2023 Transgender Youth Healthcare Bills

At this time, we have two bills filed that are intended to remove some or all transgender affirming healthcare for our youth. SB0016 is from Sen Kennedy and aims to block surgeries for minors. HB0132 is from Rep Shipp and aims to remove all affirming healthcare for transgender youth.

Let’s start with SB0016. This bill targets what it refers to as Primary Sex Characteristics Surgical Procedure and Secondary Sex Characteristics Surgical Procedure. In the October Interim Health and Human Services Committee (video replay: https://le.utah.gov/av/committeeArchive.jsp?mtgID=18287), the bill sponsor made the statement that the World Professional Association of Transgender Health (WPATH) Standards of Care (SOC) states that surgeries are not recommended until a person reaches adulthood and that the SOC document is fully supported by the Endocrine Society. I understand that it may be easy to misinterpret the SOC as there are terminology definitions throughout the document and it may require extensive reading. So let’s be clear on align of terminology and then discuss.

First, I fully agree with Sen Kennedy that the SOC is the governing document and guide for transgender healthcare and has been since 1979. With this, I will use the SOC as my reference throughout this text. I also agree that the Endocrine Society supports the SOC and I will extend that to the American Medical Association, the American Psychological Association, and the American Academy of Pediatrics along with many other major medical organizations. As a note for those not familiar with it, the SOC is a 260 page document with the last 80 pages being the footnote list which is to a treasure of scientific research and analysis. Since we agree on that, let’s discuss what this guiding, evidence based document says.

First let’s discuss Genital Surgery (I will use SOC terminology going forward). This is not a recommended intervention for youth and doesn’t happen in the transgender healthcare system. Beyond any discussion of when a transgender person should make this decision, the standards indicate a path that requires years of cooperative treatment and assessment between the parents, medical doctors, and mental health providers. This naturally creates a path into adulthood before being a recommended intervention. This is the surgery standard that appears to be what Sen Kennedy referenced. But the standards for Gender Affirming Surgery do allow a path for youth with the appropriate treatment plan and execution with the involvement of parents, medical doctors, and mental health providers. Chapter 13 is the complete set of standards on surgery. For brevity, the Statement of Recommendations at the start of the chapter, have these two entries:

13.6- We suggest health care professionals consider gender-affirming genital procedures for eligible* transgender and gender diverse adults seeking these interventions when there is evidence the individual has been stable on their current treatment regime (which may include at least 6 months of hormone treatment or a longer period if required to achieve the desired surgical result, unless hormone therapy is either not desired or is medically contraindicated).
13.7- We recommend surgeons consider gender-affirming surgical interventions for eligible* transgender and gender diverse adolescents when there is evidence a multidisciplinary approach that includes mental health and medical professionals has been involved in the decision-making process.

With the clarity of terminology and these two statements of standards of care, the bill is unnecessary relating to genital surgery, since it is not a recommended treatment and harmful on gender affirming surgery since it removes that scientifically backed medical intervention that its removal will have negative mental health outcomes (see various major medical statements). This means the existence of the bill is harmful to youth hearing their existence and treatments debated while having no positive impact if passed.

Now let’s look at HB0132. This bill is a boilerplate that has been run across the country. There are a few that have passed and with lawsuits being filed, injunctions are in place. In Utah, this is the fourth year this bill is being run with little change in original wording, and none of the previous efforts have achieved traction (2022 – HB0127; 2021 – HB0092, 2020 – HB0449). This bill intends to remove all transgender related healthcare for youth. Obviously all the surgical options already discussed apply to this bill. The additional items covered in this bill over SB0016 are related to the use of Puberty Blockers and Hormone Therapies.

Puberty Blockers are exactly that, they pause the commencement of puberty. This is a non-permanent pause button type of action that give the youth, parents, and providers the ability to perform needed assessments and determinations of the path forward that is determined for this particular individual. This can include moving to hormone therapies or ceasing puberty blockers and entering puberty. This is extremely important as the onset of puberty is the greatest time of risk of negative mental health outcomes due to the onset of unwanted physical changes. These medical paths are evidence based, and recommended with direction throughout the SOC. These paths do no harm to the youth and at times, are life saving to remove the youth from the distress associated with gender dysphoria.

With the issues discussed on surgeries and the importance of puberty blockers and hormone therapies, HB0132 is demonstrably unscientific and causes harm to transgender youth through its discussion and more harmful if passed.

One comment we hear at times is how can a youth be old enough to make these decisions. We need to fully understand that the youth do not make these decisions. The parents with the input of their kids along with the doctors and mental health professionals are who make these decisions. In this context, this is no different than any other medical decision made on minors. Utah is broadly a proponent of parent’s rights and that is exactly what applies here. We allow the parents to determine what is best for their children in many areas, especially medically.

One of the inclusions in both of these bills is the exclusion of surgery limitations for Intersex youth. This is ironic as it goes against all their arguments against transgender youth having surgery. The general Intersex stance is that these surgeries as a baby or infant are unnecessary and can have long lasting impacts. We should wait until the child can give input, like a transgender youth. The existence of these exclusions only creates cosmetic surgery paths on Intersex youth. This is an area we are behind in learning on more than even transgender medicine. There is an entire chapter in the SOC on Intersex individuals, and the statement quoted below gives the SOC’s recommendation.

10.9- We suggest health care professionals counsel parents and children with intersexuality (when cognitively sufficiently developed) to delay gender-affirming genital surgery, gonadal surgery, or both, so as to optimize the children’s self-determination and ability to participate in the decision based on informed consent.