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Utah banned gender-affirming care for trans kids. What does that mean?

Utah Gov. Spencer Cox (R). (Rick Bowmer/AP)
6 min

Utah banned doctors from providing certain forms of gender-affirming health care for transgender minors, the first of several states poised this year to pass laws to make it more difficult for trans people to live as their self-identified gender.

It is the fifth state to pass legislation restricting health care for trans children after Tennessee, Alabama, Arkansas and Arizona enacted similar laws, although Arkansas’s and Alabama’s laws are temporarily blocked as they are challenged in court. Similar changes have been attempted in states like Florida and Texas through executive orders and state agencies, with mixed success in the courts.

Republicans say state-level bans are required to protect children’s health and point to gaps in existing medical research on the longer-term impacts of gender-affirming care. Activists say the restrictions ignore the medical consensus and put trans children in danger. Here’s what you need to know.

What is gender-affirming care?

Doctors can offer a number of treatments to people under 18 who experience psychological distress because their biological sex and gender identity do not align, or who identify as trans. Available options range from reversible puberty blockers to certain surgeries.

For children showing the physical changes of puberty, blockers can be prescribed to temporarily pause the process and help prevent unwanted changes to teenagers’ bodies, such as periods in transgender boys or the deepening of the voice in transgender girls.

For older adolescents, hormone therapy allows patients to acquire the secondary sex characteristics aligned with their gender identity. These medications can lead to facial hair growth and a deeper voice in transgender boys, for example, and breast growth in transgender girls. Most U.S. states require parental permission to undergo hormone therapy or surgery before 18, according to the American College of Obstetricians and Gynecologists.

Top surgeries are among a number of surgical options that can be performed on transgender teenagers before the age of majority in a given country, which is 18 in the United States. According to standards of care from the World Professional Association for Transgender Health, it should be done “preferably after ample time of living in the desired gender role and after one year of testosterone treatment.” However, U.S. clinical guidelines say children should not undergo gender-affirming genital surgeries before they turn 18.

FAQ: What you need to know about transgender children

When do doctors choose gender-affirming care?

Doctors say some treatments allow children to feel supported in their identity and provide them with important mental benefits.

“Gender-affirming care seeks to minimize the distress trans individuals experience by providing a supportive, nonjudgmental environment that acknowledges the individual’s gender identity,” the American Medical Association’s president, Jack Resneck, wrote in August. A phased process of care for transgender minors — beginning with reversible interventions like puberty blockers — allows young people to explore their identified gender while keeping options open, he said.

The American Psychiatric Association noted in 2020 that puberty blockers in particular can relieve emotional distress and are associated with “notable gains in psychosocial and emotional development.”

The largest U.S. study to date on the topic, published this month in the peer-reviewed New England Journal of Medicine, added to a growing body of evidence that kids’ mental health improves with gender-affirming treatment. After following 315 transgender and nonbinary people ages 12 to 20 who had received puberty blockers over two years, the study’s authors determined that “life satisfaction increased, and depression and anxiety symptoms decreased.”

At the same time, medical experts have called for more research into gender-affirming care for youths, particularly into potential longer-term health consequences, the capacity of minors to consent to important decisions, and the impacts on bone and brain development.

An editorial accompanying the New England Journal of Medicine study on gender-affirming care concluded that although further research was needed, on balance, regulators should weigh those considerations against the benefits experienced by minors who receive hormone therapy.

What does Utah’s ban mean for trans kids and their families?

Utah’s legislation, approved Jan. 28 by Gov. Spencer Cox (R), bans trans minors from accessing puberty blockers or hormone therapy if they had not already been diagnosed with gender dysphoria before the law came into effect and forbids all gender-affirming surgeries for trans youths.

Minors who were diagnosed with gender dysphoria before the cutoff date will still be able to continue puberty blocking and hormonal treatments.

The law also introduces a complete prohibition on all gender-affirming surgical procedures for minors — although many of those listed as restricted are not, in practice, performed on people under 18 in the state.

When kids come in saying they are transgender (or no gender), these doctors try to help

Why are states blocking trans health-care provisions?

Trans children and adolescents have received gender-affirming health care from doctors for years — but it is only recently that their medical care has become politicized.

Republican legislators behind the restrictions cite the health and safety of the children involved.

“Our country is witnessing a radical and dangerous push for children to enter this version of health care,” state Sen. Mike Kennedy (R), who sponsored Utah’s ban, said last week. He said gender-affirming procedures lacked “sufficient long-term research.” Cox, upon signing the bill into law, suggested in a statement that it could provide time to wait “until more and better research can help determine the long-term consequences.”

Anti-trans laws are on the rise. Here’s a look at where — and what kind.

What do activists say?

Activists say Utah’s restrictions — like those passed in other states — violate the rights of trans minors and their families and prevent them from receiving the medical care they require to live healthy lives.

“For a lot of families, having the ability to access puberty blockers buys time and gives families just a little bit of breathing room to figure out what the next steps might be in the course of their child’s treatment,” said Marina Lowe, policy director at Equality Utah, the state’s largest LGBTQ rights advocacy group. “That’s what feels harmful and frightening,” she added.

“They are very concerned, scared, uncertain,” Lowe said of families with trans children in the state. “It’s really an unprecedented step for government essentially to step in between parents, children and their doctors and say, ‘Care, which is lifesaving, which is critical for the well-being of your child, is no longer going to be available.’”

Legal activists are planning to challenge the law’s constitutionality. “We cannot allow states to usurp the role of loving parents and medical professionals,” the National Center for Lesbian Rights said in a tweet, announcing it would be working with the American Civil Liberties Union to challenge the law. In a letter Friday, the ACLU described the law as “riddled with numerous constitutional issues.”

“This story is not over,” Lowe said. “The conclusion of whether it’s the ability of the government to step in this way will ultimately be decided by the courts.”

Samantha Schmidt and Spencer S. Hsu contributed to this report.