Utah lawmakers to push for permanent ban on youth transgender treatments amid criticism of state report

Utah lawmakers plan to replace a moratorium on gender transition treatments for minors with a permanent ban during the 2026 legislative session, according to state House Speaker Mike Schultz.

Hormonal transgender treatments for children, defined as any medical action taken to facilitate an “attempted sex change,” are already illegal in Utah. But Schultz said his Republican majority aims to solidify the state’s stance on the issue.

“Kids should not be transitioning. Period. End of story. Minors should not be transitioning. Period. End of story,” Schultz, R-Hooper, told the Deseret News.

In 2023, the Legislature passed SB16, which prohibited sex reassignment surgeries for minors, put an indefinite pause on puberty blockers and cross-sex hormones for new child patients, and ordered a review of medical evidence to inform future policies.

The review, conducted by the University of Utah’s Drug Regimen Center for the Utah Department of Health and Human Services, was presented to the Legislature in May. It purported to find positive health outcomes for “gender affirming treatments.”

A report published in December by Do No Harm — a group of doctors who say they are focused on “keeping identity politics out” of medical research — identified significant flaws with Utah’s review, including a failure to scrutinize low quality data and “life-altering adverse effects.”

Schultz, as well as the sponsors of SB16, now-U.S. Rep. Mike Kennedy and state Rep. Katy Hall, told the Deseret News they agree with Do No Harm’s evaluation that the Utah Department of Health and Human Services review was biased and that its recommendations should not be used to inform lawmakers.

“Common sense is common sense,” Schultz said. “I don’t need a report, one way or the other, to tell me that. I just firmly believe that minors should not be transitioning.”

In a statement to the Deseret News, a spokesperson for University of Utah Health continued to defend hormonal transgender treatments for minors, shining a light on the ongoing debate in the U.S. over evidence surrounding child transgender treatments, even as a host of other countries move to restrict their application.

What did Utah’s DHHS review say?

Between April 2023 and August 2024, Utah’s Department of Health and Human Services contracted with the University of Utah’s Drug Regimen Review Center to conduct what it called “likely the most comprehensive” systematic review of studies related to transgender medical treatments to date.

The 1,000-page review compiled 134 English-language clinical studies, representing more than 28,000 transgender minors. Based on the evidence, Drug Regimen Review Center Director Joanne LaFleur said there is no justification for restricting hormonal transgender treatments for children.

“It is our expert opinion that policies to prevent access to and use of (gender-affirming hormone therapy) for treatment of (gender dysphoria) in pediatric patients cannot be justified based on the quantity or quality of medical science findings or concerns about potential regret in the future,” the review stated.

Hormonal transgender treatments pose a negligible risk to long-term health, the Utah DHHS review said. This runs counter to reviews by England’s National Health Service and the U.S. Department of Health and Human Services, which identified heightened risks of decreased bone density and stunted brain development.

The Utah Department of Health and Human Services review, which refers to hormonal transgender treatments as “gender-affirming care,” claims there is “virtually no regret associated with receiving the treatments.” Infertility was “not an outcome of focus” in the Utah review, despite the direct impact of hormonal transgender treatments on sexual function.

Upon receiving an initial presentation, the legislative task force overseeing the review noted that nearly all of the studies only reported short-term findings, tracking patients for just 1-2 years. The review’s authors then worked to include additional information from studies that measured outcomes for at least five years.

The final version of the review, presented in May 2025, acknowledged that hormonal transgender treatments “may lead to irreversible physical changes,” and are accompanied by an increase in mortality risks driven by suicide, non-natural causes and HIV/AIDS.

However, the review still concluded that, “Overall, there were positive mental health and psychosocial functioning outcomes.”

Recommendations provided by the Utah Department of Health and Human Services included: creating a hormonal transgender treatment board managed by DHHS, limiting the providers who can deliver care and instituting an enhanced informed consent and assent process for minors.

Was Utah’s DHHS review ‘debunked’?

In a report published on Dec. 9, Do No Harm urged legislators not to consider the Utah Department of Health and Human Services review as “a credible source.” As an advocacy group, Do No Harm opposes gender-related treatments for minors and discrimination related to diversity, equity and inclusion (DEI) in medical education and practice.

The Utah department review does not meet the standards of a systematic review, according to Do No Harm, because it fails to synthesize evidence, emphasizes volume of data over quality, relies uncritically on guidelines from national groups and dismisses negative effects of treatments.

“Unlike true systematic reviews, it does not assess the reliability of studies and whether the research can provide guidance for weighing the risks and benefits of medical intervention for children with gender dysphoria,” the report says.

“Nevertheless, the Utah Report asserts that puberty blockers and cross-sex hormones are safe and effective amid a sea of weak evidence ... .”

Each of the study compilations cited in the Utah Department of Health and Human Services review is ranked “low” on the AMSTAR 2 tool to assess systematic reviews, which means they should “not be relied on to provide an accurate and comprehensive summary of the available studies.” Other, more recent, studies were left out.

While the Utah Department of Health and Human Services review states that hormonal transgender treatments are “generally safe,” a peer-reviewed report published by the U.S. Department of Health and Human Services in November found significant risks associated with puberty blockers and cross-sex hormones.

Puberty blockers decrease bone mineral density during an essential time for bone development, which can cause osteoporosis. They also halt the maturation of sex organs, which can lead to permanent sexual dysfunction and infertility, particularly if followed by cross-sex hormones.

