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SALT LAKE CITY — A proposed prohibition on doctors from performing gender reassignment treatments on minors stalled in a House committee on Friday after an emotional debate between doctors and LGBTQ advocates.
Under HB92, physicians and surgeons would be restricted from performing gender reassignment treatment on minors, including internal surgeries and facial feminization or masculinization surgeries. The bill would also prevent doctors from prescribing hormone therapy for minors who are considering transitioning.
Bill sponsor Rep. Rex Shipp, R-Cedar City, introduced a new version of the bill Friday that would prohibit such treatments for children under age 16 instead of 18.
"This is about protecting children. I have seven children of my own. I love them dearly. I have eight grandchildren as well," Shipp told the House Health and Human Services Committee.
Puberty blockers are harmful to children, according to Shipp, and more kids are getting them each year. The Controlled Substance Database shows how many kids are taking testosterone treatment in Utah, and the number has risen for the past several years with more than 600 kids receiving the treatment in 2020, Shipp noted.
Exemptions in the bill would include those who are born with external biological sex characteristics that are "irresolvably ambiguous," those who are intersex; those with both ovarian and testicular tissue; and with other related conditions.
Gov. Spencer Cox said Thursday he had "threatened to veto" the bill due to "many, many flaws." But the new version of the bill is "closer to what medical standards are now," Cox said.
Venturing into a 'gray area?'
Before the hearing, committee Chairman Rep. Merrill F. Nelson, R-Grantsville, said lawmakers have received "lots of emails from both sides of this issue over the past several weeks, and we receive and read the emails and we take the matter seriously."
"You need not assume that we know nothing. You should assume that we are informed, that we've read what we've received, and we welcome more today," Nelson said.
You need not assume that we know nothing. You should assume that we are informed, that we've read what we've received, and we welcome more today.
–Rep. Merrill F. Nelson, R-Grantsville
Dr. Quentin Van Meter, a pediatric endocrinologist from Georgia who testified for the bill, said gender reassignment treatments for children are "not based on science" but ideology.
"There are no studies. You cannot find a body in a morgue where you can do a diagnosis and find the biological markers of an incongruent gender. There are no tests that prove it. It is a state of mind," Van Meter said.
"Suicide threat is a sledgehammer" used to convince parents to let their kids transition socially and medically, he said.
He said that "100%" of children who take puberty blockers will later choose to transition.
"These are troubled children. They are hanging onto the idea that a new gender will solve their problems," Van Meter said. But after about 10 years, he said, many question whether the decision made them happy but find they can't go back.
These are troubled children. They are hanging onto the idea that a new gender will solve their problems.
–Dr. Quentin Van Meter, pediatric endocrinologist from Georgia
Rep. Ray Ward, R-Bountiful, a family physician, asked Van Meter if he believes the guidelines from major medical associations that support hormone treatment "are false and not evidence-based, or you just disagree with those societies' guidelines."
Van Meter said guidelines put together by the Pediatric Endocrine Society and American Academy of Pediatrics were written by "transactivists" and did not have consensus among all in those medical fields.
During Shipp's presentation of the bill, he tried to show a video of a transgender male who described his regrets of transitioning after experiencing sexual trauma. But due to technical difficulties, the video couldn't be played.
Ward asked whether the science is "completely settled" on the issue.
"I have read a lot on this issue over the past interim since this was brought to our committee last year. And from the detransitioners that I looked at and read in these books, it's not reversible what they've gone through," Shipp said.
Ward acknowledged that individuals' experiences can be "terrible," but he pressed Shipp about whether the medical science is resolved.
"If there is still gray area and the science is getting better, why would we then step in with a statute to try to tell the medical establishment ... what the answer is of what is medically necessary and unnecessary?" Ward questioned.
If there is still gray area and the science is getting better, why would we then step in with a statute to try to tell the medical establishment ... what the answer is of what is medically necessary and unnecessary?
–Rep. Rex Shipp, R-Cedar City
Shipp reiterated that puberty is important for kids and hormone treatment can cause "irreversible damage."
An emotional debate
Dr. Nicole Mihalopoulos, medical director of the Gender Management and Support Clinic at University of Utah Health, spoke against the bill on behalf of herself and not the university. She contended that puberty blockers are reversible.
When a puberty blocker is taken away, its major effects on the body end, and the body continues to function how it did before the puberty blockers started, she said. They become dangerous if they're given for several years without any additional hormone added back. The current length of time to give puberty blockers is three to five years, she said.
Some of the changes like those to the voice and hair growth can be irreversible, according to Mihalopoulos.
When parents seek care, doctors discuss the benefits and risks of all treatments, including treatments for gender dysphoria, Mihalopoulos said. Articles in medical journals are increasingly recommending the use of puberty blockers, hormones and surgery, she said, describing such treatments as "lifesaving."
"The proposed bill is dangerous to adolescents who seek or have started gender affirming treatment," Mihalopoulos said.
The bottom line is that politicians should not be stepping into medical decision of parents and their doctors.
–Dr. Nicole Mihalopoulos, medical director of the Gender Management and Support Clinic, U of U Health
In response to a question from lawmakers, she said genital sex change surgeries aren't happening on youth under 18 in Utah. Sometimes, those under age 18 are given mastectomies.
Others who opposed the bill urged lawmakers not to interfere with doctors and parents.
"The crisis that's being made here, I fail to grasp, because there is no real crisis. The bottom line is that politicians should not be stepping into medical decision of parents and their doctors," said Dr. Candice Metzler, executive director for Transgender Education Advocates of Utah.
Troy Williams, executive director of Equality Utah, said the bill was drafted without collaboration with those it impacts in the LGBTQ community.
"Message bills are never genuine collaboration with stakeholders. They don't seek solutions by bringing people together, they only incite the ongoing culture wars," Williams said.
He said the bill seeks to say that transgender kids don't exist.
"But they do exist, and they are my heroes," Williams said.
Kody Valera, a transgender man, said many transgender people suffer from instability, and kids are too young to make the decision to change their sex.
"We have kids growing up and they're being told by media, by social media and by therapists who have a bias toward the LGBT community that they need to be trans," Valera said.
"Let kids be kids. ... We need to let these kids to grow up. We need to allow them to experience life," and then make that decision when they're 18, Valera said.
Erin Brewer said she once believed herself to be a "trans kid." She explained that she believed she was a boy because she had been sexually abused. If she had been urged to get gender reassignment treatment, she says her true issues wouldn't have been addressed.
Billy Burleigh, who used to be transgender, said he also believed as a child that he was supposed to be a girl.
"The therapy I received wasn't helpful, but I was told that if I went down the road of transition that I would be happy, and boy did I want to find happiness because I was miserable," Burleigh said.
He says he started taking estrogen and testosterone blockers. He later underwent gender transition surgeries as an adult, which ended in medical problems. He said that "no matter how many" surgeries he had, he still saw a man looking back at him in the mirror.
"After seven years of presenting myself as female, I decided to transition again back to male," Burleigh said, pleading with lawmakers to "please help kids like me."
But Maryann Martindale, Utah Academy of Family Physicians, said the bill will exacerbate the risk to kids experiencing gender dysphoria.
"We oppose any legislation that would seek to come between the sanctity of a doctor and their patients," Martindale said.
After the hearing, Rep. Robert Spendlove, R-Sandy, said he is concerned about the process the bill went through to get to the hearing and requested it to be returned to the rules committee to "flesh out problems."
The majority of lawmakers on the House committee agreed. That means a revised version of the bill could potentially get another hearing.