H.B. 174 Sex Characteristic Change Treatment Amendments: transcript

Uh, thank you Madam Chair, hall and committee members. Um, there will need to be a, uh, an amendment moved. We'll be talking to the first sub, which has already been subbed out of rules, but there is an amendment, uh, that's, uh, on the system that will need to be moved as well. So in 2023, uh, the legislature passed, uh, SB 16. Uh, so SB 16, uh, put a moratorium on any transgender treatments, and it, uh, also grandfathered in those that were already taking those, uh, treatments and, but did not allow any others to continue. It also required the Utah Department of Health and Human Services to do a systematic study, uh, medical evidence review, I should say, uh, to determine what, uh, type of, uh, treatments would be proper to be done. So, uh, the purpose of the bill before us today, uh, and by the way, uh, Dr. Uh Becker, Dr. Elli and Dr. Smith will discuss this systematic medical evidence review, uh, and the, and the fact that it's a flawed report, uh, with a lot of bias in it, and I'll leave that to them. But the purpose of this bill today, uh, is to make permanent the moratorium. Uh, second is to require that the street treatment stop by January 28th, 2027, basically a year from tomorrow. Uh, so with that, I'm gonna turn the time over first to Dr. Becker. Then after him, Dr. Elli, then Dr. Smith. Uh, then we have, uh, Jeffrey Benon, and then we'll finish up with Chloe Cole. So go ahead, Dr. Becker. Thank you.

My name's David Becker. I have some handouts. Did everybody get those? Okay. Um, I'm a board certified pediatrician. I trained a primary children's. I retired about four and a half years ago after 37 years of general practice in pediatrics in Salt Lake County. Shortly before retiring, I had a patient come to my office with her mother. Her daughter was, uh, appearing sad and thinking that she was supposed to be a boy. At that time. I was completely naive about this, having no idea that there was such a thing as a gender clinic in Utah, let alone a hundred of them nationwide. But that experience and the rise of public attention to the issue led me to this, uh, led me to extensive study and learning about the medicalization of gender theory became something of a subspecialty for me. I ended up before this committee in 2023, testifying on behalf of representative ships total band bill, and by extension, uh, sb uh, 16, it was heard that same day later in 2024, I was privileged to help with and sign an amicus brief to the Supreme Court regarding USV ctti. On behalf of the community of detransition, I'll use my time to explain the basic essentials of evidence-based medicine. Take a quick a look at a few of the systematic reviews, review some of the harms of hormonal treatments and deconstruct for you the hollow dogma that all the medical associations agree. So let's dig in. Evidence-based medicine and the terms systematic review will come up repeatedly today. These are precise terms and having a basic knowledge of what they mean is critical to the debate, and even for future debates that might come to this healthcare committee. The evidence-based medicine research paradigm has been internationally accepted for over four decades as the standard for evaluating the reliability of medical research. The evidence pyramid, which which is page one of your handout, depicts the basic concept. Each horizontal bar represents various types of studies with the width representing the usual amount of studies of each type compared to the others. As you move up the pyramid, you can see the amount of evidence goes down, but the quality of evidence increases with a systematic review being the pinnacle of evidence, the gold standard of research. The term evidence certainty is critical and will come up again, just as in a trial court. Not all medical evidence is e of equal certainty or believability. The smoking gun with fingerprints or the clear security video is, uh, stronger evidence than is the, uh, testimony of the suspect's aunt as to his character or for that matter, the testimony of a dozen of his friends. The judge and the jury sort through this. The systematic review does this for medical research. Producing a systematic review involves a well-defined 26 step process. This is page two of your handout, And there's a front and back From the pyramid. All of the available studies of all types are gathered using a specified literature search and retrieval process. Each is then critiqued and duplicate by neutral research technicians for risk of bias and certainty. Step 20 is the all important four, four-part evidence synthesis, which you'll also hear more about. This allows the researchers to make a reliable overall assessment or verdict about the certainty of evidence contained in all of the studies, rating it as either very low, low, moderate, or high. This process is labor intensive and expensive. So with that background, there are a few dozen systematic reviews now on different aspects of so-called gender affirming care. I will briefly mention just a few that have had been most impactful so that the current Utah context can be better understood. Number one, Finland and Sweden, culturally very liberal societies and two of the early leaders in gender affirming care decades before America conducted systematic reviews in 20 and 2022. The result both nations all but shut down their pediatric gender clinics and moved to non-medical care models in England. Number two, the National Health Service in 2020 commissioned what became known as the CAS Review. It is named after its chair, Dr. Hillary Cass, the former president of the Royal College of Pediatrics and Child Health. The preliminary CAS report was published in 2022 based on two systematic reviews, and it resulted in the closure of Tavistock England's only gender clinic and the world's largest England moved to a non-medical approach to treating gender confusing confusion, emphasizing psychotherapy. Instead, the final cast report issued in 2024 is based on eight more newly commissioned systematic reviews on a range of topics. Notwithstanding the neutral language and gracious tone of the report, it nonetheless presents a scathing indictment against gender medicine, including hormone interventions, which were subsequently banned in England and elsewhere. Time does not permit even a quick summary of its findings and recommendations except for one, which I'll get to in a minute. Last summer, number three, the US Department of Health and Human Services released a comprehensive umbrella umbrella review of systematic reviews on transgender procedures. We can call it the U-S-H-H-S review to distinguish it from the Utah DHHS report. The 400 page review provides a methodological, sound and transparent assessment of the evidence. It includes authoritative chapters on ethical considerations, psychotherapy as a means for helping gender confused kids. I might note also that the majority of the reviews authors are self-identified political liberals who certainly are not sympathizers of the current executive administration, but they are independent thinking and intellectually honest arbitrators of the evidence. Put simply, the cast review in the HHS review are the most reliable and con comprehensive evidence-based reviews of so-called gender affirming care. All the reviews, reviews essentially reach the same overarching conclusion. The evidence for, uh, efficacy of so-called gender affirming care in key domains such as psychological outcomes, quality of life, and long-term health is a very low certainty. What that means is the hoped for outcomes are unlikely to happen. The benefits claimed by supporters of these treatments simply haven't been demonstrated yet. The evidence of mental health and psychological harms is documented when people say that so-called gender affirming care is evidence-based at the, at the best. They do not understand evidence-based medicine or they intentionally reject it and consider only the lower quality studies on the evidence pyramid and give them unmerited or exclusive credence. This is like giving the aunt's character testimony equal weight to the smoking gun. Of course, doing so is absurd. Dr. Maselli will be discussing in greater depth how the problem manifests itself. In the Utah DHHS report, blocking puberty is harmful and is certainly not fully reversible. Puberty cannot be put in suspended animation without potential irreversible harm to developing organs and sy systems and tissues disrupting the maturation of a child's secondary sex characteristics can be mostly reversed, but other organ systems and tissues, particularly the brain and bones meanwhile continue to develop, but without the physiologic con concentrations of the sex hormone upon which they're dependent for normal development. So they develop abnormally from the vantage point of these organ systems. Time spent on puberty blockers is lost and cannot be co recovered fully. Once a person goes down this pathway, she can never fully return to her premedicated body. The consequences can include chronic bone and joint pain, brittle bone disease, including fractured vertebra, jaws and hips, even in children and young adults. Likewise, the brain brains normal neurocog neurocognitive function simply can't develop without the constant influence of the norm normal sex hormone. At the orchestrated time, Sally Baxendale, a researcher from Oxford, recently published a systematic review on puberty blockers and neurocognitive impairments. She found memory loss, significant loss of global IQ points, increased suicidality and depression among, among other harmful effects, so that the claim that puberty blockers are fully reversible, is misleading and cavalier opposite. Sex hormones are equally problematic. Long term estrogen use in men increases the risk of thromboembolic disease, including heart attack, stroke, and pulmonary embolism. This is also true for females taking testosterone as well as reducing bone mineral de density resulting in osteoporosis. The incidence of certain cancers is also increased, including brain and liver tumors and even fatal hepato carcinomas in regard to this. Speaking of the death of a female to male trans person in a leaked internal communication made public, a WPATH doctor commented, quote, to the best of my knowledge, it was linked to his hormone treatment. Most importantly, use of cross-sex hormones, especially if they follow puberty blockers can often result in permanent irreversible infertility or sterility. Mr. Benon who testifies in a minute, will expand on the mental health, uh, effects of hormone treatments. But the MO notion that a person can consume these hormones long term without adverse consequences and irreversible harms is simply false. There is a place in medicine to be sure for using hazardous experimental treatments, but the tenets of medical ethics require three conditions be met. Number one, there must be a 100% accurate diagnosis. Number two, less risky treatments do not exist. And three, the condition if left untreated must be dire. A rare cancer. None of these requirements are met using so-called gender affirming care to help youth who have confusion or discomfort about the reality of their biological sex. And lastly, people who promote the use of hormone treatments insist that there is a medical consensus in favor of this, but the final CAST report reveals this to be based on an empty circular citation scheme. So please refer to, uh, page three. This comes straight from the CAST report. Have a glance at it, but my head explodes when I look at it. Fortunately, uh, and for time's sake, the L-B-G-B-T Courage Coalition, uh, made a simplified version, which is easier to understand. And that's page four, realized two facts. First, the key organizations, specifically the Endocrine Society, the Blue Circle, and WPATH in purple, the so-called World Professional Association for Transgender Health are not entirely distinct or independent thinking, coming to the same conclusions each on its own. Rather, they have substantial overlapping membership on policy committees. Many WPATH members populate and influence key committees, including that the Endocrine Society, the American Academy of Pediatrics, and the American Psychiatric Association. Second, the circularity begins with the Endocrine Society's Clinical Prac Practice guidelines, which the Endocrine Society itself admit, have, have evidence with a quote, moderate risk of bias and quote, the quality of evidence is low. That's quoting right from their document. The cast review even states that WPATH and the Endocrine Society guidelines, quote, lack developmental rigor and quote, are linked through co-sponsorship, just what I was talking about. So looking at the diagram from left to right, WPATH 20 20 12 Standards of Care cites the Endocrine Society's low quality guidelines. Then several organizations cite WPATH and the Endocrine Society for their own guidelines. Then several organizations, uh, cite wpath the Endocrine Society, oh, I'm sorry, and their, uh, for their own policies having done no independent research or systematic reviews on their selves. They, they just quote each other. Next, the Endocrine Society cites WPATH 2012 for its updated 2017 Clinical Plastic Practice Guidelines. And finally, looking from right to left, WPATH 2022 cites the Endocrine Society, which previously cited wpath, which had of course originally cited the Endocrine Society. As you can see, this amounts to a circular citation scheme, which gives the illusion of widespread agreement, but all based on the cantus of low quality evidence from the Endocrine society. All the medical associations agree to essentially nothing Quoting the CAST report. The circularity of this approach may explain why there has been an apparent consensus on Q of practice despite the evidence being, uh, poor. In short, there is no professional medical consensus, just a media amplified Echo, echo chamber featuring a couple of weak and discredited voices. So in closing, it is not surprising that dozens of gender clinics all over the country have closed just five this month in blue states not having enacted bans. This is happening under the weight of malfeasance, evidence-based medicine and Common Sense. HB 1 74 follows the evidence and therefore should be adopted to permanently ensure protection for our troubled and vulnerable youth from harmful interventions. I thank you for your attention and I welcome your questions at an appropriate time.

Thank you. Chair Hall and members of the committee, thank you for the opportunity to testify. My name is Kurt Elli. I'm a board certified physician in both internal medicine and psychiatry. With over two decades of experience today, I serve as Chief Medical Officer for Do No Harm Action, do No Harm Action is affiliated with Do No Harm, a diverse group of over 50,000 healthcare professionals and other concerns citizens committed to ensuring that the practice of medicine is driven by scientific evidence at Do no harm. We have documented the scope of these hormonal interventions that we've been talking about. Our Stop The Harm database based on insurance claims shows that nearly 14,000 minors receive sex change treatments between 2019 to 2023, including 135 children in Utah. Of these 106 receive cross-sex hormones or puberty blockers, totaling 691 prescriptions for that time period. In 2023, Utah passed SB 16, putting in place the moratorium already mentioned, and also requiring the Utah Department of Health and Human Services to quote, conduct a systematic medical evidence review systematic review of the use of hormonal agents in the medical treatment of transgender minors under the age of 18 with gender dysphoria. This resulted in the DHHS report prepared by the Drug Regimen Review Center, DRRC of the University of Utah. It was completed in early August, 2024 and delivered to the interim HHS Committee in May, 2025. Along with an executive summary, it's essential that we examine this report carefully. First and foremost, the DHHS report is not a systematic review, whereas it should have produced an analysis that is clear, precise, and honest about the strengths and limitations of the evidence in adolescent gender medicine. It didn't let me outline a few major concerns. The DHHS report claims to follow, but only as closely as possible, widely used and internationally accepted reporting standards for systematic reviews known as prisma. Those standards refer to key elements like the study selection process, eligibility criteria, synthesis methods, protocol registration, and so on. Yet its failures to meet those standards is substantial from the start, there was no formal synthesis of the evidence which the report itself directly acknowledges. In fact, the executive summary to the DHHS report states there were insufficient resources for DRRC to conduct a full evidence synthesis capturing all the studies and priority outcomes included in the report. DRRC also stated that its contract with DHHS did not call for an evidence synthesis. The legislature is thus left with a loosely organized material on which unjustified and unreliable conclusions are based rather than a quantitative synthesis of the evidence. This stands in contrast to several well-established evidence-based systematic reviews available at the time, but omitted from the report such as those by Dr. Joe Taylor and colleagues at the United Kingdom's Cast Review or for the United Kingdom's Cast Review, whose conclusions differ greatly from those of the DHHS report because no synthesis of the evidence was conducted. There is consequently no ability to assess its certainty or quality. That is how confident can we be in what the evidence is actually telling us. A thorough assessment calls for examining the consistency of findings across studies since wide variation and results signals meaningful uncertainty. But this step is absent from the DHHS report. Additionally, studies with small sample sizes produce less precise and more uncertain results. Further publication bias can skew how effective an intervention appears the study design itself must be considered. Again, the DHHS report is devoid of any such certainty assessment and therefore lacks relevant and vital analysis. Instead, it relies on a data dump of observational and descriptive studies that suffer from major quality limitations, which do include small sample sizes, high attrition rates, short followup, period selection bias, lack of comparison groups, and uncontrolled confounding or the unaccounted for factors that could skew results. These weaknesses result in very low certainty of evidence in the face of life altering interventions. Drawing broad conclusions from such studies is inherently unreliable. Yet the report fails to acknowledge this simple but key point. In fact, without a formal certainty assessment, small methodologically weak studies and better quality studies end up contributing to the conclusion on essentially equal footing with no systematic way to distinguish their reliability. The outcome is that lawmakers, again, are presented with conclusions that lay atop at unstable foundation. When we're making decisions about the care of our children, especially involving life altering interventions, we need confidence that the footing is solid, very low certainty evidence is anything but solid. To further clarify this critical point, let me offer an analogy. Think of evidence synthesis as putting together a puzzle so we can see the overall picture that that puzzle forms and think of the certainty of the evidence as checking how well those puzzle pieces fit together without both steps we're left with scattered puzzle pieces that don't fit and form no reliable image to guide decisions. In fact, the DHHS report effectively handed us a bunch of random puzzle pieces without any clear picture. Worse, the DHHS report leaves many of the key pieces missing. Notably, the DRRC reduced their initial priority outcomes, uh, list to a shorter list of high priority outcomes. Despite the fact that persistence desistence and regret were pointedly of interest to the legislature analysis of which was expressively required by SB 16. The DHHS report did not list these among their high priority outcome categories. They were offered as an afterthought, effectively modifying the outcomes of interest during the review process, and thereby introducing an element of bias. Similarly for the identification and selection of studies, not all relevant and pre-identified databases were searched, thereby introducing the possibility of missing relevant studies and falling victim to selection bias. And worst of all, the DHSS report failed to address some of the most serious permanent and life altering consequences, which can result from administering these hormonal interventions to minors, most notably infertility and sterility. The executive summary summary dismisses this issue in a single sentence, noting infertility is a known risk of cross-sex hormonal treatment and was not an outcome of focus in the DRRC systematic review. Consequently, the report itself does not meaningfully discuss infertility at all. Similarly, sexual dysfunction is ignored despite its importance to long-term wellbeing. These omissions reflect a disregard for critical scientific evidence and directly violate SB sixteen's requirement to analyze both effects and side effects of treatment. Another key piece missing comes from the DRCs analysis of systematic reviews, prominent reviews, including those conducted by the National Institute for Health and Care Excellence. In 2020, the University of York reviews that were a vital part of the cast review and the systematic review of adolescent gender dysphoria literature by Dr. Lucy Thompson and colleagues, which was included in the US HHS Review, are notably absent. Even though these reviews were available before the DHHS report was submitted to the legislature in 2025, interestingly, these reviews all reached the same conclusion about the lack of high quality evidence supporting the use of puberty blockers or cross-sex hormones from minors. Setting aside the omission of these major systematic reviews and focusing only on the seven included in the DHHS report, six received a critically low overall confidence rating based on risk of bias assessment done by the DRRC authors themselves, and a seventh was rated as low as a result. Any apparent evidence of benefit from puberty blockers or cross-sex hormones noted in these reviews rests on evidence of very low certainty and should not be relied on. Oddly, however, what is included without any degree of critical analysis are a select number of clinical practice guidelines. Whereas the CAS review identified 23 relevant guidelines in its systematic reviews. The DHHS report offered only four and four of the most biased guidelines at that. Yet a risk of bias assessment was not conducted on guidelines as part of the current work. Because the DRRC restricted inclusion to recognize medical authorities who published evidence-based guidelines, the report blindly re relies on the standard set by WAF and the Endocrine Society without examining their evidentiary basis or the controversy surrounding them. This is the very opposite of scientific rigor. All this is to say that the DHHS report ends up making many grave mistakes. These serious methodological flaws were not only outlined by do no harm as summarized in this testimony, but also by the US HHS Review, which independently analyzed the Utah DHHS report and came to the same conclusions. Basically, the Utah report conflates the quantity of guidelines and studies no matter how biased, uncertain, and unreliable they might be with the quality of evidence the authors appear persuaded by the volume of publication rather than the strength of the underlying data. This reflects professional carelessness and undermines the reports credibility and conclusions. In summary, the DHHS report neither provides a rigorous synthesis of the evidence nor evaluates the quality or certainty of that evidence. O missions are substantial and its definitive Conclusion in favor of hormonal treatments is greatly flawed, offered without any recognition of the inherent uncertainties evident throughout the literature and absent the methodological rigor required to substantiate them, these failures undermine the report's credibility and render its conclusions unreliable. This committee would be far better served by consulting both the cast review and the umbrella review conducted by the US Department of Health and Human Services, which itself has undergone peer review. These comprehensive reviews provide a far more methodologically sound and transparent assessment of the evidence. Thank you for your time and attention to this critically important matter. I'm happy to answer any questions at the appropriate time.

