) 50
\ No newline at end of file
diff --git a/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-setState-in-effect-from-ref-arithmetic.js b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-setState-in-effect-from-ref-arithmetic.js
new file mode 100644
index 0000000000000..d312b139b7012
--- /dev/null
+++ b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-setState-in-effect-from-ref-arithmetic.js
@@ -0,0 +1,18 @@
+// @validateNoSetStateInEffects @enableAllowSetStateFromRefsInEffects
+import {useState, useRef, useLayoutEffect} from 'react';
+
+function Component() {
+  const ref = useRef({size: 5});
+  const [computedSize, setComputedSize] = useState(0);
+
+  useLayoutEffect(() => {
+    setComputedSize(ref.current.size * 10);
+  }, []);
+
+  return computedSize;
+}
+
+export const FIXTURE_ENTRYPOINT = {
+  fn: Component,
+  params: [],
+};
diff --git a/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-setState-in-effect-from-ref-array-index.expect.md b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-setState-in-effect-from-ref-array-index.expect.md
new file mode 100644
index 0000000000000..a7c3714b18f87
--- /dev/null
+++ b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-setState-in-effect-from-ref-array-index.expect.md
@@ -0,0 +1,69 @@
+
+## Input
+
+```javascript
+// @validateNoSetStateInEffects @enableAllowSetStateFromRefsInEffects
+import {useState, useRef, useEffect} from 'react';
+
+function Component() {
+  const ref = useRef([1, 2, 3, 4, 5]);
+  const [value, setValue] = useState(0);
+
+  useEffect(() => {
+    const index = 2;
+    setValue(ref.current[index]);
+  }, []);
+
+  return value;
+}
+
+export const FIXTURE_ENTRYPOINT = {
+  fn: Component,
+  params: [],
+};
+
+```
+
+## Code
+
+```javascript
+import { c as _c } from "react/compiler-runtime"; // @validateNoSetStateInEffects @enableAllowSetStateFromRefsInEffects
+import { useState, useRef, useEffect } from "react";
+
+function Component() {
+  const $ = _c(3);
+  let t0;
+  if ($[0] === Symbol.for("react.memo_cache_sentinel")) {
+    t0 = [1, 2, 3, 4, 5];
+    $[0] = t0;
+  } else {
+    t0 = $[0];
+  }
+  const ref = useRef(t0);
+  const [value, setValue] = useState(0);
+  let t1;
+  let t2;
+  if ($[1] === Symbol.for("react.memo_cache_sentinel")) {
+    t1 = () => {
+      setValue(ref.current[2]);
+    };
+    t2 = [];
+    $[1] = t1;
+    $[2] = t2;
+  } else {
+    t1 = $[1];
+    t2 = $[2];
+  }
+  useEffect(t1, t2);
+  return value;
+}
+
+export const FIXTURE_ENTRYPOINT = {
+  fn: Component,
+  params: [],
+};
+
+```
+      
+### Eval output
+(kind: ok) 3
\ No newline at end of file
diff --git a/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-setState-in-effect-from-ref-array-index.js b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-setState-in-effect-from-ref-array-index.js
new file mode 100644
index 0000000000000..90459ac445cf1
--- /dev/null
+++ b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-setState-in-effect-from-ref-array-index.js
@@ -0,0 +1,19 @@
+// @validateNoSetStateInEffects @enableAllowSetStateFromRefsInEffects
+import {useState, useRef, useEffect} from 'react';
+
+function Component() {
+  const ref = useRef([1, 2, 3, 4, 5]);
+  const [value, setValue] = useState(0);
+
+  useEffect(() => {
+    const index = 2;
+    setValue(ref.current[index]);
+  }, []);
+
+  return value;
+}
+
+export const FIXTURE_ENTRYPOINT = {
+  fn: Component,
+  params: [],
+};
diff --git a/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-setState-in-effect-from-ref-function-call.expect.md b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-setState-in-effect-from-ref-function-call.expect.md
new file mode 100644
index 0000000000000..8a46686fcde25
--- /dev/null
+++ b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-setState-in-effect-from-ref-function-call.expect.md
@@ -0,0 +1,75 @@
+
+## Input
+
+```javascript
+// @validateNoSetStateInEffects @enableAllowSetStateFromRefsInEffects
+import {useState, useRef, useEffect} from 'react';
+
+function Component() {
+  const ref = useRef(null);
+  const [width, setWidth] = useState(0);
+
+  useEffect(() => {
+    function getBoundingRect(ref) {
+      if (ref.current) {
+        return ref.current.getBoundingClientRect?.()?.width ?? 100;
+      }
+      return 100;
+    }
+
+    setWidth(getBoundingRect(ref));
+  }, []);
+
+  return width;
+}
+
+export const FIXTURE_ENTRYPOINT = {
+  fn: Component,
+  params: [],
+};
+
+```
+
+## Code
+
+```javascript
+import { c as _c } from "react/compiler-runtime"; // @validateNoSetStateInEffects @enableAllowSetStateFromRefsInEffects
