Utah report finds affirming care for trans youth "safe" and "effective"
will the state repeal its ban on the practice?
In January 2023, Utah governor Spencer Cox signed into law S.B. 16 which banned the use of gender-affirming medical approaches when treating adolescents. In a statement, Cox happily joined the nationwide push to target trans adolescents by “pausing these permanent and life-altering treatments for new patients until more and better research can help determine the long-term consequences.”
S.B. 16 was somewhat unique among the litany of anti-trans legislation in that it also charged state agencies with conducting a systematic review of the evidence around affirming care for adolescents. This review could, conceivably, provide insight for Cox and others whose public support for the law questioned whether affirming care is safe and effective.
This systematic review was released publicly this week. The 1,000+ page report was authored by 10 scientists at the Drug Regiment Review Center, operated by the College of Pharmacy at the University of Utah. The conclusions are unequivocal:
The conventional wisdom among non-experts has long been that there are limited data on the use of [gender-affirming hormone therapy] in pediatric patients with [gender dysphoria]. However, results from our exhaustive literature searches have led us to the opposite conclusion… The consensus of the evidence supports that the treatments are effective in terms of mental health, psychosocial outcomes, and the induction of body changes consistent with the affirmed gender in pediatric [gender dysphoria] patients. The evidence also supports that the treatments are safe in terms of changes to bone density, cardiovascular risk factors, metabolic changes, and cancer.
The report examined 25 primary studies of the gender-affirming model with outcomes from 10,147 trans adolescents. In total, studies find that affirming approaches lead to “positive mental health and psychosocial functioning outcomes.” In coming to these conclusions, the authors meticulously compiled published research results into tables, assessing not only the research findings but also assessments of the methodologies according to best research practices.
Per the procedure laid out in S.B. 16, this report was submitted to the Utah Department of Health and Human Services (UDHHS) who would share the results with Utah legislators. In doing so, UDHHS included an summary of the report to guide lawmakers.
UDHHS stopped short of recommending that legislators repeal their ban on affirming care, but they did halt provide recommendations on ways to safeguard adolescent safety IF the legislature were reinstate affirming-care as a medical option. In doing so, UDHHS acknowledged that uncertainty is always part of medical care, that medical providers should work to minimize potential harms, and that medical care should be wholistic by treating all facets of health and (in the case of minors) including input from parents/guardians. From these values, UDHHS recommendations include:
Establishing a treatment board under UDHHS that advises on minimum standards of care and continuing education for health care providers
Limiting the providers who can provide affirming care to trans youth
Requiring an interdisciplinary care team to oversee medical transition to ensure that adolescents’ mental and physical health needs are being met
Instituting enhanced informed consent processes
From my perspective, these “compromise” recommendations will, if enacted, continue to leave some youth without access to life-saving care. Utah is geographically large with low population density. By restricting the medical providers who can practice affirming care, rural residents will likely face continued hurdles to having their needs met - even if they otherwise meet all the required criteria to receive affirming care.
Additionally, the political nature of the proposed UDHHS treatment board will leave open the possibility of interference from the governor and right-wing activists. Such bad faith actors could work to undermine the treatment board or even hollow it out from within.
Simultaneously, no adolescents are currently able to access affirming care in Utah. Even a weak repeal of the affirming care ban (such as what UDHHS is recommending) will allow some Utah adolescents to resume or start care. That would be great progress even if the fight to fully restore this care in Utah would not be over.
So, the question remains: What will the legislature do with this overwhelming data discrediting safety concerns about adolescent affirming care? Governor Cox has been silent on the issue since the release of the report, but Republican Reps. Katy Hall (the sponsor of S.B. 16) and Bridger Bolinder (chair of the committee overseeing UDHHS) told the Salt Lake Tribune that they have no intention of repealing the law: “Simply put, the science isn’t there, the risks are real.”
It’s safe to conclude that Hall and Bolinder did not read the report they commissioned because they were never interested in the truth. If you live in Utah, you can find the contact information for your state legislators here to demand the repeal of the adolescent affirming care ban in light of the authoritative review.
That’s incredibly frustrating, they commission a study and then say there’s not enough evidence when they’re told there is?!?!?