The effect of puberty blockers on neurological development is uncertain because of a lack of data, the U.S. HHS report found. However, increasingly, studies show the impact of sex steroid hormones on brain development connected to emotional regulation and intelligence quotient.

“The (Utah DHHS review) itself was commissioned to be a systematic medical evidence review, but it is just not that at all,” Do No Harm medical director Kurt Miceli told the Deseret News.

“We’ve got to do all we can to keep kids safe, to promote their well being, and that’s not through these procedures that don’t have really any degree of evidence to support them.”

Bill sponsors and university respond

As a practicing family physician, 3rd District Rep. Kennedy spearheaded Utah’s transgender legislation in 2023, making Utah the fifth state in the country to ban hormonal transgender treatments for children, and making him the target of vandalism by opponents of the bill.

Kennedy said he was motivated by a desire to protect children from irreversible treatments in an area of medicine with very little long-term data. He had hoped that commissioning a systematic review of the evidence would help to inform future policies, but the Utah DHHS review “has flaws,” Kennedy said.

The ban on transgender treatments for children is already “permanent” unless the Legislature acts to lift it, Kennedy said. Framing it as a moratorium was important to passing the bill because some lawmakers wanted more data on the effects of puberty blockers and cross-sex hormones, Kennedy said.

While nearly two dozen states have now followed Utah’s lead, Kennedy said he is proud of Utah’s law because it has yet to be litigated. But he worries a federal bill that would criminalize transgender treatments for minors could undo his work in Utah.

On Dec. 18, Kennedy became one of four Republicans to oppose the “Protect Children’s Innocence Act” because he said he worried it would preempt Utah’s legislation, potentially leaving the state with no restrictions at all if the federal law were to be enjoined in court.

Kennedy’s co-sponsor, Rep. Hall, R-South Ogden, told the Deseret News via email she believes the moratorium should be made permanent. The Utah Department of Health and Human Services review only highlighted how small sample sizes, reliance on self-reporting and lack of randomized trials result in low-quality evidence, she said.

In a statement to the Deseret News, a spokesperson for University of Utah Health defended the review they conducted on behalf of the Utah Department of Health and Human Services, saying the group found “an extensive body of research regarding the safety and efficacy of these treatments.”

“Our review also found that the consensus of that evidence is that the treatments are safe in terms of changes to bone density, cardiovascular risk factors, and metabolic changes; and they are effective in terms of positive mental health and psychosocial outcomes.”

The Utah Department of Health and Human Services review included multiple advisers who have previously advocated on behalf of gender-related treatments.

Dr. Nicole Mihalopoulos, the chief of adolescent medicine at the University of Utah, lists “transgender healthcare” as one of her special interests, has treated patients who received transmasculine top surgery and has published an academic article arguing that state governments “actively resist efforts promoting equal rights” for “transgender/gender diverse youth.”

Dr. Brooks Keeshin, the associate vice chair of research in child mental health at the University of Utah, published an academic article in October 2024 arguing that the systematic review requested by SB16 could reopen a “limited pathway” for adolescent Utahns to receive “gender-affirming care” in the future.

These ties to child transgender treatments were not disclosed along with other potential conflicts of interest which were disclosed in the Utah DHHS review.

Is Utah DHHS on board?

In recent years, Utah has banned DEI initiatives in public institutions, and blocked transgender access to single sex public bathrooms and high school sports. But Do No Harm’s investigation suggests there may be opposition to these policies within state health agencies.

In one of several such email exchanges obtained by Do No Harm through a government records request, an unnamed Utah Department of Health and Human Services employee is quoted by public information officer Charla Haley in January 2024 as asking why more is not being done “to push back against” policies to remove pro-DEI, and gender-related language from state resources.

“This effort to remove references to health equity, race, gender identity, ethnicity, and sexual orientation is reprehensible censorship that invisibilizes communities who have already experienced disproportionate negative health outcomes from systemic oppression,” the email said.

This is an example of “political ideologues” within the Utah Department of Health and Human Services “pushing against what the governor, and what the DHHS was aiming to do,” Miceli said, “which fits a broader trend in states across the country, as well as professional associations, of a progressive ‘expert class’ trying to influence policymakers.”

“I have a deep concern about the administrative state ... and how they allow their own personal ideology to influence the day-to-day work that they’re doing,” Kennedy told the Deseret News. “And in my opinion, the administrative state should follow the Legislature and not the reverse.”

Hall shared this concern of public employees potentially “trying to circumvent state law.” In 2024, it was reported that a long-awaited National Institutes of Health study of child transgender treatments was not published because it did not show mental health improvements, Hall pointed out.

The unwillingness of American medical elites to slow the application of child transgender treatments is unique.

While transgender treatments are supported by groups like the American Academy of Pediatrics, the American Psychological Association and the Endocrine Society, six European nations, including Finland, Norway and Sweden have recently limited hormonal transgender treatments for children.

England and Scotland joined these countries in 2024 after the release of the “Cass Review,” which found a lack of reliable evidence for informed clinical decisions, “unclear” rationale for prescribing early puberty suppression and “unknown” effects of cross-sex hormones on minors.

When SB16 passed, it enjoyed the support of 54% of Utahns, according to a Deseret News/Hinckley Institute of Politics poll.

A New York Times/Ipsos survey conducted in January 2025 found 71% of American adults said no one under 18 should have access to hormonal transgender treatments.