Good afternoon. My name is Dr. Allen Smith. I'm a practicing family physician in Delta, Utah. Uh, I was educated at the University of Utah, both the my undergraduate and my medical school career. Uh, I completed a family medicine residency at the MCAD Hospital System in Ogden. After residency, I opened a solo family practice, uh, clinic in Delta and I've been there for 34 years. In 19, or excuse me, in the year 2018, I was appointed by the governor to be a member of the Utah Physician Licensing Board, and since 2023, I've been the chairman of that board. As you know, the, uh, Senate Bill 16 required the Department of Health and Human Services in consultation with the Department of Professional Licensing, the Physician Licensing Board, the Osteopathic Licensing Board, uh, the University of Utah and Intermountain Healthcare to perform a systematic review of the scientific literature and then give the legislature recommendations regarding the future of the moratorium, specifically the moratorium on hormonal transgender treatments for minors. Dr. Michelle Hoffman, who is then the Executive Medical Director of the Utah Department of Health and Human Services, took an independent lead in this. In early 2023, she, uh, contracted with the University of Utah School of Pharmacies Drug Regimen Review Center to perform the literature review. Dr. Hoffman received the final draft in October of 2023. Between then and January of 2024, she gathered an an advisory committee to review the report and Helper with the required recommendations, uh, to the legislature. Dr. Hoffman's committee was composed of nine members. Dr. Hoffman herself, the chairman of the physician licensing board me, uh, the chairman of the Osteopathic Licensing Board, who, uh, declined to participate. Another osteopathic board member was then assigned, but only provided minimal participation. The remainder of the committee was made up of representative transgender health providers in Utah, namely physicians and pharmacists. Dr. Hoffman's goal in assembling an advisory committee was to develop a consensus of recommendation for you the legislature. On our first meeting, uh, that occurred in January, 2024, we were provided confidential access to the College of Pharmacies draft report, and we met to discuss and, uh, form our recommendations. Now, I personally and professionally have a fundamental disagreement with the administration of gender affirming hormone treatments to minors. That disagreement is based on 40 years work as a scientist and 60 years of common sense hormone treatments and body altering surgery cannot change a child with gender dysphoria into the opposite sex. Though chemical and surgical procedures can change the outward appearance to some extent, it is not scientifically possible to change a girl to a boy or a boy to a girl. Administering medically unhealthy treatments to healthy minors in an effort to do so raises serious and troubling ethical implications. It was obvious at the outset of the advisory committee that it was very biased in favor of transgender treatment for minors, and the committee itself did not meet the intent of legislature's instructions. I was the only advisor on the committee who raised, uh, the underlying negative scientific issues and the ethical concerns and the implications of this care. My concerns were effectively dismissed and the discussions in the subsequent meaning were aimed at quote unquote changing Dr. Smith's mind. After reviewing the College of Pharmacy's report, I found it was clearly biased in favor of gender affirming hormone treatments and minors. The report totally dismissed core issues about the propriety and ethics of administering cross-sex hormones to children. Additionally, it simply eng lowered the most serious and irreversible consequences of these treatments such as sexual dysfunction, infertility, and even sterilization. It then downplayed the few consequences that it did acknowledge. I found it curious that the report stated objectives did not even include the purpose of this study as required by Senate Bill 16 quote, to provide the legislature with recommendations to consider when, uh, to lift the moratorium. The report used pro gender, pro transgender terminology throughout, and its entire tone was in favor of gender affirming treatments. Thus, it was anything but unbiased. This report failed to meet the legislature's mandate, and as such provided no scientific basis to make any recommendations. In contrast, the 2020 forecast review from the United Kingdom and the United States Department of Health and Human Services 2025 review both extensively evaluated the science, underlining gender affirming care, and provided valid evidence-based data and analysis showing that the asserted benefits of hormone transgender treatments do not outweigh the real and many times permanent risks and harms. Both reports produce data showing that the suicide risk among minors who had transitioned with hormones or surgery was actually the same or possibly higher in the trans transitioned group compared to the non-transmission group. Overall, the College of Pharmacy report cannot be relied upon for any guidance or recommendation. Dr. Hoffman initiated the review independently and completed her executive summary involving only a cursory consultation with Doppel and the licensing boards relying almost exclusively on opinions of practitioners who provide transgender care. It was like having the Fox guard, the henhouse, the College of Pharmacy's report and Dr. Hoffman's executive summary are not founded on scientific principles. The recommendations are unsupported by scientific literature and fail to provide any basis on which the legislature can rely. Now, as members of the legislature and you and I and our official capacities, we share a common obligation and a common mandate that is to protect the citizens of the state of Utah. With that in mind, I urge you to vote to protect these gender confused youth, some of the state's most valuable and vulnerable citizens by voting to permanently prohibit transgender hormone treatments and minors. Thank you.

Uh, my name is Jeff Banyan and I'm a licensed marriage and family therapist and a founder of the Gender Harmony Institute, a non-profit mental health clinic that specializes in non-medical approaches to gender related distress. I've published and presented on the topics of gender and sexuality, and I have over 30 years of professional and peer led experience with these issues, including treating young people experiencing gender dysphoria. I've just have four brief points to make today. First, and this is the most important, the distress experienced by these young people is real. It's profound, painful, and overwhelming. At times. These children and their families deserve compassion, seriousness, and care, not ridicule, not abandonment, not indifference. But my second point is that compassion should not require us to abandon our good judgment and our concern for suffering children and they are suffering does not relieve us of our responsibility to do no harm, especially irreversible physical harm. Gender dysphoria is a mental health condition, not a medical disease. There's nothing medically wrong with the bodies of physically healthy children who experience gender related distress. There's no blood tests scan objective medical marker that can diagnose a transgender identity. The mental and emotional distress is real. It does exist, but interfering with normal puberty young bodies are undergoing is not necessary evidence and evidence quality matters, especially when we're talking about children. Despite the frequent public claims to the contrary and that we read in this report, there is no reliable evidence that medical or hormonal gender interventions reduce suicide risk or improve long-term objective mental health outcomes in minors, as Dr. Ger Smith and MS have previously mentioned, the most comprehensive reviews have acknowledged this. At best, the evidence is weak and low quality, and at worse it suggests permanent harm. The DHHS authors and the pharmacists who wrote it were not only outside their expertise and what the legislature asked them for when they claimed that there was strong evidence for the mental health benefits of these procedures. They were also wrong. For example, the recent comprehensive study by Joanne Olson Kennedy showed that at best they didn't further degrade. Adolescent's mental health and other studies show even worsening mental health such as increases in suicidality or greater anxiety, depression, and poor life functioning. While I acknowledge the research at this point is far from definitive, that's my third point. The burden of proof here is not met. Experimental interventions that permanently alter healthy bodies requires strong evidence. We do not have it even, and especially in this legislative report you requested, there is no valid and reliable way to assess childhood beforehand, which children will persist in their transgender identity into adulthood and which will not. Earlier research found that in most cases, even very serious ones, up to those were resolved when puberty was allowed to proceed. Normally up to 92% of those cases resolved naturally. Newer claims of load assistance and lack of regrets suffer from serious methodological problems, such as short follow up periods and high dropout rates, and we already have a safer and more humane approach. The role of mental health professionals should be to help people reconcile themselves to the reality, the internal reality of their distress, the external reality of their bodies, not help them escape one or the other. Effective therapy helps young people find meaning, flexibility, self-acceptance within their biological sex. That's gonna look different for every child, but it doesn't require rejecting their body or interrupting healthy development, which is my last point. Unfortunately, most of my colleagues and nearly all the professional associations we belong to believe that medicalization availability is the only ethical response to gender related distress. Along the way, they've abandoned the many young people like my friend Chloe here, who regret their medical transition efforts. We have worked with some of the, my clinic and I have heard their stories due to both wishful thinking and shallow media reports. Many of my therapists colleagues believe that this report represents your opinion and your beliefs on the child gender treatments, and therefore that you will soon be compelled to lift the moratorium. Some of this may lead their minor vulnerable minor clients to believe that because of this report, there's a chance the moratorium will soon be lifted, further damaging them with false hopes. Making this moratorium permanent would send a clear message to the therapists and their associations that supportive evidence-based therapy, not experimental medical interventions is the appropriate standard of care for young people. Making the moratorium permanent would also make it clear that you reject this report entirely and that it did not provide what you asked for in its biased and flawed conclusions. To include, we should treat physiologic psychological distress with psychological care, not medical harm. Proponents of child medicalization claim denying these experimental treatments to children is cruel, and that treating their gender dysphoria with compassionate therapy is conversion therapy. On the contrary, it is cruel to alienate children from their bodies, and it is conversion therapy to teach them or collude with them in the belief that surgery will allow them to escape from their shame about their sexual orientation. Supportive therapy is careful and compassionate. It's consistent with both evidence and ethics. While mature adults may choose differently for themselves, children deserve protection, not reckless experimentation. Thank you.

My name is Chloe Cole, and I am a D transition. I testified here years ago about the damages that I personally suffered from this treatment as a child. As many of you may already know, I once identified as a transgender boy and underwent childhood sex rejection procedures, beginning with puberty blockers and testosterone injections at 13, going on to have a double mastectomy at 15 and Daggett transitioning at 16 after I realized the impact on my health, on my fertility and my future. I chose to come back this year because I want to stress just how important it's for future generations that the moratorium on childhood mutilation becomes a full permanent ban. The last time that I was here, I spoke about some of the consequences for my health. Almost none of those complications have gone away since some have even worsened over the years, and I've had the opportunity to repurpose the pain that I've been through to do amazing things as I've entered adulthood, but the scars underneath my clothes are still the same, and I'm just as uncertain about how my future is going to unfold over the next few decades of my life. You're probably gonna be told today by those in opposition to this bill, that puberty suppression and wrong sex hormones are not only reversible, but also beneficial for children. My scars serve as living proof that this is a complete lie. I was put on Lupron, one of the most common puberty suppressant medications when I had just had my first period. Because of this, I started off my adolescence going into menopause, complete with hot flashes and emotional symptoms. Because of the combination of Lupron and weekly and testosterone injections, I started developing issues with my bladder, including frequent infections and U uti, like U uti, iLike symptoms. I started to develop blood clots and even bits of tissue from my urinary tract that would pass through my waist during the duration that I was on them. I also experienced emotional disturbances. I was prone to getting angry. I completely, radically changed in terms of my personality and to my mom and dad. They watched as over the course of my adolescence. I became a shell of a little girl who I once was when I had surgery, whether I liked it or not, I permanently lost a part of my adult sexuality and my identity before I even had my first kiss. With the scars and the shape taken away, I frankly, I absolutely hate the way that I fit into dresses and blouses now, but this is not just a cosmetic change. This is a part of myself that I could have learned to love if I was given the chance that I could have shared with my future husband that I could have nourished my future children with. But I wasn't allowed that. It's gone forever and it doesn't end there. It's been almost six years since I lost my breasts, and my body is still failing to heal a part of itself that it's never going to come back. There have been multiple instances over the years where my skin grafts, my scars have burst into open wounds with no explanation and no help from my doctors in the long term. I've had near absent mens leading me to question whether I'm gonna be able to have children or not. Now that I'm an adult, I have aching joints, I get back pain that shoots up and down my spine. I'm left with severe at times pelvic pain, and I don't know what the risks are going to look like for my health going forward because there are no standards of care there with which doctors can treat me because the healthcare system does not recognize detransition as something that happens, and there's no conclusive data on what happens to the children who are experimented upon. The worst part is I'm not just a one-off experience. There is a rapidly growing community of thousands of men and women and boys and girls who end up regretting their transition, who have irreversibly arrested developments, and they are completely infertile or sexually dysfunctional by the time that they reach adulthood. I have met 20 to 30-year-old men who permanently look and sound like teenage girls already menopausal young women who have damaged vocal cords and people of either sex entering their late teens and early twenties, relying on canes, walkers, and wheelchairs to get around because the drugs have destroyed their bones and their joints. No amount of terribly conducted studies or institutionally abused children being used as pawns for an ideology is going to refute objective reality. The very basis of so-called gender affirming care is a lie. It is fraudulent. Male and female are not feelings. Sex is not a feeling, but an immutable inborn characteristic, and it cannot be changed by mutilation or chemical castration, and there is no such thing as a transgender child because no child is born in the wrong body. But if you try to change a child's sex through cruel and experimental drugs and butchery, you are going to leave them scarred for life. And it's not to say that the distress that these children are experiencing isn't real, but we're not being dismissive by saying that the answer isn't To say yes to these feelings is to carefully examine where they come from and to guide our children through them. I once is, I once was in that position myself where I thought that I was happy to live like this, and I believe that I really was a young man, but the feelings of children are fleeting and ever changing. That is why, that's why it's upon us as adults to recognize that immaturity As mothers and fathers, as big brothers and sisters, grandparents, doctors, teachers, leaders of our communities, and of course representatives of our constituents to act on that. If California had a law back then like this, I would've never been subjected to this permanent harm when I was a child. This bill makes me think of my friends and my family members who grew up here, who live here, and their children, and how if this doesn't pass, they might go through exactly what I did and they won't be protected. When you look at young people like me, you're seeing a mirror of thousands of other children who will suffer the same fate, or perhaps they already have. I'm asking you today to make the right choice to ensure that the children of Utah will never again be led astray before you hear the same testimony from a child in your own state. Thank you for your time.

