EDIT 2/6: We accessed an outdated version of the bill when writing this blog. As signed into law, there is a moratorium on hormonal treatment for transgender and gender diverse youth. We will have an update soon regarding our practice in Utah.
Utah Governor Spencer Cox signed SB 16 into law on Saturday, drastically changing youth rights in Utah to obtain and receive appropriate medical care. This law effectively bans gender affirming care for transgender and gender diverse Utah youth. This will also be fought in the courts. The National Center for Lesbian Rights, Equality Utah, and the ACLU of Utah have stated that they will fight back. Chris Geidner summarizes the current state at the LAWdork substack.
What This Law Does
The law as signed was updated from our previous reporting. Requirements that providers counsel minors on medical risks that are cherry-picked for maximum scare factors. We hope to compile a talking points list of citations that refute the assertions in the law. For now, we’ve linked to blogs and resources below.
Right Here, Right Now: Rights in Utah
Restrictions on care go into effect immediately if this law is not blocked by the courts.
If you are a minor in Utah, or you are the parent or legal guardian of a minor in Utah, and you are considering starting gender affirming care, we are working on what this law will and will not allow between now and when the moratorium is lifted.
This law intentionally increases the burden of provider documentation and administration and requires youth to establish care with both a hormone provider and a mental health professional. This will make care harder to get.
The law allows individuals to withdraw consent for care and claim damages for malpractice up to the age of 25, even if they and their families were fully informed and consented at the time of treatment. It also increases the required documentation that providers must include in the medical chart. Some of this documentation may be impossible – for example, a requirement to document “all” of an individual’s health issues that may contribute to gender dysphoria. Providers may stop providing care because of the threat of suits a decade or more in the future.
What You Can Do To Support Youth Rights In Utah:
Follow and support groups in Utah (this list is just the beginning):
For tracking legislation:
- @erininthemorning (on Substack, on Twitter, and on TikTok)
Call and write to your legislators and the Governor expressing your dismay and anger.
Write letters to your local newspaper’s editorial board.
The Fine Print
- Immediate: hormonal treatment may not be prescribed to a minor who was not already diagnosed with gender dysphoria
- Charges the Utah Division of Professional Licensing, the Physicians Licensing Board, the Osteopathiic Physician and Surgeon’s Licensing Board, and the University of Utah with conducting a systematic medical evidence review of treating transgender youth with hormones.
- This review will advise the legislature regarding lifting the ban on gender affirming care for youth
- There is no due date for this review.
- Charges the Division of Professional Licensing with creating a “transgender treatment certification” by July 1, 2023
- Certification will require 40 hours of “education related to transgender health care for minors from an approved organization”
- Renewal of certification will require 20 hours of continuing medical education on transgender health care for minors
- As of January 1, 2024, providing “hormonal transgender treatment” to a minor without a certificate will be considered unprofessional conduct.
- Providers may not prescribe hormonal treatment to patients not diagnosed with gender dysphoria before July 1, 2023 without significant barriers to care (see below.)
- Prohibits gender affirming surgical procedures on transgender youth (but gender affirming surgical procedures for cisgender youth are fine, and surgical procedures on youth with disorders of sexual development before they can state if those procedure are affirming for them are fine)
- Allows individuals to take back their consent and sue for medical malpractice until the youth is 25 years old
As of July 1, 2023
- Before prescribing, the provider must
- Determine if “the minor has other physical or mental health conditions, identify and document any condition, and consider whether treating those conditions before treating the gender dysphoria would provide the minor the best long-term outcome”
- Consider if “an alternative medical treatment or behavioral intervention to treat the minor’s gender dysphoria would provide the best long-term outcome”
- Document in the medical record that the provider has done the above two steps, along with
- providing hormonal treatment is the best option
- written consent from the youth, the youth’s parent(s) or legal guardian(s)
- that the minor and legally responsible adults have been advised of the
- risks of treatment (but not the benefits)
- expected timelines
- the likelihood that treatment will meet the minor’s expectations
- If providing puberty blockers, document that the minor has been advised that
- puberty blockers are not approved by the FDA for the treatment of gender dysphoria
- “possible adverse outcomes of puberty blockers are known to include diminished bone density, pseudotumor cerebri and long term adult sexual dysfunction”
- “research on the long-term risks to children of prolonged treatment with puberty blockers for the treatment of gender dysphoria has not yet occurred”
- “the full effects of puberty blockers on brain development and cognition are unknown”
- BIG NOTE HERE: puberty blockers have been used in cisgender and transgender youth FOR DECADES. Routine care for youth on blockers includes recommendations for weight-bearing exercise, sufficient vitamin D and calcium intake, and monitoring of bone density. Studies also show that bone density returns after the minor stops taking blockers or starts hormone treatment. This is scare-mongering.
- Read our Puberty Blockers FAQ.
- If providing hormones, give the minor the following information:
- “the use of cross-sex hormones in males is associated with risks that include blood clots, gallstones, coronary artery disease, heart attacks, tumors of the pituitary gland, strokes, elevated levels of triglycerides in the blood, breast cancer, and irreversible infertility”
- “the use of cross-sex hormones in females is associated with risks of erythrocytosis, severe liver dysfunction, coronary artery disease, hypertension, and increased risk of breast and uterine cancers”
- BIG NOTE HERE: this is also scare-mongering. Providers routinely discuss risks and benefits before prescribing. Read the following for more nuanced information about risks”
- obtain a mental health evaluation
- performed by a mental health professional who
- as of January 1, 2024 has a current transgender treatment certification
- is not the prescribing provider
- determines that the minor suffers from gender dysphoria according to the DSM-V (NOTE: it is not clear if this includes the DSM-V-TR, which modified the language we use when talking about gender dysphoria)
- documenting that there have been at least 3 therapy sessions
- documents “all of the minor’s mental health diagnoses and any significant life events that may be contributing to the diagnoses
- performed by a mental health professional who
- A provider may not provide hormonal treatment to a minor who has not been diagnosed with gender dysphoria before the effective date of this bill.
We are committed to providing appropriate gender affirming care based on informed consent. The majority of reputable professional organizations and associations agree that gender affirming care is the appropriate treatment for minors with gender dysphoria.
We provide gender affirming care in Utah, including prescriptions for hormones (estradiol, testosterone, progesterone,) blockers, antiandrogens (including bicalutamide,) and SERMs. We will continue to provide treatment as long as we are legally able to do so.