+import { useState, useRef, useEffect } from "react";
+
+function Component() {
+  const $ = _c(2);
+  const ref = useRef(null);
+  const [width, setWidth] = useState(0);
+  let t0;
+  let t1;
+  if ($[0] === Symbol.for("react.memo_cache_sentinel")) {
+    t0 = () => {
+      const getBoundingRect = function getBoundingRect(ref_0) {
+        if (ref_0.current) {
+          return ref_0.current.getBoundingClientRect?.()?.width ?? 100;
+        }
+        return 100;
+      };
+
+      setWidth(getBoundingRect(ref));
+    };
+    t1 = [];
+    $[0] = t0;
+    $[1] = t1;
+  } else {
+    t0 = $[0];
+    t1 = $[1];
+  }
+  useEffect(t0, t1);
+  return width;
+}
+
+export const FIXTURE_ENTRYPOINT = {
+  fn: Component,
+  params: [],
+};
+
+```
+      
+### Eval output
+(kind: ok) 100
\ No newline at end of file
diff --git a/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-setState-in-effect-from-ref-function-call.js b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-setState-in-effect-from-ref-function-call.js
new file mode 100644
index 0000000000000..e37b3f3ea2b4b
--- /dev/null
+++ b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-setState-in-effect-from-ref-function-call.js
@@ -0,0 +1,25 @@
+// @validateNoSetStateInEffects @enableAllowSetStateFromRefsInEffects
+import {useState, useRef, useEffect} from 'react';
+
+function Component() {
+  const ref = useRef(null);
+  const [width, setWidth] = useState(0);
+
+  useEffect(() => {
+    function getBoundingRect(ref) {
+      if (ref.current) {
+        return ref.current.getBoundingClientRect?.()?.width ?? 100;
+      }
+      return 100;
+    }
+
+    setWidth(getBoundingRect(ref));
+  }, []);
+
+  return width;
+}
+
+export const FIXTURE_ENTRYPOINT = {
+  fn: Component,
+  params: [],
+};
diff --git a/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-setState-in-useLayoutEffect-from-ref.expect.md b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-setState-in-useLayoutEffect-from-ref.expect.md
new file mode 100644
index 0000000000000..cacd46bfe42a6
--- /dev/null
+++ b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-setState-in-useLayoutEffect-from-ref.expect.md
@@ -0,0 +1,63 @@
+
+## Input
+
+```javascript
+// @validateNoSetStateInEffects @enableAllowSetStateFromRefsInEffects
+import {useState, useRef, useLayoutEffect} from 'react';
+
+function Tooltip() {
+  const ref = useRef(null);
+  const [tooltipHeight, setTooltipHeight] = useState(0);
+
+  useLayoutEffect(() => {
+    const {height} = ref.current.getBoundingClientRect();
+    setTooltipHeight(height);
+  }, []);
+
+  return tooltipHeight;
+}
+
+export const FIXTURE_ENTRYPOINT = {
+  fn: Tooltip,
+  params: [],
+};
+
+```
+
+## Code
+
+```javascript
+import { c as _c } from "react/compiler-runtime"; // @validateNoSetStateInEffects @enableAllowSetStateFromRefsInEffects
+import { useState, useRef, useLayoutEffect } from "react";
+
+function Tooltip() {
+  const $ = _c(2);
+  const ref = useRef(null);
+  const [tooltipHeight, setTooltipHeight] = useState(0);
+  let t0;
+  let t1;
+  if ($[0] === Symbol.for("react.memo_cache_sentinel")) {
+    t0 = () => {
+      const { height } = ref.current.getBoundingClientRect();
+      setTooltipHeight(height);
+    };
+    t1 = [];
+    $[0] = t0;
+    $[1] = t1;
+  } else {
+    t0 = $[0];
+    t1 = $[1];
+  }
+  useLayoutEffect(t0, t1);
+  return tooltipHeight;
+}
+
+export const FIXTURE_ENTRYPOINT = {
+  fn: Tooltip,
+  params: [],
+};
+
+```
+      
+### Eval output
+(kind: exception) Cannot read properties of null (reading 'getBoundingClientRect')
\ No newline at end of file
diff --git a/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-setState-in-useLayoutEffect-from-ref.js b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-setState-in-useLayoutEffect-from-ref.js
new file mode 100644
index 0000000000000..339b550730d77
--- /dev/null
+++ b/compiler/packages/babel-plugin-react-compiler/src/__tests__/fixtures/compiler/valid-setState-in-useLayoutEffect-from-ref.js
@@ -0,0 +1,19 @@
+// @validateNoSetStateInEffects @enableAllowSetStateFromRefsInEffects
+import {useState, useRef, useLayoutEffect} from 'react';
+
+function Tooltip() {
+  const ref = useRef(null);
+  const [tooltipHeight, setTooltipHeight] = useState(0);
+
+  useLayoutEffect(() => {
+    const {height} = ref.current.getBoundingClientRect();
+    setTooltipHeight(height);
+  }, []);
+
+  return tooltipHeight;
+}
+
+export const FIXTURE_ENTRYPOINT = {
+  fn: Tooltip,
+  params: [],
+};