I don't think that any child does. There's a reason, there's a reason why we have these restrictions on children under the age of 18, being able to get married on their own or to be able to buy a house or buy cigarettes or alcohol. Thank you. It's because they simply are not old enough. They do not have the world, the experience or the developmental maturity to make decisions that will permanently affect them, and that is why we as adults have to step up.

Uh, we'd like that's, that's our presentation, uh, for the reasons it has been mentioned here. Uh, we feel like this bill needs to pass. There is an amendment to the first sub that needs to be moved at the appropriate time. Uh, if there's any questions, we're happy to take questions for any of the presenters. If you have questions for Ms. Cole, uh, ask them first because she needs to leave early to on, on her way to another meeting. Thank you.

Uh, Madam Chair and members of the committee, my name is Ann Bur, uh, from Layton, Utah. I am a Democratic candidate for House District 15. I'm holding the court ruling that found that the risk benefit analysis weighed in favor of my son receiving gender affirming care as a minor. That ruling establishes judicial standing for parents whose children are denied care despite evidence of medical benefit. The constitution prohibits laws that advance or enforce religious doctrine. Representative Trevor Lee has described transgender people as satanic. That is a religious claim, not a medical one. And the predominant religion in the state codified its opposition to transgender rights. In an amicus brief, if the legislature wishes to rebut an establishment clause challenge, it must rely on neutral evidence-based justification. But Representative Shipp cited do no harm report, which aside from quoting Fox News as its primary source on potential sex organ harm, the Swedish and finish guidelines, the highest rigor science, I am holding the actual Swedish guidelines here, which state on page four, puberty suppressing treatment can, in some cases be of great benefit even in Tanner stages four and five, that aligns with Utah's commission to review, not the bill. When a legislature disregards its own evidence and selectively cites Christian aligned sources courts, and for pretext, that significantly increases the likelihood of a successful constitutional challenge taken together with companion bills.

Chair and members of the committee. Thank you. I recognize that this bill brings up. Can You please introduce Yourself? I'm Shaylee Millard, mother of four. I recognize that this bill brings up deep feelings and I want to be clear about why I support it. At its core, HB 1 74 is about medical caution and responsibility when it comes to children. ETT acknowledges that minors are still developing physically, emotionally, and psychologically. And that permanent or life altering medical interventions require an especially high standard of care. This bill does not deny compassion or dismiss the struggles some families face. Instead, it seeks to ensure that treatments involving puberty blockers or cross-sex hormones are approached carefully, consistently, and with clear safeguards, including guidance for safely continuing treatment when it's no longer appropriate. I believe protecting children means slowing down, prioritizing long-term health, and making sure state policy reflects humility in areas where medical evidence is still evolving. Thank you.

Thank you. Madam Chair, members of the committee. My name is Dr. Kuhn. My pronouns are they them. I'm non-binary trans mask adult. I specialize with children and adolescents who are gender diverse in numerous ways. And I wanna just give a little statistic to start off. What we see with the anti-trans laws and what they cause is up to a 72% increase in suicide attempts. Conversely, research from Dr. Joelson Kennedy shows a 73% lower odds of suicidality. There's been a lot of talk in this room about harm, and I want to address that. I think we have different definitions of what that means. For me, harm is suicide. It is drugs and alcohol. It is smoking, vaping, skipping school, not being able to graduate, which can lead to all kinds of things, including being unhoused, which then, if we talk about affordability, costs the state of Utah even more. But I want to let you know just a little bit about what I hear from the kids. And the world doesn't want them, and they're not valid. Who they are doesn't matter. They're not being seen. These kids exist and they know who they are. They know themselves inside and out, and the relief that I see in them is undeniable.

Go ahead. My name is Aurora Nma Nino. I am a representative of the worldwide organization of women, and I definitely believe and have concerns also for kids that are going through this. Um, but something that we need to realize is biological sex isn't a label we assign. It's written into the body into more than 30 trillion cells. Every nucleated cell in a child's body carries that chromosomal reality. No drug changes it, no surgery changes it. We can alter appearance, we can suppress development, but we cannot rewrite 30 trillion cells. What we can do is cause permanent harm in trying. The international medical community, as we've heard before, is in retreat England shut down its flagship youth gender clinic after the class review found virtually no qualifying evidence. These treatments work and alarming evidence they cause that they do cause lasting harm. Sweden, Finland, Denmark, Norway, all of these nations were the nations that pioneered this care, have now abandoned it for minors outside strict research settings. Why? Because the children grew up and the lawsuits started and the regret stories piled up. HP 1 74 draws a simple defensible line wait until adulthood, not forever, just until the brain finishes developing, until the child becomes a legal adult who can weigh these permanent trade-offs for themselves. Every European nation that looked hard at the evidence came to the same conclusion. You saw Utah should not be the last to listen. Please protect Utah children. Thank you. Thank you.

Good afternoon, chair members of the committee. My name is David Torrey. I use they them, their pronouns and identify as trans, non-binary by gender and queer. I'm a Salt Lake City, Utah resident, and I'm here today because these bills directly threaten my health, my stability, and my future as well as children's future. I'm currently on hormone placement therapy and I'm actively pursuing surgical care as part of my transition. These are not abstract ideas or political theories for me. This is my body, this is my medical care. This is what allows me to function, to feel whole and to stay alive. These bills tell me that the care I rely on can be questioned, restricted, or taken away at any time. They force me to live with uncertainty and fear about whether the state will interfere with decisions I make with my doctors about my own body. That fear is constant. It affects my mental health, my sense of safety, and my ability to plan my life here in Utah. I'm not asking for special treatment. I'm not asking not to. I'm asking not to have my healthcare turned into a political weapon. This is my home. I deserve dignity, autonomy, and the right to make medical decisions about government. And without government interference urge you reject these, these bills, not only for me, but for youth. Thank you.

Hello, I'm Phyllis Gimpel. Uh, I represent the worldwide organization for women. And I, um, really, uh, appreciate the research and the information that was given by the sponsors of this bill. Um, I agree with the points that have been made. Children should not be having transgender treatments and therapy. They should not have that. They should wait until they're adults. And then if that's what they want, that's fine. Um, I ask you to please pass this bill. Thank you.

chair and members of the committee. My name is Catherine Dillon and I'm a parent of a 16-year-old transgender daughter who is currently grandfathered in. This affects her directly. She has a bright future and knows exactly who she is. And I'm not asking you to understand my daughter's identity, only to understand that this law won't change it and it will harm her. There are no 13 year olds getting care right now. This bill does not protect children. It forces 16 and 17 year olds who are already grandfathered into detransition. Something doctors know that doesn't work and families know that will not happen. This bill only pushes care underground, outta state and out of reach. Senator Kennedy has said SB 16 already ended access in the state. Clinics have not taken new patients for over a year. If a small government means anything, it means that the state does not belong in my home, our doctor's offices, or in my teens medical care. By forcing medically stable teens to stop care, the state assumes responsibilities for their pre unpredictable harm that follows mental health crisis and hospitalizations. And worse, the costs don't disappear. I believe in personal responsibility, parental authority, and limited government. This bill violates all three. Please don't make our family collateral damage in politics. And I wanna take a note that that study said only 135 minors right now. A lot of them have aged out. This affects less than 116 and 17 year olds. And my daughter is one of them. And I don't know if you want to see a photograph of her, but I brought one to show the committee so you can see who this is affecting. And it's affecting my kid. It will take away her healthcare. She has already transitioned a long time ago. Thank you, Catherine. Thank you. Would you, can I present this to the committee please?

Go ahead. Hi, I'm Delaine England. I am speaking on behalf of Utah Eagle Forum and also United Women's Forum. I'm really pleased at the, the, um, extent of compassion that has been expressed. And my heart is filled with compassion and love for those who suffer from gender dysphoria and identity. And I think the best thing that we can possibly do for someone suffering this is to tell the truth. It is impossible to change a person's sex. And it is important that we as a society and as adults, to protect our children and make sure that they are, their rights are protected and their interests are in protected, and we do what is best for them. Um, I'm sure most of you, I have a friend that has suffered from anorexia, as I'm sure most of you do, or bulimia. And if, can you imagine her going into her therapist and her therapist saying, you're right, you are fat. You should not eat. You need to be on a very strict diet. It would never do that because it would be extremely damaging. And, um, the serious and diverse health risks for, um, for everybody, but especially for our children that are on puberty blockers and cross-sex hormones makes the treatment and pub and, um, inappropriate and extremely damaging. Um, I would love to list those things, but apparently I'm about out of, out of time. We don't let our children, um, go get their tattoos or earrings. Please do not sacrifice our children. Crony capitalists who are only seek to make money. Thank you so much. Thank

Hi, everyone. My name is Mia Barbin, um, a 25-year-old transsexual woman. I started to socially transition at age 14. I started hormones at age 17 and later on proceeded to get surgery and everything that I needed, I'm opposed to this pill because me transitioning and aligning my mind with my physical body was lifesaving. I don't think that this is a luxury or something that I can choose or not choose to do. This was just something that was meant to be in my cards. So it is already hard enough to pay for hormones, pay for surgeries, and trans people don't have thousands of, of dollars to, to transition or at least try to match their physical to their internal. I feel like surgery and hormones completely alleviated my gender dysphoria. Um, I looked like this. I go to the world and I live as a woman. Um, ever since I was very little, I identify as a girl. Obviously, I didn't know what trans was. I obviously, everyone would try to like, make me to behave as a boy, but that actually just put me in depression. So as soon as I knew what trans was, I knew that that was what I needed to do, and it was to transition. So, yeah, this is not luxury. This is lifesaving.

Ga Ika with Utah Eagle Farm. It was about seven years ago that I met with, uh, then Governor Herbert and, and discussed this very issue with him. He was astounded and said, well, we don't do that in Utah. At that point, I showed him the evidence that it was happening in Utah, and he was really concerned, especially as we talked about the surgeries and all the things that were happening. Seven years now, this has been happening and, uh, I'm just grateful that, uh, changes are being made. Um, Senate Bill 16 with, with, uh, Senator Kennedy, uh, slowed this down. You know, put some guardrails up, but it didn't end what we were doing to the children. This bill today will in a year end what we're doing just to the children. And so I would ask all of you to please, please vote no on this bill. You heard all the evidence today. It was, it was amazing. I was here when Chloe was in, uh, interacted with her when she was here, those, uh, those few years ago. And I'm glad that she is, you know, seeing her now and as a beautiful woman that she is. And I hope and pray that her future will be a good future, that she's made these decisions, but what she has been through is just unbearable. Let's don't put any more children through that. Thank you.

My name is Jenna. I'm a transgender woman, born and raised in Salt Lake City, Utah. I'm here to voice my opposition of HB 1 74. Ever since I was a little boy, I remember wanting to be a girl. I would push my chest together to form what looked like breasts. I would wrap towels and t-shirts on my head to represent hair. I would even skip out on school lunch so that I could afford makeup and heels that I would hide from my parents. I, I didn't know what it all meant at the time looking back, but that was all a form of gender affirming care that I needed to survive. I wasn't doing these things for attention. I wasn't brainwashed and there wasn't anything wrong with me. I did these things as a child because it's what made me feel like me. Trans people are not being harmed by hormones, but they are being harmed by people who don't think they should exist. They are necessary, and they are truly lifesaving as a transgender adult hormones. And access to gender affirming care is what gives me the same euphoric feeling that was inside my little girl self, too. Please vote no to HB 1 74. Thank you.

My name is Isabel Gilan, and I would like you to urge you to not to vote against this bill. Um, I'm not sure how many of you have ever seen the, the show. I am Jazz, but she started her therapy when she was a child, and, uh, she just graduated from Harvard and she absolutely has no regrets. Uh, she's living life without regrets. I think this medical decisions belong in a medical setting and not in the legislature. Therefore, I do urge you to vote against this.

chair members of the committee. My name is Heather Kester. I'm a resident of Eagle Mountain. I, I'm the spouse of an 18 year Army service member and the mother of five, including a transgender teenager. Um, we have been grandfathered in, um, when my teenager was 13 years old, she attempted suicide due to gender dysphoria. Um, after years of careful, careful multidisciplinary care at Primary Children's Hospital, including therapy before even entertaining the idea of HRT or blockers, um, we have received life-saving care there and eventually moved into HRT and blockers. She is currently alive, thriving, happy back in public school and looking into her future. The doctors at the beginning of this meeting spoke of bone density issues or, um, the the things that might happen in the future to these bodies of the children that are taking medications. My child is alive today because of them, and if we have to deal with bone density issues, I will. Because she's alive. It's better than having a dead child, and that is a reality that our family has faced several years ago. This legislature has promised families like mine that this, uh, Utah would study this care before banning it. The study was completed by the University of Utah. As I've you've all heard today, it's been rejected. I urge you all to maybe offer another study or a way to further look into that research before completely putting a ban in for these, for these, uh, children, um, HB 1 74 does not protect children. It is harming them, mine included. They add insult to injury by codifying harm that is already being, um, administered by other bills that are, um, that have been proposed. Thank you, Heather. Um, I urge you to reject these bills. Thank you.

My name's Orion Maxfield. I work for Gender Harmony Institute with, uh, my coworker Jeff behind me, who testified in front of you already. Uh, we've heard multiple times, uh, this topic of suicide to which I wanna speak on. Um, proponents of this issue often claim that gender affirming surgery reduces suicide risk, but that claim is not supported by consistent or high quality evidence. A large recent matched cohort study conducted just last year in April, uh, conducted with over 107,000 patients with gender dysphoria compared those who underwent surgery with similar individuals who did not. The results showed that patients who had surgery were signi significantly more likely to be diagnosed with depression, anxiety, suicide ideation, and substance use disorder than their non-surgical counterparts. These differences were statistically robust with relative risks ranging from approximately 1.5 to nearly five times, indicating meaningfully higher mental health burden in this surgical group rather than a protective effect. Chloe Cole just talked to us about some of these effects. Um, and so I urge you to protect our children, and the best way to do that is to pass this.

