Lisa Hansen: Mental health professionals see the danger in Utah’s anti-transgender law

Law threatens the mental, spiritual and physical health of Utah’s teens.

(Francisco Kjolseth | The Salt Lake Tribune) Abby Thornton, 9, helps put up a line of transgender flags in front of the Utah Pride Center in Salt Lake City on Saturday, March 18, 2023, as part of Transgender Day of Visibility on March 31.

The signers of this essay are mental health professionals who are citizens of Utah, deeply committed to the mental, spiritual and physical health of Utah’s teens.

As of one month ago, a vulnerable and sizable group of Utah’s teens have been denied essential medical care by Utah’s Legislature. As a marriage and family therapist, with a Ph.D. degree from Brigham Young University, I join with my colleagues who work with trans and nonbinary teen clients to express our horror at this misguided and harmful legislation.

We declare that the SB16, passed by the Legislature and signed by Gov. Spencer Cox on January 24, constitutes medical discrimination against a protected class and increases risks to both health and safety in Utah’s vulnerable population. This legislation brands Utah as reckless and culturally ignorant, while committing both measurable and immeasurable harm against its own trans and nonbinary citizens.

While the bill calls for “a systematic review of the medical evidence regarding hormonal transgender treatments,” it bans life-saving care that hundreds of teens have benefitted from already here in Utah and which they and their families credit for dramatically improving their mental health.

Legislators who voted for this bill, and Utah’s governor, have failed to take into account significant peer-reviewed research supporting the role of hormone therapy in adolescent mental health.

The respected journal Pediatrics reports that hormone therapy for teens resulted in 73% lower odds of suicidality and 60% lower odds of depression compared to those who did not take puberty blockers or gender-affirming hormones. These results are supported by other peer-reviewed studies, including one in the Journal of Adolescent Health, which surveyed nearly 12,000 transgender/nonbinary youth and reported significant reduction of depression and suicidality in youth who were prescribed gender-affirming hormone treatment.

A 2020 Pediatrics study showed that trans and nonbinary youth who desired treatment but did not receive it had higher lifetime odds of suicidal ideation.

Prohibiting this care does not simply delay treatment; it is associated with lifetime consequences. The American Academy of Pediatrics reported in a 2020 study that waiting even until later in puberty for hormone therapy was associated with worse mental health outcomes (depression, self-harm, suicide attempts) than providing hormone therapy at an earlier age.

Lowering depression by 60% and suicidality by 73% is far superior to any other program or treatment for teens who qualify for and seek treatment for gender dysphoria. Schools and legislators are willing to spend thousands of dollars on treatments that reduce suicidal ideation by 3% to 5%. Yet Utah’s government has now ignorantly thrown away a critical medical intervention that is currently and spectacularly benefitting the mental health of hundreds of LGBTQ teens in Utah.

Gender-affirming medical care is recommended for trans and nonbinary youth by the prestigious American Academy of Pediatrics and the Endocrine Society. Comprehensive review of research of the effects of gender-affirming medical care was conducted by Cornell University and concluded that access to such care improves the overall well-being of transgender individuals and found no evidence that it causes harm.

Gender-diverse clients seeking hormone therapy already experience numerous hurdles and are carefully screened by mental health professionals and medical providers prior to qualifying for treatment. It is inappropriate for lawmakers to deny access to life-saving medical care supported by research, mental health professionals, and medical care providers.

Halting this care demonstrates a callous recklessness with Utah citizens who already have lots of reasons to wonder if Utah wants them to thrive.

At nonprofit Flourish Therapy, our 36 therapists are already feeling the weight of this legislation. As one therapist described it, “It is as though the governor and legislators have thrown our teen clients off of a bridge — and they hope somehow therapists can swim around holding everyone’s heads above water.”

Our job has become exponentially more time-consuming and heavy. We are horrified at the naivete of our leaders in government and deeply concerned for the increased health and life risk to our clients.

We are certain if the legislators and governor were in our shoes and saw what we see every day in working with these adolescent clients, they would not have passed this law. Certainly they know that LGBTQ+ teens are already at high risk for depression and suicidality.

In March of 2022, Cox reported his awareness that 56% of transgender youth have attempted suicide as he pled with the legislature last year not to pass a ban on transgender youth sports participation.

Unfortunately, lawmakers have now signaled to trans and nonbinary youth that they are willing to cause them harm. These adolescents will feel the weight of being cut off from life-saving intervention by Utah’s leaders no matter how we might try to interpret this law as protecting them.

They see the truth. The LGBTQ community sees the truth. Access to evidence-based medical care has been banned. Their lives have been politicized with scare tactics by people who have not bothered to absorb the research and what it means to their daily lives. Their needs do not matter to Utah.

How do families of these teens feel about this new law? They recognize that Utah is discriminating against their children. They know that non-gender-diverse teens can still be prescribed hormone therapy for a variety of medical reasons. They know that non-gender diverse teens can still pursue permanent surgeries.

Families with gender diverse children will now have to travel out of state to access care when their children suffer with the intense depression and suicidality frequently associated with a diagnosis of gender dysphoria. Some may choose to access hormones illegally to save their child’s life. This means that gender-diverse adolescents will face the secondary trauma of putting their families under greater stress and higher risk to pursue life-preserving treatment.

And Utah will gain notoriety as a state that sacrifices its marginalized population while it waits.

Trans and nonbinary youth are our leaders tomorrow. They have unique gifts and maturely compassionate ways of seeing our world. We need them to be their best – for themselves, for Utah, for the future.

Unfortunately, they will remember what Utah did to them in January, 2023.

Our message to Gov. Cox and legislators who voted for this bill is this: We on the front lines and in the trenches every day with these adolescents know that talk therapy is no substitute for necessary medical care. As of January 24, 2023, depression and suicidality are immediately on the rise. Please rethink this legislation before it is too late for these adolescents – and for Utah.

Lisa Tensmeyer Hansen

Lisa Tensmeyer Hansen, Ph.D., LMFT, is CEO of Flourish Therapy Inc., a 501(c)3 nonprofit mental health clinic located in Utah and Salt Lake Counties serving the needs of the LGBTQ+ community.

This essay is also signed by Laura Skaggs, MS, LMFT, Juliann Ogilvie, LCSW, and Luann Hawker, CSW, all of Flourish Therapy. By Lauren Smithee, Ph.D., LMFT, of Deeply Rooted Therapy. By Sami Simpson, Ph.D., LMFT. And by Lacey Bagley, Ph.D., LMFT, Cass Henriques, LAMFT, Chloe Agyin, CSW, Lex Linford, CMHC, Dallyn Steenerson, CSW, Morgan Monet, LAMFT, and Makaela Caldwell, LAMFT, all of Celebrate Therapy.