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Last summer, with a new diagnosis of Hashimoto's disease in hand, Alex went shopping for an endocrinologist to help him restore his thyroid health.
What he found instead was a roadblock. The Salt Lake City specialist he'd been referred to by another physician refused to treat Alex because the 35-year-old is transgender.
"As soon as I told [the receptionist] that I was transgender, she immediately cut me off," said Alex, who asked only to be identified by his first name. "She said the doctor didn't see people like me."
The refusal left Alex, a government contractor who was born female, in tears.
"My trans status shouldn't dictate whether I get health care," he said. "You're talking about somebody's life, their health and well-being. And if you're going to discriminate because of your belief in God, that's not really what God stands for."
With some effort and help from a nurse from his hormone doctor's office, Alex did finally get the care he needed, but his story underscores what many in the lesbian, gay, bisexual and transgender community experience here in Utah and nationwide: Discrimination based on gender identity or sexual orientation can block them from access to things — employment, housing, medical care and other basic goods and services — which others take for granted.
It's also at the heart of a Utah legislative debate over LGBT rights.
Three bill proposals have been introduced:
• Senate Bill 100 would bar LGBT discrimination in housing and employment matters.
• Senate Bill 99 proposes expanding those protections by adding "sexual orientation or gender identity" to existing public accommodation law that prohibits businesses from refusing service to anyone based on age, gender, race, religion or other factors.
• House Bill 322 seeks to ban discrimination in housing and employment for all, while protecting the right of organizations or individuals to refuse service if doing so would violate their religious beliefs.
A team of lawmakers is now trying to negotiate compromise language to balance LGBT rights with protections for religious enterprise. So far, the discussions have primarily included Sens. Stuart Adams, R-Layton, Steve Urquhart, R-St. George and Jim Dabakis, D-Salt Lake City, and Rep. Brad Dee, R-Ogden.
Representatives of the gay rights advocacy group Equality Utah and The Church of Jesus Christ of Latter-day Saints have also been consulted. In a rare move, church leaders recently endorsed legislation that safeguards religious freedom while protecting LGBT citizens in "housing, employment and public accommodation in hotels, restaurants and transportation."
Adams said last week that he is hopeful they can reach some consensus that will satisfy everyone, possibly as early as this week.
"If we find a way to merge these things together, I think it will be a little miraculous," Adams said. While Adams said he thinks they can make a deal, it's more important that they get it right. If they can't, he said, there may not be a bill at all.
No federal laws specifically protect LGBT Americans from discrimination. And data from the Human Rights Campaign, a national gay rights advocacy group, show that despite gains in marriage equality at the state level, 29 states have not passed anti-discrimination legislation.
Utah municipalities began tackling nondiscrimination issues in housing and employment in 2009, with the support of the LDS Church. To date, 19 such ordinances have been enacted by cities or counties, although all include exemptions for churches and church-owned institutions.
Whether such laws have worked to stem problems is difficult to tell.
Among a handful of cities contacted in an informal poll by The Salt Lake Tribune, only one had registered any complaints. Salt Lake City had one registered complaint in 2010, the year after it passed the state's first local ordinance. Two complaints were filed in 2011, and none was filed in either 2013 or 2014, city spokesman Art Raymond said.
Christopher Wharton, a family law attorney who also sits on the board of the Utah Pride Center, handles roughly 10 workplace discrimination cases on behalf of LGBT individuals annually and says the local data belies the breadth of the problem.
"I think people would rather just believe it doesn't happen," he said, adding that many people may not know where to turn even when they do have a complaint to report.
Wharton believes the existing laws don't adequately protect LGBT individuals. A complaint will only result in a fine against a perpetrator and does not restore an individual's lost housing or job.
Despite local efforts to give Utah's estimated 37,000 LGBT workers some protections, the lack of a statewide nondiscrimination law also leaves many vulnerable, a 2014 report from the Williams Institute, a University of California, Los Angeles, think tank for LGBT issues.
The report, which draws on polling and survey data from multiple sources including the U.S. Census, found that more than 53 percent of Utah's workforce is not covered by the 19 existing local ordinances.
In addition, a 2010 survey of LGBT Utahans found 43 percent of LGBT respondents and 67 percent of transgender respondents reported being fired, denied a job, denied a promotion, or having experienced other forms of discrimination at some point in their lives, the Williams report found. An even higher percentage of survey respondents said they experienced verbal harassment at work on a weekly basis.
"How many people is a tolerable amount when it comes to discrimination?" asked Wharton. "I think that our answer should be zero. Whether it's five people a year or 500 people a year, it's about making a policy that this is not an acceptable practice in Utah."
Utah conservatives and religious groups, who have an interest in what they believe are issues of sexual morality, have long balked at codifying any LBGT protections in state laws, but after years of debate, some progress has been made.
Even Utah's Sutherland Institute, which opposes both SB100 and SB99, can see "some merit" in legislation that ensures access to homes and work.
"Really everyone can agree that being denied housing or being denied employment is a big deal," said Bill Duncan, Sutherland's director of family and society.
The real friction now is on public accommodation law, which Duncan contends makes it difficult to delineate between things "that can maybe appear to be essentially social slights and not so much core denials."
"I think there is a feeling of 'Gosh, can't we just work that out in the marketplaces?' " he said. "Once the government gets involved it creates even more challenges."
The reality, however, is that leaving it to the marketplace doesn't always work, said Marina Lowe, legislative and policy expert for the ACLU of Utah.
"Nationally, we see a lot of stories, particularly in the marriage-related services area where cake-makers or wedding photographers won't provide services," she said. "Those stories are very real. Sometimes the law has to set norms to make sure that everybody comes along."
No one should fear that nondiscrimination laws aim to ensure any special rights for LGBT persons, said Troy Williams, Equality Utah's executive director. Rather, the goal is to make sure the LGBT community has access to legal protections or goods and services that equals the rest of society — like the access to medical care Alex struggled to get.
"It's about being fully integrated in all areas of public life," he said. "That's the objective."
Williams finds evidence of Utah's progress around accommodating all facets of the community in the recent decision by Park City High School to designate two single-stall restrooms as "all gender" facilities. It's a move the high school made, not for political reasons, but to ensure its transgender students could have the same expectations for privacy and safety as others.
"The brilliant thing about it is that it's so simple," he said. "It accommodates everyone and protects those who are the most vulnerable. That really is the spirit and purpose behind public accommodation."
As Utah's only openly gay senator and the sponsor of SB99, Dabakis said he may be willing to bend on public accommodation law this year to advance nondiscrimination in other areas.
Dabakis believes there's wide unity among Utahns that all acts of discrimination are wrong, but said he understands there are "significantly broader" questions about SB99.
"It may be a step process where we are happy and pleased with nondiscrimination in housing and employment this year and we move on to tackle the broader issue next year," he said. "We may let it go."
Reporter Robert Gehrke contributed to this story.