Um, representative Daley Provo. Thank you. Um, I would like you to just state the report that you referenced so that I can look it up.

Yeah, absolutely. Gimme one moment. This is published in the Journal of Sexual Medicine, examining gender specific mental health risks after gender affirming surgery, a national database study conducted by Joshua e Lewiston, a number of other colleagues. Volume 22, issue four, April, 2025. Thank You.

Uh, hi. My name is Oliver. I'm a 21-year-old library worker. I'm born and raised in Salt Lake City, and I'm a proud transsexual man. I am very angry right now. First of all, why during the subject, trust the word of a clearly ignorant doctor who said himself, he didn't know what transgenderism was over an actual person who has taken this medication do no harm, should just be honest and change their name to intentionally harmful. What I originally wanted to say today was a lot more courteous, but what I'm not being treated with and shown civility, you are not getting a civil in courteous response back from me. I'm not gonna stand here and be another person recounting my experience as to why HRT saved my life, because you heard it all before, and you know that is true. And frankly, I don't think you care. You've heard the pleading from people who need this healthcare to live. You've seen the data, you know, the deadly consequences of making this healthcare inaccessible. And this is just cruelty. It's intentionally cruel and violent to legislate another attack on not one, on not only one of the most targeted communities in America, but to target the most vulnerable amongst us children, you'll be stripping away the right of bodily autonomy for minors. I cannot downplay the consequences of taking away this healthcare. It will be catastrophic. But again, you already know that the blood of the children who will take their own lines will be on your hands. And I'm afraid you don't even care. It is unfortunate having to constantly remind our legislators where their place is and who they work for. You work for us. You work for the people, not your own agendas, not your own ideologies. And the people of Utah say no to HB 1 74 and trust me, we are watching. We know who amongst you is not working for the people. And we will be, and there will, will be repercussions. All Of thank you, all of I I wanna remind the public that we don't impugn, um, we don't impugn legislators. We won't impugn you. Let's have respect for each other.

Hello, chair. Thank you. Go ahead, committee. Um, I am, my name is Ari Olson. I'm here to speak about the transgender care and the effects that it can have on youth and how beneficial it can be. I didn't receive transgender care as a youth myself, however, I have been socially transitioned since I was 16. Um, and it was the best thing I ever did. It really helped me come outta my depression. I believe that all of the sightings of increased risk of suicidality during transition are more so because of external social factors, such as the social stigmas that, uh, passing a bill such as this might, uh, exacerbate. And I think that I would prefer that we avoid telling people what to do and how to treat their bodies. I think that we should emphasize educating people on the effects of transgender healthcare and all of its side effects, all of the potential detriments, all of the potential for regret or harm in the future. But we need to make sure that people have the option if they need it, otherwise it could lead to more harm. And I strongly urge you to say no to this bill.

Thank you, Ari. Hi, my name is Fauna Harris and I'm a queer woman that has worked with hundreds of trans children over the last four years. I work at a center downtown and we specialize in non-medical, gender affirming care, offering community peer support groups. Um, and I'm asking you to oppose HB 1 74 because you don't know these children like I do. And like the many people sitting here asking you to oppose this bill, the case made in support of this bill is nothing but confirmation bias. Nothing. No one on that presentation team was a trans person telling you about the, about any harmful effects that they're experiencing as an adult. And we're also not talking about the target demographic that this bill is affecting. And it's a small handful of people, and I see so many of those kids every week, um, and I'm asking you to not support this bill because the argument in support of it is fractured and biased. And is it not scientific enough that these children are alive and happy when they're receiving treatment and have community? And I wanna note that no one is saying sex isn't permanent. It's called gender affirming care, not sex affirming care. And if you don't know the difference, then you cannot vote in favor of this bill. You are legal stewards. You do not have enough information or nuance to approve this bill. It is important to make sure that we are also not allowing faith to play a part here, because that would require a calling of spiritual, of spiritual stewardship. And who are you to these children? God and their infinite curiosity created billions in different sizes, colors, hearts and brains that work differently. And if you think of approving this bill, then how dare you minimize his curiosity and the special journeys of the people these bills affect. Thank You. Funny.

Chair Hall, members of the committee thank you for the opportunity to speak. My name is Sophia Tigi. I'm a former US Navy sailor, a software engineer by profession, and I currently serve as the president of the A CLU of Utah. Though I wanna be clear that I'm speaking today at my own personal capacity based on my own experience, and the fact that I'm here today gives evidence to the long-term positive aspect of gender affirming care. I'm here to oppose HB 1 74 and HB 1 93. Across my career in military service, engineering and civil liberties work, I've learned that complex systems fail when decision makers ignore expertise and experience of evidence. This is what concerns me most about these bills. The Utah legislature commissioned extensive medical and scientific analysis on these issues. Thousands of pages intended to inform careful responsible policy making. Yet these bills move in the opposite direction. Disregarding that work is substituting rigid political mandates for individualized medical judgment. When lawmakers ignore their own evidence and override medical expertise, people get hurt. These bills undermine the doctor patient relationship and interfere with healthcare decisions that should be guided by patients, families, and qualified professionals. From a civil rights perspective, laws that restrict access to care for specific communities, even when framed as neutral, often function and practiced as discriminatory barriers. As an engineer, I know systems designed without expert input fail As a veteran, I've seen the cost with leadership substitutes ideology for judgment. And as someone who has worked on civil liberties for issues for years, I know that public trust odent evidence is ignored. I urge you to vote no on HB 1 74 and HB 1 93 and to respect both the evidence you commissioned and the people who will live with the consequences of this decision. Thank,

Hello, my name is Ty Johnson, and I oppose this bill. As a transgender person who lives here in Utah, I know firsthand how these bills would affect our community. I know so many transgender children who would be affected by these bills. I may not have data and facts about my statements, but I do have personal experience working with trans youth every day. For the past two years, your legislation has made it impossible for, um, trans youth to thrive. And over the past few years, and as a constituent, I am embarrassed by my representatives targeting ma marginalized community. Lives will be affected, and because you don't know these trans people, you'll remain unaffected. Your privilege of being able to ignore these kids is terrifying. How can you make decisions based off a com a community you don't know?

Hi, everybody, my name is Dre and I'm here to speak against this bill and protect life-saving care for trans people. We are focused on the wrong 1%. When Utahans are struggling with housing, groceries and comprehensive healthcare, we're focused on the marginalized communities rather than the billionaires we should be tackling. At 16, when I came out to my mom, I almost died at her hands, which then led me to enter foster care, not because of who I am, but the isolation and fear and hatred that followed. Access to evidence-based healthcare is what keeps trans people alive. It's not experimental, it's not political. It's care. Trans people's healthcare is backed by every major medical and mental health organization, including the American Medical Association and the American Psychology Association. To pass this bill would fuel stigma, embolden harassment, and creates real harm. Laws like these do not exist in a vacuum. They translate to real mental health and physical harm as people of God, I ask you to not fear what you do not know, but have empathy. And instead, pass pol policies that protect and statistically back lives and live by the words he invited them all to come onto him. Black and whites bond and free male and female and all alike onto God.

Thank you for hearing me. My name is Laura Clark. I am transgender. I have called Utah home, my home for my whole life. I have known that I was trans since I was three years old. Very simply, I want you to vote to keep the state out of the doctor's office. Kids with gender dysphoria deserve the time. Puberty blockers will buy them to decide what is best for them. I wish I had had that option. Going through a male puberty did not make me appreciate being male. Living with gender dysphoria through puberty and into adulthood left me with a deep and unshakeable depression. For decades, I abused alcohol, three bottles of whiskey per week, smoked a pack of cigarettes per day, and engaged a plethora of other risky behaviors. If insurance beha assistance had not been available for, for therapy and gender affirming care, my life and health would be drastically different and more expensive. I urge this committee to vote no on HB 1 93 and 1 74. I want to address one point from the opposition that infertility and sexual function are both pointed out as major harms. I put it to you that if fertile, cisgender people work hard in school and apply themselves, that lost fertility can be made up for the government is unequipped to determine appropriate medical care, nor should it try as a matter of principle. Thank you.

Alright. Howdy, y'all. Uh, my name's Eric. Well, I wasn't gonna come up here, but, uh, I just listened to 30 minutes of doctors buy to you. So I just wrote down some fact checks here. Uh, there was a guy that was talking about the cast review. The cast reviews had its ass kicked by anyone from Yale to the National Institute of Health. It's a total lie. Uh, don't use it for your decisions. Uh, maybe fact check something. I don't know. Uh, anyway, uh, WPATH 20 17 20 22, uh, do reference, uh, the Endocrine Society, but they also reference thousands of other studies. Um, the 2024 DHSS study wasn't asked for evidence, syn synthesis, and its overall consensus, not just with transgender care, but with homelessness and everything else, was that we need more data, not less so. Why would you vote to ban it? I know, um, there was, uh, that really shady third guy, I think his name was Allen, something. Again, Please don't impugn people's people please. Thank you. All right. The perfectly normal guy Allen, uh, claims that some of the most serious outcomes that he wants to count are things like loss of sexual function, but already the most prescribed medicine to men in Utah is Viagra. So, uh, maybe he should work on those. Uh, and then last but not least, the, uh, guy that came in here last, Josh, uh, the guy that was referencing the study by Josh Lewis, I pulled up that study and it actually says, gender affirming care is great. Thank you, Eric Eureka, and that we just need mental health care for people after surgery.

Thank you. Hi, everybody. Uh, my name is Shane Taylor, and I was once a transgender kid. Uh, I'm now a transgender adult. I'm a resident of Utah, and I'm a law student, uh, who is hoping to build a career here working like all of you to make Utah a fair, more livable place for everyone, uh, including people who disagree with the very core of my existence or what I'm saying today. Um, when bills like HB 0 1 7 4 and HB 0 1 9 3, which I know we haven't really discussed yet, but when they're introduced and debated, they're often discussed in abstract terms. Um, but for people like me and many of that you've heard today, um, they're not so abstract. These are real uncertainties that we have to face about access to care, about stability and long-term wellbeing, and about whether the state we love and try to serve, truly sees us as participants and fair equal participants in a civic life. Um, I now, I I'm just a law student, but I am a law student. I'm learning about good law making. And, and one thing that I've learned is that good laws, um, do not just consider what's permitted, but they also consider what's wise, proportional, and humane. Um, laws that single out one group for restrictions don't just regulate conduct, they communicate exclusion. Uh, Utah leaders often speak about healthy disagreement. Um, to me that means disagreement, that still recognizes each other's humanity. So I ask you to consider these impacts, um, and about how they impact transgender utahns and their future in the state. Thank you.

Yes. Are you okay? Yes. Here we go. Uh, thank you Chair Weiler. Uh, we appreciate the opportunity to serve, uh, be here with your committee, uh, and, uh, SB or HB 1 74. I'm in the Senate committee. Almost said the wrong letter.

First sub HB 1 74. Uh, the legislature enacted SB 16 in 2023. Uh, that law, uh, does not, not allow surgeries on minors, and it put a moratorium on puberty blockers and cross-sex hormones. Uh, that did. Uh, there are some exceptions in the, in the process for rare, uh, uh, issues that have to do with, uh, uh, intersex and, uh, precocious puberty and so forth. But other than that, it set the moratorium, but it also required the Utah Department of Health and Human Services to do a systematic study of the evidence, uh, to come back to the legislature with some suggestions on what we do going forward. And at this point, the one thing I wanna mention, uh, is in a lot of ways we always protect our minors. There's many, several, a lot of laws out there, they can't smoke or drink to certain ages. And it's there for a purpose, uh, that we can protect these minors, uh, where they have a mental health condition that's gender dysphoria. It's real. It, it, it's, uh, something to not ignore, uh, but to, to damage a, a healthy body, uh, when it's a, a mental health issue is, is not right. And, and that's what this bill does. Uh, the purpose of the bill is to make the moratorium permanent. Uh, and also we're gonna have some discussion about the, the study that was done that is, was not done as a systematic study. It did not have the synthesis of the evidence, and therefore it can't be relied on. There are a couple of other studies that have been done. Uh, the CAS report by the UK and also the US Health and Human Services did a report that was what, that they were systematic review. So, uh, as far as, uh, part of my presentation, uh, Mr. Chair, I'm gonna have, uh, Dr. Becker here present. Then I've got Dr. Elli, Dr. Smith, and, uh, Mr. Bean. And then we'll have Chloe Cole at the end. So thank you.

That you work. Yes. Uh, my name is David Ter. Uh, thank you Mr. Chairman and, uh, committee members. Um, I'm a board certified pediatrician. I trained at Primary Children's a while ago. I was, I've become compelled to read about and research the medicalization of a gender theory after a mother came to me with her daughter who was sad and thinking that she was supposed to be a boy. At that time, I was completely naive about this matter, and I had no idea that Utah even had such a thing as a gender clinic. Two years later, I testified in 2023 on behalf of Representative Ships Total Ban Bill and by extension SB 16, which is being heard at the same time. Fast forward three weeks ago, I testified before the House HHS Committee in favor of this bill, HP 1 74. There I provided a basic understanding of evidence-based medicine and the systematic literature views, which have led states and nations to reverse course by replacing hormones and surgeries with mental health support aimed at affirming a person's immutable biological sex instead of rejecting it. The handout you have, um, summarizes some of that information. I also explained why blocking puberty is mostly not reversible, dispel the myth that so-called gender affirming care is evidence-based and untangled the echo chamber like mantra that all the medical associations agree with it. If you have any questions about these matters, I'd be happy to answer them at appropriate time today, I will get right to my conclusion. The medicalization of gender theory is going down as the most egregious and harmful scandal ever in the history of medicine. None come even close. All medical scandals eventually get discovered and come to an end. Such is the case for this one, and it's happening all around us as I speak. So I'll bring you up to date on this. What had been going on unchallenged for three decades began to unravel in 2017 when Swedish Public Television, uh, aired a documentary about a cluster of young girls with debilitating spinal fractures. These investigators discovered that they were all on puberty blockers prescribed by the Stockholm Gender Clinic, and they had severe osteoporosis as teenagers. The public, there was outraged and the National Health Services of the Scandinavian nations and England launched investigations, and they began to closely examine the evidence that had been used to support their transgender protocols by conducting the systematic reviews of the literature. This is when England commissioned the cast review. These early leaders in transgender practices and others reversed course in a major way. This was in 2020 and 22. At one point, America was a complete outlier on the world stage, but gradually states began to ban transgender affirming practices for the same reasons. Currently, 27 states have enacted bans. These bans were upheld one year ago by, by the Supreme Court's landmark decision in USB ctti, which determined that because gender identity is not an immutable characteristic, that this is not a civil rights issue. And two days ago, get this, Missouri made its moratorium a permanent ban. Now gender clinics are in rap, are rapidly closing down three so far this month. The latest, just this morning, the famed NYU Lege Medical Center, six, six others closed in January 35, closed in 2025, mostly in blue states. And this is in addition to all the clinics that shuttered in the 27 states. Having enacted bans. Public opinion is also turned against so-called gender affirmative care for minors. A recent NY uh, New York Times opinion poll revealed that 90% of Republicans and 55% of Democrats now oppose it. This is a major shift upwards for Democrats by almost double, at least 20 major investigations are underway by the Federal Trade Commission into gender clinics and the practitioners. A basic tenet of law is that you cannot mislead consumers with false or unproven claims. Gender affirming care seems to be the poster child of this, this problem. And just last week, the FTC announced additional probes into the American Academy of Pediatrics and into wpath, the euphemistically named World Professional Association of Transgender Health. The FTC is serious about this, having just hired a top-notch attorney to head up these investigations and prosecutions, medical malpractice premiums arising, and some carriers are already excluding coverage for transgender patients practices. This trend will accelerate now that a White Plains New York jury recently awarded a $2 million judgment against a detransition mental health health, thera mental health therapist and the surgeon for malpractice. Additional plaintiffs are coming to trial and about two dozen cases are pending nationwide that we know of with England's, uh, first case when it Uintah the Supreme Court, over 1000 suits followed, causing the closure of tavistock, their only pediatric gender clinic and the largest in the world, malpractice insurance will pre will become unobtainable, I predict by the end of this year, and the remaining gender clinics will be out on their own. And last week, the American Society of Plastic Surgeons issued a startling new and unexpected position statement, which cautions its members to refrain from performing surgeries on clients under the age of 19. It also points out to its 11,000 members that even hormonal treatments are supported by only very low certainty evidence and not to consider a patient's use of hormones as an indication or justification to perform surgeries at any age. The A SPS also commended the federal DHHS report for its 400 pa, uh, DHSS for its 400 page report, which like the CAST report, uh, presented a scathing rebuke of so-called gender affirming care on minors. And when within just hours, the a American Medical Association began to backpedal on its support of transgender practices. And last week, the ultra liberal Atlantic Magazine printed an article eulogizing the unfolding demise of what they called quote medicalizing gender dysphoria end quote. And finally, we parents do not have the right to do whatever we want to. And with our kids, who by themselves cannot give ethical informed consent for these practices. We have boundaries, nor is the doctor patient relationship some sort of untouchable sacred cow. We doctors have always had boundaries and are implicitly and explicitly regulated on how we practice our specialties. If anything, the real scandal here is how the professional medical organizations, the self-proclaimed experts, have failed to self-police, or at least the, at the very least, to hold the gender doctors account to the same high standards of evidence that is demanded in every other area of medical practice. This failure is not a footnote to this debacle. It is the core of the malpractice because instead of blind, they have instead blindly advocated for it. These so-called ex experts have indeed failed to protect the very people they claim to serve. So in 2026, given the extensive evidence of long-term physical and mental harms of hormonal treatments, and the persistent lack of solid evidence that these improve long-term mental health of people who believe that they were born in the wrong body and that this is sold to these people who are searching for help by using fraud and deception, there is no rational argument for allowing this to continue in Utah any longer. The legislature has a duty to end it to close. I will quote Justice Clarence Thomas and his ascent to the majority opinion on USB tti quote, states are never required to substitute expert opinion for their legislative judgment. And when the experts appear to have compromise or credibility, it makes good sense to chart a different course. HBA HB 1 74 charts that different course for Utah. So let's take it. Thank you.

