Utah study on trans youth care extremely inconvenient for politicians who ordered it

In 2022, Utah Gov. Spencer Cox was the rare Republican governor who seemed to truly care about the well-being of transgender kids. “I don’t understand what they are going through or why they feel the way they do. But I want them to live,” he wrote in a letter that year, explaining why he was vetoing a bill that would have banned four trans middle- and high schoolers in Utah from playing on sports teams with classmates who shared their gender identity. “All the research shows that even a little acceptance and connection can reduce suicidality significantly.”

Meanwhile, nationally, Republican politicians were making opposition to trans rights a core tenet of their platforms, filing hundreds of bills attacking trans kids at the doctor’s office, at school, and on the field. Early in the 2023 legislative session, Cox capitulated, signing a bill that placed an indefinite “moratorium” on doctors providing puberty blockers and hormone therapy to trans kids with gender dysphoria. The bill ordered the Utah health department to commission a systematic review of medical evidence around the treatments, with the goal of producing recommendations for the legislature on whether to lift the moratorium. “We sincerely hope that we can treat our transgender families with more love and respect as we work to better understand the science and consequences behind these procedures,” Cox said at the time.

Now, more than two years later, that review is here, and its conclusions unambiguously support gender-affirming medical care for trans youth. “The conventional wisdom among non-experts has long been that there are limited data” on gender-affirming pediatric care, the authors wrote. “However, results from our exhaustive literature searches have lead us to the opposite conclusion.”

The medical evidence review, published on Wednesday, was compiled over a two-year period by the Drug Regimen Review Center at the University of Utah. Unlike the federal government’s recent report on the same subject, which was produced in three months and criticized gender-affirming pediatric treatments, the names of the Utah report’s contributors are actually disclosed on the more than thousand-page document.

The authors write:

The consensus of the evidence supports that the treatments are effective in terms of mental health, psychosocial outcomes, and the induction of bodychanges 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…

It is our expert opinion that policies to prevent access to and use of [gender-affirming hormone therapy] for treatment of [gender dysphoria] in pediatric patients cannot be justified based on the quantity or quality of medical science findings or concerns about potential regret in the future, and that high-quality guidelines are available to guide qualified providers in treating pediatric patients who meet diagnostic criteria.

In a second part of their review, the authors looked specifically at long-term outcomes of patients who started treatment for gender dysphoria as minors:

Overall, there were positive mental health and psychosocial functioning outcomes. While gender affirming treatment showed a possibly protective effect in prostate cancer in transgender men and breast cancer in transgender women, there was an increase in some specific types of benign brain tumors. There were increased mortality risks in both transgender men and women treated with hormonal therapy, but more so in transgender women. Increase risk of mortality was consistently due to increase in suicide, non-natural causes, and HIV/AIDS. Patients that were seen at the gender clinic before the age of 18 had a lower risk of suicide compared to those referred as an adult.

Submitted with the review was a set of recommendations—compiled by advisers from the state’s medical and professional licensing boards, the University of Utah, and a Utah non-profit hospital system—on steps the state legislature could take to ensure proper training among gender-affirming care providers, in the event it decides to lift the moratorium.

But according to the Salt Lake Tribune, legislators behind the ban are already dismissing the findings they asked for. In response to questions from the Tribune, Rep. Katy Hall, who co-sponsored the 2023 ban, issued a joint statement with fellow Republican state Rep. Bridger Bolinder, the chair of the legislature’s Health and Human Services Interim Committee, that dismissed the study’s findings. “We intend to keep the moratorium in place,” they told the Tribune. “Young kids and teenagers should not be making life-altering medical decisions based on weak evidence.”

Why ignore their own review? Polling, the legislators’ statement suggests. “Utah was right to lead on this issue, and the public agrees—polls show clear majority support both statewide and nationally,” Hall and Bolinder added in their statement. “Simply put, the science isn’t there, the risks are real, and the public is with us.”

Others, like former state Rep. Mike Kennedy, a co-sponsor of the 2023 ban who now represents Utah’s 3rd district in Congress, have so far been silent on the state review’s findings—as has Gov. Cox, who did not respond to the Salt Lake Tribune‘s request for comment.