SALT LAKE CITY (ABC4) – “Mom, Dad? I am transgender.” Those words are some of the hardest a person who is transgender can say, especially if they are under 18. It’s not easy, it can be awkward for everyone, both children and parents.

The moment of “will my parents still love me?” is paramount to the very existence of the child. For parents whose view of the world could be influenced by social convention, religion, or politics can also challenge their existence. It can create a type of shock for everyone involved.

The entire situation is not easy. It is so challenging to deal with studies that say 40% of all transgender people attempt suicide.

There are two bills at the State Legislature in Utah trying to change Utah law about how we will deal with young transgender people. One stops transgender athletes from competing in High School Sports. The other stops medical professionals from giving adolescents medication or performing gender confirmation surgeries on kids under 18, even if they have their parent’s permission.

The two bills have sparked heated debate. Governor Cox said about the athlete bill, “If you have not spent time with transgender youth, then I would encourage you to pause on this issue,” Gov. Cox says. “We have so many people who are in a tough spot right now. And we have very few if any transgender girls participating in sports.”

HB 92 proposes banning all medical interventions for transgender minors, including puberty blockers, hormone therapies, and surgeries. Under the legislation, all of these interventions would be considered unprofessional conduct by medical professionals and could be punishable. 

The truth is that transgender people exist, and how the phenomenon is defined is subject to a lot of debate. Research in the last few years has gained exponentially, but before that, a lot of information was based on antiquated studies in the last century.

Representative Rex P. Shipp, who sponsored HB 92, the bill told ABC4. “That he knows there is dysphoria and he has empathy for biological and sex dysphoria, there is no question it is real.”

The bill was drafted because there are concerns middle-school-aged children and their parents might not make the right decision together. The bill wants to keep puberty blockers and hormones from being available to kids under 16. The example given to ABC4 news was about being careful about choices. Like our society is about drinking, smoking, and driving, you can’t do things until you are a certain age.

Medically being transgender is diagnosed as gender dysphoria.

According to the U of U Transgender health, gender dysphoria is called a DSM (diagnostic statistical manual used in the mental health profession) diagnosis given to transgender people who experience significant distress from their physical bodies not aligning with their internal sense of gender identity.

Gender dysphoria can also have external factors; our society focuses on a strict binary of gender expression and roles, and how our society treats those who live outside of those norms is what causes gender dysphoria for this community.

The U of U clinic cautions that not all trans people experience this, and there are many problems with diagnosis as a form of gatekeeping.

One of the myths is people choose to be transgender. They don’t. According to the CDC, only 3% of kids identify as being trans.

Amanda Darrow, Director of Youth, Family and Education programs at the Utah Pride Center, explains gender like this, “Sex: what we are born with (biology) is shown with sex characteristics and sex assigned at birth. Gender Identity: How we feel on the inside. Cisgender is when your gender identity and sex align. Transgender is when your gender identity and sex do not align. Gender expression: how you express yourself on the outside.”

Representative Shipp said, “that he knows parents want to do what is best for their children, and he is a supporter of parents rights. He states that when “kids are at puberty and they are taking puberty blockers and cross-sex hormones it can cause irreversible damage. The example he gave is that currently, the process is more like saying. you have a migraine, and someone puts a cast on your foot.”

There is concern research on the drugs used to help with gender confirmation is not complete and that there might be a degree of experimentation on the kids. Ship says “We should not be experimenting on kids.”

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Nicole Mihalopoulos, MD, MPH, The Medical Director of Gender Management and Support at Primary Children’s Hospitals testified against the bill. She said “We provide evidence-based care to 100’s of adolescents, and young adults, following the guidelines of the World Professional Association for Transgender Health. These guidelines recommend treatment of severe gender dysphoria with 100% reversible puberty blockers.”

The Pride Center’s Darrow says, “There is a great deal of psychological trauma that can come from requiring a transgender youth to wait until the age of 16 for treatment. Research has shown that youth around the age of 3 start to understand their gender identity. That of course varies from person to person. But, they typically can tell if they are more of a boy, a girl, a little of both, or neither around this age and up. Now, this can be influenced by their surroundings and their brains. If the spaces that these youth grow up in do not make room for them to grow into their gender identities and they grow up being told they are biologically female they may only grow up believing that is the only choice. This does not change that they might always know that something inside of them just doesn’t match.”