Uh, to the chair members of the committee, my name is Kurt Elli. I'm a board certified physician in both internal medicine and psychiatry. With over two decades of practice experience. Today, I serve as Chief Medical Officer for Do No Harm Action, which is affiliated with Do No Harm, a diverse group of over 50,000 healthcare professionals and concerns citizens committed to ensuring that the practice of medicine is driven by scientific evidence. As we know in 2023, Utah's law, SB 16 imposed a moratorium on hormonal treatments for minors with gender dysphoria and directed the state's Department of Health and Human Services to conduct a systematic medical evidence review on such interventions. Much can be said of that review given time, I will focus my comments on three concerns that deserve emphasis. First, the DHHS report is not a systematic review. The executive summary to the DHHS report explicitly acknowledged insufficient resources for a full evidence synthesis. While the Drug Regimen Review Center stated the contract did not require one, the result instead of a clear quantitative synthesis with assessments of evidence, quality, or certainty, the DHHS report presents loosely organized material from observational and descriptive studies, many plagued by limitations such as small sample sizes, high attrition rates, short follow-up periods, selection bias, lack of comparison groups, and uncontrolled confounding, or those unaccounted four factors that could end up skewing results. These weaknesses result in very low certainty. Evidence in the face of life altering interventions, drawing broad conclusions from such studies is inherently unsound. Yet the DHHS report fails to acknowledge this simple but essential principle. Instead, it claims puberty blockers and cross-sex hormones are effective and safe. The data simply does not support this conclusion. Second, the DHHS report omits discussions of serious permanent harms like infertility and sterility from cross-sex hormones, dismissed by the executive summary as an outcome not of focus despite the law requiring analysis of both effects and side effects in a similar manner. Sexual dysfunction is also ignored by the DRRC. This pattern of omission leaves lawmakers without a clear accounting of some of the most consequential, irreversible risks, but it doesn't end there. Key high quality systematic reviews available before 2025, including those conducted by the National Institute for Health and Care Excellence from 2020. The University of York reviews that were a vital part of the cast review and the systematic review of adolescent gender dysphoria literature by Dr. Lucy Thompson and colleagues, which was included in the US HHS Review, are all notably absent. Interestingly, these reviews all reach the same conclusion about the lack of high quality evidence supporting the use of puberty blockers or cross-sex hormones for minors. Lastly, what is included without any degree of critical analysis are four clinical practice guidelines. One of those is from wpath and another from the Endocrine Society guidelines, which suffer from a self-referential loop. Yet these documents are accepted at face value. There is no risk of bias assessment that was conducted. It totally bypassed the scrutiny of evidentiary foundations amid the ongoing controversies. It is well documented that wpath, for example, committed serious violations in developing its eighth edition of the so-called standards of care, ranging from suppression of systematic reviews to failures in managing conflicts of interest, and even the removal of age minimums for explicitly political reasons. Taking these flawed practice guidelines at as face value is just the opposite of scientific rigor overall. The DHHS report conflates quantity with quality. It provides neither a rigorous synthesis of the evidence nor evaluates the certainty of that evidence. Its omissions are substantial and its definitive Conclusion in favor of hormonal treatments is greatly flawed, offered without any recognition of the inherent uncertainties evident throughout the literature and absent the methodological rigor required to substantiate them, these failures undermine the report's credibility and render its conclusions unreliable. In seeking information about the risks and benefits of puberty blockers and hormones and minors, I would strongly urge the committee to instead consult the United States HHS report from November, 2025, which itself has undergone peer review. There is much more that could be said about the DHHS report as well as the reliable systematic reviews. And I'd be happy to answer any questions at the appropriate time. Thank you. Thank

Uh, good afternoon. My name is Dr. Allen Smith. I'm a practicing family physician from Delta, Utah. I was educated at the University of Utah, both undergraduate and medical school, and completed a family medicine residency at the McKay Ogden Ho or Ma Macka Hospital in Ogden, Utah. After residency, I opened a solo family medicine practice in Delta and I've continued to practice there for 34 years. I was appointed to be a member of the Utah Physician Licensing Board in 2018 and have been the chairman of that board since 2023. That's how I became involved with 2023 Senate Bill 16 and this House Bill 1 74. As you know, Senate Bill 16 required the Department of Health and Human Services in conjunction with the Department of Professional Licensing, the Physician Licensing Board, the Osteopathic Licensing Board, the University of Utah and Intermountain Healthcare to perform a systematic review of the scientific literature and then give the the legislature recommendations regarding the future of the moratorium on hormone transgender treatments for minors. Dr. Michelle Hoffman, who was then the Executive Medical Director of the Utah Department of Health and Human Services, took an independent lead in this. In early 2023, she contracted with the University of Utah School of Medicine Drug Regimen Review Center to perform a literature review. Dr. Hoffman received that draft report in October of 2023. Between then and January of 2024, she gathered an advisory committee to review the report and Helper, submit the required recommendations back to you. The legislature, Dr. Hoffman's committee, was comprised of nine members. Dr. Hoffman herself, the chair of the physician licensing board me, the chair of the Osteopathic Licensing Board who declined to participate. Another osteopathic board member was assigned but only provided minimal participation. The remainder of the committee was made up of representative transgender health providers in Utah, namely physicians and pharmacists. Dr. Hoffman's goal in assembling the advisory committee was to develop a consensus of recommendations for the legislature. Our first meeting occurred in January of 2024. We were provided confidential access to the College of Pharmacy's draft report, and we met to discuss and form our recommendations. I personally and professionally have a fundamental disagreement with the administering of gender affirming hormone treatments to minors. That disagreement is based on over 40 years, work as a scientist and 60 years of common sense. Uh, hormone treatments and body altering surgery cannot change a child with gender dysphoria into the opposite sex. Though chemical and surgical procedures can change the outward appearance to some extent, it is not scientifically possible to change a girl into a boy or a boy into a girl. Administering medically unhealthy treatments to healthy minors in effort to do so raises serious and troubling ethical implications. It was obvious at the outset that the advisor committee was very biased in favor of transgender treatments for minors. The committee did not, uh, did not meet the intent of the legislature's instructions. I was the only advisor on the committee who raised the underlying negative scientific issues and the ethical concerns and implications. My concerns were effectively dismissed and the remainder of the discussions and the remaining meetings were really aimed at quote, unquote changing Dr. Smith's mind. After reviewing the College of Pharmacy's draft report, I found it was clearly biased in favor of gender affirming hormone treatments and minors. The report totally dismissed core issues about the propriety and ethics of administering cross-sex hormones to children. Additionally, it simply ignored the most serious and irreversible consequences of these treatments such as sexual dysfunction, infertility, and even sterilization. It then downplayed the few consequences that it did acknowledge. I found it curious that the reports stated objectives did not even include the purpose of the study as required by Senate Bill 16, which was quote, to provide the legislature with recommendations to consider when deciding whether to lift the moratorium. The report used prot transgender terminology and its entire tone was in favor of gender affirming treatments. Thus, it was anything but unbiased. This report failed to meet the legislature's mandate, and as such provided no scientific basis to make any recommendations. In contrast, the 2024 cast review from the United Kingdom and the United States Department of Health and Human Services 2025 review, both extensively evaluated the science and underlying, uh, underlying gender gender affirming care, and provided valid evidence-based data and analysis showing that the asserted benefits of hormone transgender treatments do not outweigh the real and many times permanent risks and harms of those treatments. Both reports produced data showing that the suicide risk among nine minors who had transitioned with hormones or surgery was actually the same or possibly higher in the transitioned group compared to the non-transmission group. Overall, the College of Pharmacies report cannot be relied upon for any guidance or recommendations. Dr. Hoffman initiated the review independently and completed her executive summary involving only a cursory consultation from the Department of a professional licensing, the medical licensing board, the osteopathic licensing boards relying almost solely on opinions of practitioners who provide transgender care. It was like having the Fox Guard, the henhouse, the College of Pharmacy Report and Dr. Hoffman's executive summary are not founded on scientific principles. The recommendations are unsupported by the scientific, scientific literature, and they fail to provide any basis on which the legislature can rely. Now members of the legislature, you and I in our artificial capacities, you as Senator Vickers, me as the Chairman of the State Physicianing Licensing Board. We have a common obligation and a common mandate that is to protect the citizens of the state of Utah. With that obligation in mind, I urge you to vote to protect these gender confused youth from these treatments. These youth are some of the state of Utah's most vulnerable citizens, and I hope that you will vote to permanently prohibit transgender hormone treatments in minor. Thank you.

Uh, so my name's Jeff Benon. I'm a licensed, uh, marriage and family therapist, a constituent of Senator pitchers and a founder of the Gender Harmony Institute. We specialize in non-medical approaches to gender related distress. So, uh, and I've published and presented on the topics of gender and sexuality, and I have over 30 years of professional and peer-led experience with these issues, including treating young people with, uh, experiencing gender dysphoria. So I'm gonna zoom in on one claim you're going to hear over and over, which is that gender medical gender transition for minors is lifesaving. That is better to have a life son and a dead daughter. These are emotionally powerful lines, but I want to caution, as suicide prevention experts have repeatedly that talking about suicide in simplistic sensationalized ways can actually suicidality, it can increase the thing that we all are here claiming to want to reduce, especially when it's vulnerable youth. We should be careful and follow national CDC guidelines, which warn against framing suicide as an inevitable outcome if a particular policy or treatment outcome doesn't happen and against attributing it to a single cause. These guidelines emphasize focusing on hope, on the complexity, and help seeking and avoiding overly simplistic X will cause y claims all mental health and medical professionals involved in the treatment of gender related distress should hold themselves to these standards. And I call upon them to do that today. So the question before us all today is not whether medical transition causes suicide, but rather a narrower one, do puberty blockers cross-ex hormones or surgeries for minors reduce or prevent suicide. And the best available evidence does not show a reduction in completed suicides, which even chase Gio, the ACLU's attorney arguing before the Supreme Court in the ETT case admitted studies with short follow-up and self-reported depression scales can't answer the mortality question. And when researchers look for differences in death by suicide, the evidence is either absent or does not show benefit. A major population level study from Finland examined every adolescent and young adult referred to gender services over two decades, over 2,883, 2083 of them, and compare them to 16,643 matched controls. Yes, this is a high risk population, we agree, but when researchers controlled for prior psychiatric treatment, the strongest predictor, there was no statistically significant difference in all cause or suicide mortality between gender referred youth and controls. The authors also found no detectable association between medical, gender, surgery and suicide risk. The clinical takeaway ident identify and treat the co-occurring mental disorders that, and that will prevent suicide. This is where we need to be focusing our efforts, which I agree are serious and profound and important. There are known benefits to mental health support for this population, and this is what will help them. You don't have to even take my word for this. Even the Endocrine Society sponsored systematic review, which only, which concluded that low quality and small bias studies might have shown a, a short term improvement in depression anxiety. The authors could not draw any conclusions death by suicide. I quote, what about higher quality reviews? The cast review concluded the overall evidence base for adolescent medical transition is of low or very low quality and does not provide strong support for claims of mental health benefit to medical transition. It urged a research protocol approach and far more robust evidence that aligns with what we've just heard. Claims of suicide prevention are not supported by strong evidence. In fact, I believe if the benefits are as clear cut as the proponents claim, it would be easy to find a very strong statistical signal in the data and it's not there. And I think that's telling some can point to short term uncontrolled single clinic cohort showing lower odds of self-reported suicidality after starting treatment. And those studies can be valuable in certain contexts, but they're limited for what we're trying to decide to today, which is their short subject to selection bias suffer from heavy at, uh, cell heavy attrition, and their outcomes are driven by solely by self-report scales rather than verified mortality data. They also fail. Most importantly, from my standpoint, they fail to distinguish between simple therapeutic support that we all agree everybody needs, uh, versus the actual medicalization. The outcomes are measuring both. They're not distinguishing them, as we saw with even the endocrine society report. Uh, even proponents will acknowledge the low certainty of this data, though not usually ins findings here like this setting. The proper question for you as policy makers, I believe is have proponents met their burden of proof that benefits clearly outweigh their risks. It is their burden to demonstrate that these experimental and very new treatments are helpful and not harmful in physically healthy children. And when it come, the burden is not on us to show that they aren't harmful. But because of the burden of proof, because these are experimental, it, the burden of proof needs to be on them and they have not met that burden. Meanwhile, we can look at populations level studies, uh, and we find there that depression, anxiety, and suicidal ideation among those who had surgery, those who don't, uh, do not show a benefit and may even show harm. You'll also hear we also aren't, we aren't seeing regret after these treatments. In fact, regret in knee surgeries is higher. That comparison misses two important points. First, so-called gender affirming treatment. Medical procedures are treating psychological distress with a much more invasive, systemic and irreversible physical interventions in minors, which raises entirely higher ethical bars than knee surgeries. Second, regret and adverse outcomes take many years to manifest longer term studies that do exist like Sweden's National Cohort show persistently elevated risks of suicide and psychiatric morbidity even after surgery. This underscores the need for lifelong comprehensive mental health care and caution about overpromising the benefits of surgery and drugs. I'm not claiming the research I'm presenting here is definitive. I'm saying it is uncertain and the burden of proof is not here to allow these, especially in minors because our job as parents, as educators, therapists, and everyone concerned with healthy society is to help children learn to navigate difficult and a sometimes painful world and to live creatively within the constraints of reality. And we do not help children when we instead collude with them in trying to escape or avoid that reality. It does not lead, I believe, to healthy or resilient adults. We all want to reduce suicide and we all want to protect and help this population. But the best evidence says to treat co-occurring mental disorders, improve family and social supports, and use responsible messaging around suicidality and self-harm, while demanding high quality long-term evidence before declaring medical transition for minor lifesaving or safe. And until that burden of proof is met, a permanent ban on administering hormonal treat, transgender treatments on minors is what is responsible. And I await any questions you may have.

