Utah’s Republican leaders, who banned access to medically recommended care for trans minors, spent more than two years demanding proof that gender-affirming hormone therapy benefits transgender youth. Now they have it — and they’re still refusing to budge.

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A comprehensive, state-commissioned report released last week shows that gender-affirming care leads to better mental health and lower suicide risk among transgender minors. But instead of lifting the state’s ban, GOP lawmakers are doubling down on a policy that doctors, advocates, and families have long warned is putting lives at risk.

Department of Health and Human Services deletes mental health report on Utah’s transgender children
What is gender-affirming care, who uses it, and do they regret it?

What’s in the report

The more than 1,000-page report, conducted by the University of Utah’s Drug Regimen Review Center and quietly posted online Monday by the Utah Department of Health and Human Services, was required by S.B. 16 — the 2023 law that banned most gender-affirming medical care for minors. At the time, Republican Gov. Spencer Cox called the law a “nuanced” approach and insisted the state needed more data. Now that the data is in, his office has gone silent.

The report eviscerates the claims Republicans used to pass the ban in the first place.

“The conventional wisdom among non-experts has long been that there are limited data on the use of [gender-affirming hormone therapy] in pediatric patients,” the researchers wrote. “However, results from our exhaustive literature searches have led us to the opposite conclusion.” The study found over 230 primary studies involving 28,056 trans youth — “far exceeding” the evidence that typically supports FDA approval for high-risk pediatric treatments, including gene therapy.

“The body of evidence we have uncovered exceeds the amount of evidence that often serves as the basis of FDA approval for many high-risk, new drugs approved in pediatric populations in the U.S.,” the authors added.

The report emphasized that such treatments are not given to prepubertal children, that puberty blockers and hormones are typically initiated only in early or mid-adolescence, and that surgeries — especially bottom surgeries — are not recommended for minors. The review also found no significant long-term safety concerns, and that “regret” associated with treatment is extremely rare. In fact, among the 32 studies examining regret, researchers found it was “virtually nonexistent” — and when present, it was “only a very minor proportion” of treatment discontinuation.

Utah Republicans reject their own commissioned review

The report’s release was met with no public response from Cox or legislative leaders, The Salt Lake Tribune reports.

Republican state Reps. Katy Hall and Bridger Bolinder, who helped pass the law, dismissed the findings outright in a joint statement. “The science isn’t there,” they claimed. “The risks are real, and the public is with us.”

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State Senate President Stuart Adams echoed their skepticism. “Utah enacted a law to safeguard the long-term health and well-being of minors while providing time to carefully examine the evolving medical landscape surrounding novel and irreversible procedures for minors,” he said, according to the Tribune.

State Rep. Mike Kennedy, the bill’s lead sponsor and a physician, declined to comment to the paper.

LGBTQ+ rights advocates say the report dismantles GOP’s justification for care bans

Chris Erchull, senior attorney at GLAD Law, told The Advocate that the report’s conclusion is straightforward.“This is the most comprehensive and the most recent review of all of the studies on care that’s been provided to transgender young people over many decades,” Erchull said. “It confirms what many providers and families already knew — that the standards of care for young transgender people provide benefits to their overall health and well-being. All of these attempts to block access to care for transgender young people have been causing harm. And any future attempts will also cause harm.”

But the science is there. The review found that youth who received care before age 18 had better outcomes, especially around depression, anxiety, and suicidality. Hormonal treatments were associated with positive mental health and psychosocial functioning outcomes. “When left untreated, individuals with gender dysphoria may experience psychological and social harms,” the report notes.

Shannon Minter, legal director of the National Center for Lesbian Rights, called the Utah report “by far the most detailed, thorough, and comprehensive review of the medical evidence relating to transgender healthcare.”

“This review shows that when the evidence is viewed objectively, there is no serious question that this care is safe, effective, and medically necessary for some youth,” Minter told The Advocate. “The report also makes clear that if legislators are concerned about this care, they can implement guardrails to ensure that it is being prescribed consistently with the standards of care.”

Minter added that while the report came too late to be submitted in the U.S. Supreme Court’s review of United States v. Skrmetti, it offers “an incredibly helpful counterpoint to the incomplete and distorted coverage of this care that has dominated the mainstream press.”

“The data show overwhelmingly that the people who need this care benefit significantly from it”

Erchull said the report also rebuts widespread misinformation.

“One of the biggest misconceptions is that this care is easy to access and handed out without oversight,” he said. “But the study tells us something very important: regret rates are exceedingly low. People may hear powerful anecdotes from individuals who felt they were over-prescribed or misdiagnosed, and those are heartbreaking stories. But they don’t represent the whole picture. The data show overwhelmingly that the people who need this care benefit significantly from it — and that medical providers are doing a good job of ensuring the right people are receiving the right medical care.”

Every major medical association in the United States, including the Endocrine Society, the American Medical Association, and the American Academy of Pediatrics, supports gender-affirming care as proven and effective treatment.

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“The findings of this report support the existing expert standard of care and do not support the bans enacted thus far in 27 states,” Whitman-Walker Institute executive director Kellan Baker told The Advocate. “I think it says that they’re not actually interested in science or evidence because when they can’t predetermine the outcome of a scientific evidence review based on their political agenda, it finds that the existing standard of care is beneficial. These findings also contradict efforts to smuggle anti-trans provisions into Medicaid for transgender people of all ages via the House reconciliation bill when it was jammed through under cover of darkness last week.”

On Thursday, Republicans in Congress passed a measure forbidding federal funding for gender-affirming care under the Children’s Health Insurance Program and Medicaid. The bill also eliminates coverage for gender-affirming care under essential health benefits, even for adults with private insurance regulated under the Affordable Care Act.

If lawmakers in Utah lift the moratorium, the report recommends that the health department outline strict guardrails: a certified treatment board, licensed experts, interdisciplinary care teams, and an enhanced informed consent process. According to The Salt Lake Tribune, those recommendations are in place, but the political will is not.

Like all medical treatments, gender-affirming care is already overseen by expert physicians and follows best practices established by the World Professional Association for Transgender Health. They note that receiving this kind of care is not fast.

Now, with Utah’s own evidence confirming what trans communities and medical experts have said all along, the question is no longer whether gender-affirming care is safe. It’s whether lawmakers will admit it matters and that transgender youth deserve to live.

The state’s justification that the medications used aren’t FDA-approved specifically for gender dysphoria also doesn’t hold. The report emphasizes that off-label prescribing is both legal and common in pediatric medicine, especially when drugs are already approved for adults but lack industry incentives for further trials in youth.

The law’s impact has been immediate. After the ban was enacted in early 2023, the University of Utah closed its pediatric gender clinic. The Tribune notes that the same year, a state-run survey found that more than 60 percent of trans students in the state had considered suicide, with one-quarter of students having attempted it.

Utah Gov. Signs Bill Banning Most Gender-Affirming Care for Youth

Advocates warned this would happen when the law was enacted. “This is a devastating and dangerous violation of the rights and privacy of transgender Utahns,” said Chase Strangio, deputy director of the American Civil Liberties Union LGBTQ & HIV Project, at the time. “We won’t stop defending your autonomy and freedom until each and every one of you can access the care you need.”