With all of the debate what really happens to a child after they say they think they are transgender? What happens when the young person approaches the medical profession?

Here’s where it can be seriously complex again. No two transgender people experience being trans the same way. For the medical profession, each person has to be treated on an individual level.

The first step is therapy. Kids go through phases, it’s important that parents understand transgender or non-binary is not a phase, it’s a bit of a journey for the child, and denying it can put the young person at extreme risk up to and including suicide.

Darrow says, “Since I do not counsel the youth, I can only speak to the way we help transgender youth get signed up for counseling. When a youth of any identity comes to the Utah Pride Center and requests Mental Health Services, we first check-in to see if there is any immediate need or if the youth is in danger of harming themselves or others. Once I have evaluated safety, I ask the youth if there is a preference on who they might want to see. I myself always have preferred women therapists. Most transgender youth will ask if there are any Transgender and/or non-binary therapists. Then, we connect both the youth and their caregiver with the Mental Health coordinator. As I usually know the youth, I will have recommended a specific therapist that I see fit for that youth. It is just paperwork and scheduling the appointments from there on out.”

Therapy continues and if the transition is decided upon that’s when it moves to a group like TransHealth Services at the University of Utah.

Dr. Mihalopoulos says, “When a family seeks care from a healthcare provider the benefits and risks are discussed. This is true for strep throat and antibiotics, it’s true for depression and treatment with anti-depressants, and is also true for gender dysphoria its evidence-based treatments.”

At the University of Utah Transgender Health Services according to their brochure, here is what happens with teens.

The process is long and takes years, it is divided into phases.

In Phase 1:

  • The teams get to know the young person and their parents or guardians – this includes medical History
  • The transition process is reviewed and questions answered.
  • Blood tests and physical exams are gathered
  • Consent forms and permission forms are addressed.

Phase 2:

  • The team continues to get to know the patient
  • Physical exams
  • Additional blood tests
  • Benefits and risks of hormone therapy and the impact on fertility
  • The team talks to the patient about their social support network

Phase 3:

  • Review and sign consent forms
  • Create a plan for the rest of the transition process
  • Start puberty blockers or hormone therapy

Phase 4:

  • The social support network is addressed again
  • Talk about how hormones are affecting the mood of the patient
  • Talk about how hormones are changing the patient’s body
  • Blood tests to monitor the effects of blockers and hormones

Patients on hormones generally will visit the medical facility once every 3 months for 2 years until the patient has completed gender-affirming puberty. Then it’s every 6 -12 months depending on the needs of the patient.

One of the myths is hormones and puberty blockers are started immediately, that is not the case. Physical health and physical health risks, mental health conditions are also addressed prior to being prescribed.

Surgeons prefer people who have had hormone therapy for at least a year and are undergoing therapy before any kind of surgery is performed top or bottom.

Gender confirmation surgeries are not performed on adolescents in Utah, according to Dr. Mihalopoulos, “There are not any sex change/genital surgeries being performed on youth under 18 here in Utah, and it’s very rare if ever. I am not aware of anyone who has had that happen at 18.”

The reality is no child is pushed into a gender-confirming program, each step is carefully monitored and carefully approached, under no circumstances does a medical professional experiment with gender on a child.

Photo Courtesy: Utah Pride Center

Nick Arteaga Adult Programs Manager at the Utah Pride Center says, “As a man, who was assigned female at birth, I can attest to the importance of validation and visibility as a transgender person. Although seeking healthcare as an adult, in the state of Utah has been made easier than before, I know how stressful it is to be dismissed, not seen as a person with needs and equal rights in all places, especially a doctor’s office. Since being on hormones, the quality of my life has flourished. My depression, my anxiety, and suicidal ideations have minimized immensely since seeking professional healthcare as a transgender patient. Even though many transgender people do not need surgery or hormone replacement therapy to find congruency with their physical appearance and gender identity, they should always have the option!

Arteaga continues, “Children cannot take themselves to the doctor and it is considered child abuse when parents neglect to meet their children’s needs. So why wouldn’t it be considered abuse for a parent or doctor to refuse to treat a child simply because they’re transgender? Our youth should always get necessary and equal healthcare, prescriptions for their medication, and necessary surgeries that they need without discrimination. Healthcare is a basic human right and should not be used as a means to discriminate.”

HB92 as of the publishing of this article has been sent to the rules committee.