My name is Chloe Cole. I'm from California and I am a senior fellow with do no harm.

As somebody who used to identify as a boy and personally has gone through childhood sex rejection procedures, this spill is one that is very important to me, and I stand behind it wholeheartedly because I was one of those many thousands of children who were mistaken that they were transgendered and led down the path of an attempted change of sex by the hands of my doctors, and in my case, through the administration, through chemical castration agents to stop my puberty weekly doses of testosterone at 13 years old and surgically removing my breasts when I was 15. I wanna affirm that if you vote to make this moratorium and to a full ban on these procedures in children, you will be keeping future generations out of harm's way. You've probably already been told that these procedures are either not happening to the, to children or that when they do happen, it's both beneficial and completely reversible. But there are permanent scars on my body that prove that this is completely untrue. Having been put on the puberty blockers before I graduated from middle school, I essentially went through a menopausal phase complete with uncomfortable side effects like hot flashes and completely numb emotions. After about a year being on testosterone, I started experiencing bladder issues that range from anywhere from infections or UTI iLike symptoms or blood clots during the duration that I was on them. And that's not to mention the emotional disturbances of being on a literal steroid. I was not emotionally stable at all. The longer that I was on it, and the further that they increased my dose, I was prone to rage. I had completely radical changes to my personality, to the point that a few years in my mom and dad could barely even recognize me. And as a consequence of the surgery, I lost a part of my sexuality and of my identity as an adult, an adult woman before I was old enough to drive a car and before I even had my first date. It's a part of myself that could have been a part of my marriage that I could have nourished my future children with. And I lost it forever. At an age before I was old enough to really appreciate just how much these things would mean to me. It's been almost six years, and my body is still trying to keep up with the part of itself that is never going to be here ever again. And the long term I have to deal with joint issues, aching pains, pelvic pains. I don't know if I'm going to be able to have children or not because my menses are barely there and I'm probably not even ovulating even though I've been able to keel a little bit since. I don't know what my future is going to look like because there is not, there aren't any standards of care. There is no recognition of Daggett transmission by any of these doctors or even within the broader me healthcare system. I've had the opportunity to repurpose all of this to help other young people, but the scars underneath are never going to go away. I don't know what my future is going to look like down the road. And that is exactly why I want to ensure that what's happened to me and thousands of other children across the country will never happen ever again. And I know I'm not alone because I've personally over the years met hundreds of other Daggett transitioners over the years who every single one of us, we wish that we could have been protected when we were kids. The other speakers on the panel have testified to the fact that these procedures are not backed by any sound scientific evidence. The only thing that this model of care firms is convenient, expensive lies. You can't feel your way into manhood or womanhood because sex is immutable. No amount of mutilation or chemical castration is ever going to change that. And more importantly, there's no such thing as a transgender child because no child is born in the wrong body. But to let them grow up believing that, that they're born so wrong, that they have to be experimented on for life while depriving them of a normal healthy future is cruelty to the highest degree. It's a crime against humanity. And it's not to say that the feelings that these children are experiencing isn't real, they are real. But that doesn't mean that they're true. I also thought that my God-given body and feminity were a curse, that the further I ran away, I would be happier. But the feelings and these immature beliefs that children experience are not meant to be the same forever. That's why the burden is upon us as parents, as big brothers, as sisters, doctors, teachers, and of course representatives of one's constituents to be a guiding authority in the lives of our children. Utah may not be my home, but it's a place that is personally very dear to me because I have friends and family here. I have childhood memories here that I look back on fondly to this day. And I firmly believe that this is a state that is well worth fighting for. And every child in Utah deserves to be protected and cherished and loved the beautiful, unique way that they are. Thank you.

Uh, that concludes the presentation. So it, uh, open to Questions. Thank you.

Yeah, I, for Dr. Smith, actually, if you's got a second. Um, as far as the providers for, um, for transgender medical, uh, intervention for children, was that primarily being done at the University of Utah prior to the moratorium? To my understanding,

That's where most of it occurred, but, um, yeah, there's not a, there's not a directory specifically to say who was doing this, but I think they were the original and the majority of who were, uh, majority of the care was occurring through them.

Okay. And you know, part of the question I have is I, I go through the report and I have the report in front of me, and I've got a few of the people on it, and it has disclosures and it, it keeps saying like no financial ties for each of the, each of the people. But I look at, for example, um, uh, Nicole Mi Opolis, um, now she's an an L-G-B-T-Q, uh, adolescent care provider. And I'm trying to understand, like, did you perceive her as having some financial ties to, uh, to the outcome of the study, given that it was a moratorium on a service that she specifically provided in the state?

It was very obvious that, that there was a conflict there. Her entire, um, livelihood where she had carved out a little niche herself, her entire livelihood was based upon being able to continue to propagate this care. And, and

My understanding is she's since left the state.

That's what I understand. That's just hearsay to me. But I, I think she is no longer in the city of Utah.

And then I, I looked up, uh, on Hello Giardino, uh, angel, I, I don't know if they call him Angel or Onlo, I don't know what his, uh, how, how he pronounces it, but Giardino, he's the chair of pediatrics at the University of Utah. That's where most of the care would've been provided presumably is within the pediatrics department at the University of Utah?

Yes, that's correct. Okay.

And did you perceive him as having conflicts of interest?

Similarly? Uh, he was involved in care for this, this childhood group. So yes, there was a conflict there,

But he didn't declare any disclosure as to any financial tie to the industry,

Not from a financial status. He didn't, never did say that.

And, and I guess technically since there was a moratorium, they would say there was no financial tie since that had presumably stopped all care. So maybe they're going on

That it had stopped, it had stopped all new care. Okay. But there was ongoing care for those who had already been, uh, established in the treatment channels.

And then so ongoing care was occurring. And then Brooks Keesen, I think I may be pronouncing that incorrectly, but, uh, uh, let's see. Yeah, Brooks Keesen, uh, he was at the Huntsman Mental Health Institute.

Yes. Okay.

And, and did they provide the medication and, and mental health care during the process of, of any transition care?

Yes. They were directly involved with medication management and, and, uh, counseling. Okay. Of those who were receiving this, this

Care. And he also said no financial ties to the industry or pharmaceutical companies, um, on his disclosure in the study. And then Catherine Smith, do you recall her?

I don't, I did not know Catherine Smith personally, and I don't know who she is other than just, she was on the committee

Now, I, I looked her up. She is known for writing the book Gender Ather, gender Affirming Therapy. So she literally book, wrote a book on gender affirming care, and she's listing no financial ties with regards to the Utah study.

Well, that, that seems, um, blatantly, uh, blatantly false or maybe I, I need to say how we asked the question, but she blatantly had a, uh, a direct financial involvement because she was making money based upon the sale of, of a pro transgender book.

Yeah. And, and so I guess that's one of the concerns that I have. And it, and it's kind of been, you know, you're, you're talking about a study created by our health department where they kind of stacked the committee with the people that were providing care prior to the passage of the bill. And is that a fair characterization?

That's very, very appropriate. And that's the way I felt in the meetings. Uh, when we would have the meetings, it was like, well, Dr. Smith, um, let, let me show you this new study, or we've got a meeting, uh, a society meeting this upcoming weekend. Why don't you come and go with us to the meeting and we can help you understand. And, and they would say, we appreciate your, your honesty and you're trying to do what's right, but let us teach you about this. Okay. And so the, that was where the whole, the whole committee was essentially.

Yeah. And, and I guess that that's been my concern on the, on the study, um, is they didn't, none of them declared financial ties or that if a moratorium was lifted, you know, all of the recommendations are, you need a panel of experts that can come up with the, with the process of care, and guess who's waiting there? The very committee members are, you know, are they're waiting to, to be the panel of experts to lift a moratorium to then start the care again. And, and so they certainly had a financial tie, you know, in that, in that respect. And, and so I'm, I'm frustrated that they did not, I mean, all they had to do is de declare their, disclose their conflicts of interest on this, and not a one of them did, even though they were, they had all been involved with the very care that had been subject to the moratorium. Is that a fair characterization? It, it,

It exactly is. And I tried to present to the committee to say what we needed. In fact, I, uh, I stated to the chairman that we really needed to disband the committee and reestablish it with a representative committee of the physicians of the state of, of Utah. My concern was this committee would give out recommendations and use legislatures, the media, the, the state would think, oh, this is representative of what the physicians in the state of Utah believe, and it's totally is not.

Yeah. And so Thank you, thank you Chair for allowing me a little leeway on

It's Escamilla Escamilla. Thank you, Mr. Chair. Um, and if, um, Dr. Smith, is that correct? Mm-hmm. So you made a, an interesting part of your statement. I listened very carefully. Um, you said that you felt, and it seems like that's the case with the questions that were asked by my colleague, that there was their bias that these individuals that were part of this presentation were biased.

That is correct. Okay.

Do you think your bias in your position?

No, I think that I have got, my position is established based upon my years and years of medical science. This is based upon science and truth, not, not, uh, opinion. So I don't think that I can, I mean, I think it's not fair to say I'm biased. I'm basing my opinions based upon scientific literature, scientific learning that I've gone through for 40 years.

Okay. A follow up question, Mr. Chair, please. Thank you. So, um, I'm not a physician, but I've served 12 years in the board of Primary Children's Hospital. So a great institution has saved the life of my children, multiple kids. So I do take a little bit of offense when they come after the doctors that have gone through the same professional career. Maybe not exactly as yours, because I don't know your resume. I haven't seen your resume. Dr. Smith, I'm sure if you were a provider and you're in the chair of the licensure board, you are a respected member of your medical community. But I do take offense and those doctors are not here. So I, I will say it was getting a little bit borderline point of order for me to allow the discrediting of those physicians that I don't know. I actually do know Juab because he was a, um, Dr. Angel Angelino, um, he was a, he's still the chair. So I interacted with him in my capacity as a former board member of Primary Children's Hospital. So I, what what is real here is that you have a position and it's respectful. I respect your position. I disagree with your position, and it's okay. And the, the, you know, the bill itself is in response to a study. And I respect now going to the sponsor of the bill to say, the policy that he's proposing is, you know, he's using this study, um, saying that the study's not correct, and he's being bringing a policy. I think, you know, what it's incredibly important to me is to understand from a medical perspective, when do you think government should draw the line and intervening on someone's medical care?

Well, I would state it several principles. Number one is based on truth. Um, we're talking about reality here. We're talking about, um, people's feelings. For example, uh, if a child or, or an adult comes in and speaks to me as a practitioner in family practice or anyone else and says, you know, I'm depressed. I'm thinking about suicide. My life isn't worth it. Uh, I'm not worth it to anyone. The world would be better off if I were not around. I'm ready to kill myself. Um, we wouldn't jump in and say, well, that's good for you. Let's support you in that. I know how I can help you to commit suicide. We don't do that. That's ridiculous. But by the same token, when someone comes in and says, you know, I was born in the wrong body. I feel like I am a girl, not a boy. I feel like I am. Um, I'm trapped in this situation. I want to become a girl. You know, we are, by the same token, we, we shouldn't wrap into that and say, it's just as much a delusion as feeling that the, that our, uh, uh, world would be better off if we're dead. It's a delusion. It's not based on fact that child is not, uh, born in the wrong body. Uh, scientifically, there's no way to ever change that. So instead of affirming their, their delusion or these feelings, we should be helping them to learn how to deal with reality and deal with life. Instead of saying, well, yeah, let's go ahead and let's cut off body parts. Let's go ahead and give you medications, let's, and tell. And in telling them, we're essentially telling them, yes, you're, you're, you really are a boy trapped in a girl's body, and we can help you. We can fix that. And that is a lie. We cannot fix that. You cannot convert a boy into a girl. You can change their sexual characteristics, but you can't change that. Uh, we should be helping them to realize what reality is and help them to deal with these feelings that they have and not lie to them.

Thank you, Mr. Chair. Thank you. Um, thanks.

Gail Ika with Utah Eagle Forum. Uh, it was about eight years ago that I, uh, started to learn about this and heard about it, but thinking, no, it can't be doing that in Utah. But then I looked into it and sure enough, so I made an appointment and went and met with, uh, then Ger, governor Herbert told him about it, and his response was, well, I'm glad we're not doing it in Utah. I shared with him the information from the gender clinics, and he could then see we were doing it here. He was very supportive in the idea of protecting children. It is all about protecting children. We're not gonna tell adults what to do, and they can do what they want, but you must protect the children. And so we, I started a journey there, there and here I am today. I started out by telling people about it. Some, believe me, some didn't. I did presentations, uh, around the state to various groups and invited me to come. I talked with legislators and found some legislators that were willing to help and even, uh, at one point had filed a bill, but those things didn't go. They were hard, hard at first. And then I was approached by, uh, re ship who said, Hey, I wanna do this. And I was so grateful. He and his wife actually came and talked with me, and we started this journey together. And it's taken a long time to get to this point where we are here now, here today asking for a complete ban on these procedures to children. And, and, and it's important that we, this, this ban it ends in the, in the date that's in the bill that says January of, uh, 2000 and, uh, 27 an extra year. We'll just make the children's suffer longer. And what would, why would we want to do that? We need to end it in 2 20 28.

I, uh, thank you Chair and members of the committee. Um, I want to be clear that any care someone, oh, tell us your name. Oh, sorry. My name is J Cilo District 23. Um, I want to be clear that any affirming care, any care, um, that someone receives for their gender is in fact gender affirming care. Um, I would urge you to look at all across the Pacific. I am the director of NUA Collective, which serves L-G-B-T-Q, native Hawaiian and Pacific Islanders, Samoan cultures. All Pacific cultures, Mexican cultures have always honored third and fourth genders. We serve our fafa f our mahu. And so I urge you to look into that. Uh, contrary to modern conservative propaganda, gender affirming surgeries for minors are exceptionally rare and are almost always performed by cisgender youth, not transgender youth. According to a study by the US Medical, um, or by the Journal of American Medical Association, another study by researchers at Harvard, TH Chan School of Public Health found little to no utilization of gender affirming surgeries by transgender and gender diverse minors in the us. The study also found that cisgender minors and adults had substantially higher utilization of gender affirming surgeries than their transgender counterparts. If we are going to ban this for trans kids, then why are we not banning this for all kids? Why are we coming at the 1%? Um, I urge you to reach out to me. I have plenty of friends who have detransition who are now protran, um, and who live in Utah and are not coming from other states and being paid to do so. Thank you. Thank you.

