by Colleen Kuhn, Ph.D.
All parties want competent care for transgender and gender-diverse youth, but what constitutes competent care has become a source of unnecessary division.
SB16, passed by the Utah Legislature and signed by Gov. Spencer Cox, purports to protect our TGD youth by banning gender-affirming medical care. As a child and adolescent psychologist who specializes in working with TGD youth, I can unequivocally say that this ban will increase depression and suicidal ideation in TGD youth.
Improperly, this law puts non-expert, non-medical entities in charge of recommending best practices rather than following guidelines from all major medical and psychological associations. These guidelines, grounded in evidence-based research, should continue to lead practitioners in providing competent, affirming, and ethical care.
The American Academy of Pediatrics, Endocrine Society, American Medical Association, American Psychological Association, American Psychiatric Association, Pediatric Endocrine Society, American Counseling Association, American Association for Marriage and Family Therapy, World Professional Association for Transgender Health, and U.S. Professional Association for Transgender Health, to name a few, provide clinical guidelines of best practices and standards of care when working with TGD youth. Time will be wasted and lives harmed while non-medical entities pause to rewrite the existing rigorously researched, widely accepted standards of care. This redundant certification process is unnecessary and harmful.
Legislators have stated, “the scientific evidence supporting these procedures are weak or very weak.” This is incorrect, there is a robust body of evidence supporting the safety and efficacy of this care.
Providers engage in a meticulous process for assessing TGD youth that is driven by a comprehensive treatment team approach. This systemic process is lengthy, thorough and ensures the youth are seen in all settings in which they are an active participant. Owing to this involved and comprehensive assessment process, we see a minimal rate of regret (at or less than 1 percent) for transgender patients who had gender-affirming surgery.
In 2022, research found that access to hormone blockers in adolescence was associated with lower past-year suicidal ideation compared to receiving hormone blockers in adulthood. Moreover, research showed that in over 9,000 transgender and nonbinary youth, depression and suicide attempts decreased by almost 40 percent when receiving puberty blockers. Furthermore, lifetime suicidal ideation was less in adults who received puberty blockers in adolescence compared to those who desired but did not receive blockers.
Positive affect and life satisfaction combined with decreases in symptoms of anxiety and depression were the result of a two-year study on psychosocial functioning. The most significant improvement in youth’s psychosocial functioning over a 12- and 18-month period occurred when they had social support and were also receiving puberty blockers. Access to puberty suppression is categorically a life-saving treatment.
SB16′s definition of competent care fails to take into consideration the lived experiences of our TGD youth and their parents and disregards science. Our legislators are conflating fear with facts in their best efforts to protect our TGD youth. They fail to recognize that healthcare practitioners indubitably base decisions on well-researched standards of care.
Of 22,800 TGNB youth surveyed last year, 93 percent of them worried about state and local laws restricting access to necessary affirming medical care. 53 percent reported seriously considering attempting suicide in the past year, compared to 33 percent of cisgender youth. Furthermore, 19 percent of TGNB youth attempted suicide in the past year compared to 9 percent of cisgender youth.
In the state of Utah in 2020, suicide was the leading cause of death for ages 10–24. Speaking about his decision to veto the transgender sports ban Gov. Cox stated, “I don’t understand what they are going through or why they feel the way they do. But I want them to live. And all the research shows that even a little acceptance and connection can reduce suicidality significantly.”
Everyone agrees that decreasing suicidal ideation is the priority for our youngest and most vulnerable TGD Utahns. Denying life-saving medication unquestionably increases the risk of more TGD youth dying by suicide. Why has Cox’s position changed, when hormone blockers have been used for decades for precocious puberty?
When transgender youth receive the care and support they need they can thrive and are happy and healthy. They have a strong foundation for lifelong health and well-being.
Speaking to Utah lawmakers, Brie Martin identified herself as a “proud transwoman” and stated, “Let me make clear that the medical interventions I am receiving are nothing short of life-saving … I am your example of three years of hormones doing good, I am not a victim, I am not a passing fad, I am not an exception to a rule… I deserve a body to feel proud of!”
How do we unite instead of divide at the intersection of medicine and politics? By recognizing that there are more similarities in the views of doctors and politicians than differences. A path forward includes ongoing comprehensive research. It does not include withholding medical treatments that are well-researched. That is not ethical. Operating on the basis of fact and not fear dictates providing gender-affirming treatment to youth on a case-by-case basis, decided by a treatment team of expert healthcare providers specializing in gender-affirming care. Delays and barriers to access to medically necessary treatments result in preventable procedures in the future.
Our legislative body has the means to directly and positively affect the mental health of our most vulnerable youth. It is unethical and immoral for them to adopt laws that disregard evidenced-based research and deny gender-affirming medical care to this already marginalized population. Not providing gender-affirming care for TGD youth is harmful, damaging, and negligent at best, and opens the door to depression, suicidal ideation, suicide attempts, and suicide completions at worst. Are we truly protecting transgender youth by banning lifesaving medically necessary care?
Colleen M. Kuhn, Ph.D., is a Salt Lake City-based clinical child and adolescent psychologist and the owner and CEO of One Haven, PLLC.