Last week, Utah Gov. Spencer Cox signed SB16, heavily legislating access to hormone replacement therapy (HRT) for transgender individuals in Utah. The passage of this bill has quickly become the center of a national debate about ethics, mental health and science.
As psychologists and social scientists who study the health of transgender Utahns, we applaud the legislation’s efforts to be science-based and see the ways in which SB16 is attempting to respond to an increase in young people identifying as transgender.
Nonetheless, we are greatly concerned that the framing of SB16 is unlikely to produce the science-based recommendations that it appears to seek, nor do we believe it will result in better mental and physical health for transgender youth in the state.
Officially, SB16 does three major things: It binds the Department of Health and Human Services to review medical evidence about HRT and gender-affirming surgeries. It requires the Division of Professional Licensing to more closely regulate the provision of HRT. It prohibits health care providers from providing HRT or gender-affirming surgeries to minors. We unpack each and its implications below.
First, authoritative reviews about the safety and efficacy of HRT have already been conducted. HRT has been deemed to be medically necessary and safe and it represents evidence-based treatment by the American Medical Association, the American Psychiatric Association and the American Academy of Pediatrics.
It is not clear what the Legislature is expecting to discover that would diverge from the findings of these three respected bodies, nor is it clear if they will abide by the recommendations made, as lawmakers have not been responsive to current guidelines established by authoritative medical organizations.
Second, closer regulation of the provision of HRT is likely to lead to a dearth of providers in Utah who are able to prescribe HRT. Without sufficient providers, transgender youth are likely to seek less regulated ways to access HRT, including going to neighboring states, using third-party sites that send HRT with minimal doctor consults or buying hormones on the street. Already, transgender people across the country are more likely to delay health care compared to both LGB people and the broader public. Thus, although bill may succeed in regulating the practice of HRT, it is unlikely to succeed in ensuring the safe practice of HRT.
Finally, not allowing transgender teens to access HRT — despite their parents’ wishes — is likely to lead to increased distress and risk for suicide for transgender teens in Utah. From our research with over 6,000 sexual and gender minority teens in Utah, we have found that transgender youth in Utah face increased social stigma and bullying, which drastically increase their risk for mental health problems like depression and suicide.
Research is also clear that transgender youth and their parents are well-informed about gender-affirming care and that these treatments drastically reduce the mental health challenges they frequently face, including making them less likely to think about or attempt suicide. Taken together, we believe the research strongly supports the notion that gender-affirming care is suicide prevention. We are troubled that this law will bar many transgender Utah teens from accessing these potentially lifesaving treatments.
Much of the reason that we believe that SB16 has been signed into law is that many Utahns are not familiar with the research or lived experiences of their transgender neighbors. We call upon all Utahns to understand the science-backed evidence of HRT and gender-affirming surgeries, as well as elevate the perspectives of transgender Utahns to help educate our state.
G. Tyler Lefevor
G. Tyler Lefevor is an assistant professor of psychology at Utah State University. He and his husband live in Kaysville.
James S. McGraw
James S. McGraw is a Utah native and currently a graduate student in the clinical psychology program at Bowling Green State University.