Delaine England. I'm representing United Women's Forum today, and I thank you so much, committee. Um, this is a very emotional decision and I ask you to make your decision based on the principle rather than the emotion. And I wanna ask you, why do you think that so many why this industry is targeting our children? Because almost all adults will overcome their gender dysphoria if they're given a chance to. Since when in the, in the medical profession and in therapy, medical therapy, do we as affirm someone's mental illness instead of treating the mental illness? We don't have someone that has, um, anorexia. We don't tell them, yes, you are fat and you should go on a diet. We treat them and we help them overcome it. That is what we do when we truly love someone and we have compassion for someone. This treatment is abusive, it's detrimental to children. And I don't know why we would consider extending the time before we help them get off. I consider it abusive and I think we need to end it as soon as possible. It is a most egregious medical scandal. The only reason to delay is to cover the revenue of the industry that is using and abusing our sacred and beautiful children. Please vote yes on this. Thank you so much. Thank

Hello State Committee. My name is Madam Alyssa. TI am a transgender utan that has been out since middle school. For those who haven't been able to know, that is eight years. I've been on HRT for about those same eight years as well. I understand that the sigma is that we will detransition in the sense of not knowing our true selves. I will go fully against that and say I'm eight years in running freely in the happiest being of my true self just because of this. I was in a very deep depressed state when I was in middle school and to the point where I did not understand myself fully. I did not wanna live as a man for it did not match me. And that might sound benign to you all, but for me, that is a very strong statement that would always sit with me. I could never fit in with any of the other boys. So instead, I did talk with my parents who supported me dearly. And I understood that this is not a thing that I would want to do eight years later. Now I'm going in strong and grand as ever. And I do wanna say this, we are all here. Ask for you to use your voice.

You. I ask along with the others in this room, to not pass this bill for it will limit the amount of young queer beings from living their true selves along with everyone else in this glorious state. Here in this room, there are beautiful beings that want to live and have families like you, Mr. Ship and you. Mr. McKay, who is not with us, lives with joy, love, and peace in Utah without fighting for our decency and humanity. We all want to be free deemed human in Utah. We all want to be free from fear in Utah. Utah is home. Please don't make it deemed not. Thank you. Thank you.

Hello. Hello. My name is Tina Horlocker. I live in Davis County. I'm representing myself. I, I want to just state that my heart goes out to these, these people who are here today and the struggles that they go through. And I don't in any way disregard their struggles. But even without the outstanding evidence that has been provided, the necessary outcome here is self-evident. The terrible harm that has been per perpetuated on a vulnerable population is no different than the experimentation and torture of mangola. During the Nazi regime, man is full of folly and error. Decisions must be based not on emotional manipulation, but on true creation principles and real science. We are sons and daughters of God. He does not make mistakes and God will not be mocked. Make this band permanent forever and without delay. Thank you.

Thank you. Hello. Hello. My name is Blair Simi. I represent myself and I've lived in Utah my entire life. I started transitioning when I was only 16 years old and I started HRT at the same age. I would not be where I am today if I did not transition. Transitioning truly saved my life. I never really felt like I fit in with anybody when I was a kid. And I really struggled with mental health. Um, but through transitioning, I have found community and love and so many people that do care for me and are willing to be there for me. And if you pass this bill, if you guys really care about saving children's lives, it just simply won't. Trans healthcare is lifesaving. So I urge you. Do not pass this bill. Thank you.

Maryanne Christensen, executive director of Utah Legislative Watch, and I'm here to speak in favor of the bill. I wanted to tell you, you about a story of a friend of mine. She's not able to be here to tell the story herself when she was a very young girl. She, her, her brother, um, accompanied her to go to use the bathroom at the park. And a gang of boys held him down and they took turns raping her. And she came out of that bathroom, determined that those kind of things don't happen to boys. They only happen to the little girls. And she decided she was a boy. She was born at a time when her mom took her to a psychotherapist and she got the help she needed. We live in a time where when people have those crises, those mental health crises, we stuff 'em in a pipeline to get 'em transgender trans, to give them transgender, uh, procedures. It's a sad place that we are at. We've been paving the road for these procedures in Utah for the last 10 years or so, and it's time for it to stop. I don't think that it's true that we can help people become happier by helping them to create a reality that really is not a reality. So thank you for voting for the bill.

Thank you. Hi, my name is Luca Copeland. Um, I am, I live in Utah my entire life, and I am voting to oppose this new amendment to the bill. I am the gs a president of Centerville Junior High, have been for two years, and I socially transitioned back in third grade or 2019. I've been on puberty blockers since 2022, and I've been on estrogen since 2024. These medications are lifesaving to so many transgender youth in this state. Without this access to this medication, I would not be here. Speaking to you to this day, if you were truly wanting to protect us, you would worry about the worst effect of not getting the resource we need. Suicide. Trans kids have a higher risk of suicide up to six times. A normal child does, and kids who commit suicide have a hundred percent mortality rate. How would I know this? One of my closest friends committed suicide back in October of 2025. Therefore, many reasons for her suicide, but one of the major ones was her lack of hair, healthcare, and the hate she gets from the world. If she was able to get the support and love she needed, she would be standing here right next to me. I had to talk to so many therapists, psychologists, and mental health professionals to get where I am to now. I did not just walk into a hospital and say, Hey, I'm a girl now, so please, I urge you to vote against this amendment for HB 1 74. If you truly wanna protect us children, because I'm currently only 14, yet, I could be dead if I was already able to have this medication.

Thank you, I appreciate that.

Hi, my name is Danny Bordeaux and I'm here representing the Coalition for the Preservation of Family Values. Um, I have worked in three different drug rehabs centers where the focus is primarily on mental health and getting health for mental health issues. And one of the things about suicide, as everyone has acknowledged, is that it's a multi, it's a multi-factor, uh, mental, mental issue. And that when someone is feeling suicidal or has depression or has any other symptoms, they do need help. One of the greatest things that we do in this, in this country is we try to protect our children and their, the gift of their body, that it can be preserved to do the things that it was created to do, including the joys of possibly becoming apparent some at some point in time and forming a family. And, and so that is something we want to provide for our children, is the protection that they will have that intact when they turn 18, and they at that point, can decide for themselves and not prior to that to remove that, that ability from them.

Thank you. Hello, Mr. Chair? Oh, is it on? Okay. Um, Mr. Chair, I'm Ann Bur. I'm the mother of a child who is grandfathered into the law, but denied care. I want you to listen to what they're saying in defense of this bill. Everyone who worked on the state report was biased but me. All the major medical organizations are biased, but Robert f Kennedy's report was not. The cash review provides guidelines for expanding capacity, beginning clinical research, and providing an individualized care model based on biocycle social mapping. But we're not gonna implement any of those recommendations, even though we're using caste to justify our rationale. And we're gonna ask you to meet the burden of proof while we shut down all research such that the, um, rationale for the law becomes the outcome of the law, which actually is, um, making an arbitrary and capricious statement. Cass and Sweden undeniably share state that the care can and will be beneficial to some minors. But we're just gonna focus on Missouri. Cass says, no formal science-based training in psychotherapy. Psychology or psychiatry teaches or advocates trying to change a minor's perception of who they are. But we're, we're gonna advocate for that. These kids just need therapy to accept themselves. Here is Cass's, the page from Cass, the CAS review. It says, there is a broad agreement that gender incongruence is a result of a complex interplay between biological, psychological, and social factors. And she advocates for bio-psychosocial mapping and individualized care.

Um, yeah, so I guess my thought is how are any of these statements that they're making indicative of a science of science centered neutrality? And if you're willing to take everything they're saying at face value without duly considering the counter evidence, which has not been able to be put forward here, how are you ensuring science based neutrality, particularly in a court of law, should someone choose to sue?

Thank you. My name is Jackie Smith. I'm representing myself. My husband spoke earlier as Dr. Smith. We have been involved in the medical world here in Utah for 35 plus years. And I would like to say that up until my time, the time that my husband was put on this committee, we had no idea that the University of Utah was on the cutting edge of minor transgender surgeries. And I would guarantee that the great majority of this state has no idea what is going on behind the scenes. We pay for these universities with our taxes. This state is one of the most conservative states in the union. We pay your salary with our taxes. You are here to represent the majority, not the vocal minority. And we are appalled that we were not the first state to pass legislation legislation against minor transitioning. It is not something that the great, great majority of the Utahans, uh, agree to. We do not, they don't even know that it is going on. And we are appalled when we find out. So please take this into consideration. This is not something that the minority gets to choose. This is a majority thing. This is a conservative state based on Christian values. And the last thing that we want is our children transgender. I am a double mastectomy can't breast cancer survivor, and the pain and the, and the, uh, uh, surgeries that I had to, um, go through to just get rid of the cancer. I cannot believe that any child could agree to a surgery like that. And the pain and the suffering that goes on is unbelievable. So please remember these things when you vote or for this bill.

Good afternoon, committee. My name is Cameron Fair. I'm representing myself. I'm a 20-year-old transgender woman who's lived in Utah my entire life. I'd like to bring up how this bill would repeal section 26 B dash one dash 2 39. A big point in the presentation was the lack of research and the lack of evidence. So it makes absolutely no sense to discontinue this study. Um, I would also like to bring up a peer reviewed study from the University of Stanford School of Medicine that found in individuals who started hormone therapy in early adolescents, saw a 220% decrease in severe psychological distress and a 135% decrease in suicidal ideation. I believe that each one of you values human lives just like me, which is why I'm urging every single one of you to vote no to this bill. Thank you so much.

Me, I live in Salt Lake, uh, county. I'm a licensed clinical social worker at the University of Utah in their transgender health program. I'm speaking as a private individual and not on behalf of the hospital or university. I'm the sole mental health provider within this program, and I've seen the impacts firsthand of what taking away access to healthcare has on patients. I have to assist in crisis work on a regular basis when they experience a loss of access to gender affirming care. And I treat not only gender dysphoria, but all co-occurring health mental disorders. And I say this not to cause fear, but as a reality that abruptly ending care for trans youth will cause an increase in depression, anxiety, and suicidal ideation. And a systemic review of 47 studies Researchers found significant improvements in all of these areas. The study done as a result of SB 16 in Utah found similar results. And even the CAS report mentioned earlier by Representative Shipp found that in three of four studies that, um, this care reduce suicidality and self-harm in youth. I can send you this data and information if you'd like, and the science is clear. Ending the course of treatment for youth already undergoing medical care would result in the adverse outcomes and increased mental health symptoms and suicidality. I encourage you all, at minimum, to allow youth receiving this care to continue working with their medical teams. At best, vote no. And at best vote no on this bill entirely. Um, ending this care would cause an undue burden not only to these families but our medical systems due to the increase in mental health symptoms and utilization of mental health and crisis resources. Thank you for your time.

Thank you, Mr. Chair and members of the committee. Um, my name is Catherine Dillon and I am a constituent of Senator Weiler. Uh, so I'm an Salt Lake County, and I'm the parent of a 16-year-old who will be directly impacted by HB 1 74. I am married to an award-winning scientist, and we need to take what has been said here today with a grain of salt, with the amount of biases from the doctors earlier. For over five years, I have been coming to this building and listening as harmful legisl legislation targeting families like mine is introduced again and again. Each time we are forced to defend our children and our parenting. And just because you do not understand our families does not mean that you have the right to step into our homes and make these decisions for us. Parenting is not a political theory. Theory, it is a lived experience. It is built on consultation with actual qualified medical professionals, guided by evidence-based care, not ID ideology or fear. And when politicians override parents and establish medical standards, that is not protection. It is government overreach. And to those who still hold faith in the constitution, this is about living up to it. To the parents watching this process, we must ban together. When the government claims authority over one family's medical decisions, it sets a precedence for every family. If this bill moves forward, please understand this, we will not disappear. We will organize and advocate, and we will pursue every lawful avenue available to protect our children. I know my words are futile here, but I urge you to reject HB 1 74. Um, our state has some of the best doctors, and I should not be planning out of state care from my

Okay. I will Please trust parents. Our children specifically. My daughter deserves better. Not one person here knows my daughter or how to best protect her. HB 1 74 protects no, no one. And Mr. Chair, I'm happy to answer any questions being that my daughter is actually gonna be affected by this and I don't know, um, that there's very many people here that, that are actually gonna be affected by this. So I'm happy to answer any questions. Thank you.

My name's Julie. I live in Box Elder County. I've lived in Utah for 32 years. I'm hoping that my case, uh, of my son will help the burden of proof for long-term evidence for the success of hormone treatment. Um, please oppose this bill. I'm speaking to you. You, because I'm a person that's taken many oaths, just as all of you have and desire. A safe place for transgender people of all ages to live and thrive. I'm a retired civil servant. I'm educated as a master of public administration. I'm a veteran. I'm a Christian. I believe in, uh, loving your neighbor as you would yourself. I am a mother of a 28-year-old transgender son who has always been transgender since he was a baby. Um, I love him and I believe he would steal your heart as well if you crossed paths. My son was born and raised in Utah, in a home focused on God and country. He's a good son, a good friend and educator, and he's a vested employee with all of you at the state of Utah. He earned his PhD last year along with somebody, King's Peak, and he's an active participant in our community. Thank God he transitioned to testosterone 10 years ago and he is living and thriving because of it. And I will always regret not getting him on it sooner because he almost died opposed this thing.

Tinley. You did it. Great job. Um, hi. I am Tinley Bean. I'm a resident of TWI County. I would like to oppose HB 1 74. I wanna address the claim that there is no evidence leaking, linking healthcare bans to suicide. We have robust peer-reviewed data showing a causal increase in suicide attempts up to 72% following the enactment of these specific bans. While a very small percentage of youth actually pursue medical care as minors, the mere existence of the option is what decreases suicidality. For many. Knowing that a professional medical path exists is a vital psychological safety net. When you remove the option, you remove hope and the data shows that that loss of hope, it has a body count. In Utah, we're only talking about around a hundred children. By passing this bill, you're overriding the expertise of medical professionals and the rights of parents. But beyond the numbers, I wanna address the perspective in the room most in this room with the responsibility to choose who can access healthcare and who cannot have no personal experience with these feelings. It is easy to legislate a one size fits all ban when you aren't the one living with the weight of the diagnosis or the fear of losing a child. I urge you to listen to the families and experts who do have this experience and who tell us that this he healthcare is lifesaving. Please vote no on HB 1 74. Thank you.

Yeah, I would move that we recommend favorably HB 1 74 for substitute.

I'm gonna make a substitute motion that we adopt amendment two in my name that would, um, push the ban back, uh, to, uh, by one year. I know we heard some public testimony against that. Um, and I, I, I'm bringing that because I know that there's been a concern about cutting off, um, potentially 17 year olds who began, um, treatment when they were 13. And, um, I believe that the amendment would, um, not force them to age out. Um, and it would prevent a situation where someone was a senior in high school and would have to stop treatment, and then as soon as they turned 18, they could start treatment again. Um, so, and I, and I'll note, I know that Representative Shipp does not support the amendment, so, um, is there any discussion to the substitute motion?

Yeah. Thank you, Mr. Chair. I'll be brief. Uh, as has been evidenced in our presentation, uh, transgender treatments, affirming care treatments are not what is best for these youth. We, uh, we all wanna protect our children. They can't really consent to something like they have no idea some of the things that they are, uh, not going to be able to experience. I have no problem, uh, Mr. Chair of, um, Minors being able to social transition where they're not damaging their bodies. What I do want to be able to do is there, is to be able to allow the time for these kids that are on them to taper off. That's why my bill has a one year period until next January. And I think we're always gonna run into the same issue that you're trying to avoid, because there's gonna be others that'll be on the treatments, uh, in 2028. So, uh, I just don't, I don't want to agree to continue to damage healthy bodies. This is a mental health condition and it's severe, and I know it needs treatment, but not to damage healthy bodies. Thank you.

Yes, I'd like to vote. Aye. Okay.

I'll, I'll renew the motion to recommend favorably HB 1 74 as amended for substitute.

Anyone else? I, I just want to say, I know that this is a, um, well, I just wanna say I, I believe every person, um, whether they're straight, cis, transgender, Daggett, transitioning, transitioning, I think every human being deserves to be treated with love and respect and to be recognized. Um, and although I'll be supporting the, the motion, one of the reasons I made the amendment, even though I was asked by a lot of people not to, is because I do believe, you know, if if parents and their children made a decision when they a child was 13, I, I don't, I, I'm not comfortable cutting off that care for a few months or, or even a year until they turn 18. So that's, that's why I brought the amendment. Um, but I, I also support the ban because I do believe that these are decisions that are best made by an adult. And I understand the, the data on the suicide rates. Um, I don't think it's as high as some of the public testimony said. I've researched that. Um, I don't deny that this is helpful for some people. Um, and what bothers me most about this ban is that wealthy families will take their children outta state and get the care and, and poor families won't. And I, I don't like that part of it. Um, but it, it is what it is.

Yeah, just, just briefly, Mr. Chair, we've, uh, we've had a lot of discussion here. Uh, I like the fact that we are, uh, making a moratorium permanent. Uh, I would rather have not had the second amendment there, as, as you understand why. And, and the main thing I wanna say at this point is, hey, we, we love our children. We want to protect them, and there's many things that we don't allow 'em to do in order to protect 'em. And I think this is one of the things that should fall into that category. So, thank you.

for their consideration. Madam Meeting Clerk Per substitute house Bill 1 74, sex characteristic change treatment amendments by Representative Shipp. This bill was heard in Health and Human Services with the vote of 11 3 0. Representative Shipp.

Thank you Mr. Speaker. SB 16 was enacted in January of 2023. It prohibited sex change surgeries on minors. There was a moratorium on hormonal transgender treatments that included puberty blockers and cross-sex hormones. Uh, there was an exception to the moratorium for minors that had been diagnosed with gender dysphoria before that date. That required also for the Department of Health and Human Services in Utah to conduct a systematic medical evidence review on providing these treatments so that they could report, uh, to the legislature as to how we should go about treating these individuals. Most of you here understand what these treatments do to the body. Puberty blockers disrupt normal development of bone and brain tissues that depend upon normal sex hormone levels, causes chronic bone and joint pains. It impairs development of neurocognitive functions and upending it upends development of normal sexual functioning, impairing ability to establish healthy, intimate marital relations, cross-ex hormones, often per or often permanent and cause irreversible infertility or sterility, especially after the use, uh, after puberty blockers. It increases risk for heart attack, stroke, pulmonary embolism, and so on. And also, there's incomplete external male genitalia development if used after puberty blockers and reduction in bone density for females. It, it's causes osteoporosis. So the purpose of HB 1 74 is to make the moratorium, the moratorium permanent and also for the use still receiving cross-sex homers, uh, cross-sex hormones under the grandfather clause. It requires them to be terminated by January 28th, 2027, basically approximately a year from now, which would've been four years from the SB sixteens enactment, excuse me, how rapidly the youth come, come off the, these hormones will be decided by the youth, their physician, and their parents, but it all needs to be completed by a year from now. So this, the need for this bill is also heightened by the DE Department of Health and Human Services report. SB sixteens required a systematic medical review when this report came out, which includes an evidence of synthesis of the information collected. So I had delivered to everybody here in the house. Uh, a paper that you probably haven't had time to look at, but it gets into the details of why this report done by the department of, uh, Utah Department of Health and Human Services is a flawed report, uh, with significant bias. Some of the most glaring problems are the fact that it did not do a systematic review, which is of the highest order of a assist of, of, uh, scientific study. So, uh, the report simply ignores the most recent and thorough systematic reviews. The uk uh, had a report called the CAS Review that did it, which was a systematic review and was very detailed. Uh, the US Department of Health and Human Services also reviewed and did an umbrella report on this very report and they con, uh, concurred with the report. So the report has displayed serious bias. Uh, and finally, there are some groups also, including the DO No Harm Group, uh, also did a detailed analysis of the DHSS report. So what kind of care do these youth need? Gender euphoria. Euphoria is a mental health problem. Distress is real and often is excruciating for these youth. These young people need and deserve compassionate care. No blood test or MRI can diagnose a transgender identity. Nothing medically wrong with physically healthy bodies of children. Youth who report gender distress or identify as transgender mental health professionals'. Job is to help people adjust to reality, not avoid it. Instead of encouraging young people to reject their bodies, we need to help them reconcile distressed emotional feelings with what their body is. So we also need to help them address the serious psychological comorbidities that accompany gender confusion. So we treat mental and emotional disorders with mental and emotional interventions. Damaging physically healthy bodies in an effort to escape reality is opposite of what emotionally confused youth needs. So in conclusion, we need HB 1 74 to protect our youth. We already protect our youth in other matters and require them to wait till they're adults. And so with that, Mr. Speaker, I'm open to questions.

Thank you, Mr. Speaker. I appreciate the opportunity to provide some scientific rebuttals to the information that has been provided. Um, to start with colleagues, I, I wanna talk about this because I know that there is a tendency to say that I can vote for this bill because the science is behind it, and I'm here to tell you why it is not. The data that has been presented in support of this bill does many things. It utilizes selective data, citation and cherry picking, misrepresentation of systematic reviews, false claims about scientific consensus, inconsistent evidentiary standards, out of context statistics, causal inference errors and dismissal of conflicting evidence. That last one is really important. I'll come back to that. Some of the background claims on the analysis in support of this bill characterize studies supporting gender transition care as being flawed, but without providing any specific methodological critiques, it makes sweeping accusations without providing the, these critiques and sets up a dismissal of evidence that contradicts positions without engaging actual findings. Using anecdotal single patient encounter as a foundation for expertise is extremely flawed on the part of healthcare providers that stand themselves up As experts in this field, witnesses have claim, have, have themselves admitted complete naivete about transgender care at the time of encounters, encounters with patients and claiming extensive studies transforms them into a subspecialty without citing any formal training. Further, there was no recognition of peer reviewed publications that challenged assumptions that were made. And that is a grave error on the part of any scientific claims. Misre further misrepresenting low certainty as evidence of harm is insufficient for making definitive decisions about something like this. All of the studies that are, that occur in all of all areas of studies that occur in science, there will be a range of findings ranging from low certainty to higher certainty with statistical analysis attached to them, selecting only those papers and studies that show low certainty does not say that harm was inflicted. It just says that more study needs to be conducted. Failing to acknowledge that le that low certainty evidence is also critically something that should be noted for all pediatric studies. This is one of the critical things that we don't, many don't understand about studies in pediatric medicine. When you do a randomized controlled trial, it is very, very hard to do that on children because it is considered unethical to do studies on children. That goes for every area of medicine and it's a double standard. And it's complicated because on the one hand, it's hard to imagine putting children and into an experiment. But on the other hand, not conducting studies on children means that we don't have certainty and data on how healthcare will impact children. And therefore many healthcare providers find it very challenging to know exactly what those results will be. This area of study is no different. Finally, another issue, the CAS review, which was po which was noted several times, um, by witnesses and is actually referenced in the paper that was provided by the sponsor itself, notes evidence, limitations, but does not recommend blanket bands for this care. Um, ano a red, a critical red flag is, is also when you're calling well-designed systematic reviews as flawed and bias without providing specific methodological critiques, without providing alternative analysis and without providing peer reviewed rebuttals. Another false claim that European countries have banned this care that is not true. Countries like Sweden, Finland, and the UK all still allow treatment, but in a very limited controlled, in restricted clinical pathways, they do not have total bans. Detransition rate claims also has been fair, falsely represented, citing high detransition rates from specific studies. The problem is only a handful of cherry pick studies about detransition rates have been presented as evidence. Also, these, uh, rate claims ignore things. Um, um, confounding factors like social stigma that is attached with being a transgender individual in our community. Surgical complications that are unrelated to gender identity and economic factors misrepresenting higher suicide rates as associated only with this care is also not represent, is not also not representative of the data that is available. In fact, most suicide claims are attributed to instead of attributing it to treatment, it should be attributed to discrimination due to lack of support, um, ignoring protective effects that family acceptance and gender affirming care creates. And again, cherry picking studies that show no change while showing, while also ignoring those that show benefit. Causal reversal is another problem, which suggests that treatment causes the crisis rather than the crisis necessitating necessitating the treatment. Suicidality is highest when youth face rejection and lack of access to their healthcare. Finally, false equivalents in cherry picking, and I'm gonna come back to this again. This study cited here showing no benefit sites at best two studies ignoring all the other meta-analyses that have been presented and treating all evidence as equally weighted regardless of sample size, study design, quality publication, be venue and replicability. Further opinion pieces put up as evidence of scientific study is a really, really big red flag in science. So finally, Mr. Speaker, I'll conclude by saying that there are some critical context that have been omitted regret rates, transgender surgery regret rate. And this is for adults, but it, I think it, it it could be broadly or generally applied surgery Regret for transgender adults is between 0.5 and 4%. General surgery regret across the population is as high as 17%. So why are we holding trans healthcare to a higher standard risk benefit Comparison risks, risk intervention versus risk of no intervention. Mental health outcomes versus, um, health outcomes with support and also colleagues. A counterfactual is not a neutral outcome. Untreated dysphoria has documented harms certainty. Comparisons are should also create a level of concern when you're looking at whether or not your scientific claims, um, support your cl uh, support the data or support the reasoning for this bill. As I mentioned earlier, most pediatric medicine lacks randomized control trial level evidence. Why would we hold these, um, the standard of care to a different level than virtually all medicine when it comes to research for children? Um, for those reasons and many Mr. Call, Mr. Speaker. Um I certainly believe that a moral argument should be made for this. And denying healthcare to a ca a a very marginalized at risk population of children is always going to be a mistake. My views on that have been clear, but I also am really, really distressed that we've allowed bad science to be reasoning for bad legislation. I would urge a no vote.

Thank, thank you, Mr. Speaker. Mr. Speaker. This is, uh, my fourth session in the body, and I've had the opportunity to hear a lot of debate, uh, in our state and in this body about these very unique challenges of our time. Something that's been evident to me throughout these conversations is we've gotta do better as a state, as the human race to better understand one another, and I think that that's something that we can all commit ourselves to. I appreciate the good, uh, representative, my good colleague from Salt Lake City, and my good colleague from Iron County for sharing. I think what we're all trying to do, which is find the right balance here, but Mr. Speaker, the reason I'll be supporting this bill is, is quite simple. That wherever you stand on the long-term impacts and, and different pieces of the puzzle here, I think we can all agree that these types of, of surgery, surgical procedures and these types of, uh, chemicals and hormones are very, very powerful and very, very serious. And those are things that I would venture to say Mr. Speaker are almost too serious for the fact of informed consent for individuals as young as 13 years old. And so I'll be supporting this bill, Mr. Speaker, because I think it's important that we, we approach this with care and with co, with with caution, recognizing that the magnitude of these types of decisions will have impacts for 10, 20, 30 years down the road. And it's important that individuals make these decisions when they're adults. Thank you, Mr. Speaker.

Mr. Speaker I'd call previous question.

Thank you, Mr. Speaker. Uh, the only thing I want to add to that is the fact that these kids do need care. It's a mental health condition. We shouldn't be damaging healthy bodies. We need to give them proper mental health help so that they can deal with the reality of, of what their biological sex is and when they become adults, they can do what they want from that point. But as minors, we already protect our kids from doing certain things. Smoking, drinking, driving. These are things that we do and we do it to protect our, our, our kids and our minors, uh, because they shouldn't be able be put in a situation to make life altering decisions because this will last their whole life. These, these, uh, what happens with their bodies with this. So with that, Mr. Speaker, appreciate the opportunity to pre present this.

Thank you Mr. President. First substitute Senate Bill, or sorry. So first substitute House Bill 1 74. This is, uh, an extension of the policy that we've dealt with over the last few years, uh, related to, uh, you know, healthcare providers that provide hormonal and transgender treatment for minors. Uh, and what this does is, uh, after amendments by committee, uh, it makes it so that, uh, there will be a, um, that there will be a discontinuation of that treatment from January 28th, 2027, uh, from here on out. And with that, uh, basically we'll take the, uh, the effort to ban that we had a couple years ago, uh, and move it forward, uh, a little bit after recent court decisions. Uh, that was the dec, the decided direction that Mr. President, I'm happy to yield to questions.

Senator McKay, will you yield? Yes, Go ahead, Senator Winterton. Okay. Um, it's a pretty simple bill, but, uh, can you tell me, is the year gonna make it a difference if we set this back another year? Or is that leaving the, opening a window for more to still get into the program when we cut it off?

McCay, go Ahead. Yeah, thank you for that question. No, it doesn't open the window for more to, uh, for more people to get that, uh, for that type of healthcare.

You. I, um, I rise and supported the amended bill. Um, we, uh, we had adopted an amendment that I proposed in committee, and the purpose of that was to, um, really respect the, um, the what we, the policy we enacted with Senator Kennedy's bill a couple years ago that we weren't going to disrupt the treatment for those that had already started. So my concern with the original bill was we could have some 17 year olds who were forced to detransition, and then as soon as they turned 18, they could retransmission. So that's why I pushed it back a year. But I really don't see this bill as a change of policy. I think this is a con continuation of the policy that we adopted before. But I do think, you know, to be transparent, instead of having a a temporary moratorium, we ought to express what the policy of the state is. And, and that's the reason for the ban and for, for the pushing it back a year. So I'm, I'm very comfortable where the bill is. And I just also wanna say, um, I think everyone in our society, including our, uh, transgender youth constituents, deserve to be treated with love and respect. I understand this bill's not necessarily what they want, but I do think that by allowing those who with their parents may have started this as early as 13 to be able to continue until they're 18, I I do think that that shows, um, some respect for parental rights and some respect for medical decisions. I know everybody won't agree that this is good medical treatment, uh, but that's kind of where I landed, uh, where, where I landed. So I'm gonna be voting I on the bills. It's presently constituted. Thank you.

Uh, thank you Mr. President and, and to the body. I think, um, there's a, a, a few things. I I really do feel obligated to get on the record as part of this discussion. Um, uh, my very first committee hearing ever here elected as a senator was in the committee hearing with Dr slash Senator Kennedy when we had the conversations about this. And, um, I understood and now still understand where his mind processing was about that. And I also appreciated the thought that went into it to try to protect the care options for the folks who were in the midst of care watching over the last couple of years. Uh, uh, and I watched as well, when the study that we asked to be commissioned, um, was commissioned, and I actually have not been able to read the full 1000 pages. Some of us are better readers than others, but, uh, in the pieces that I focused on, which are those around data and evidence-based care, I want to commend the people who worked so hard on that study. I know that there were, um, some semi harsh words spoken in committees that they weren't there to refute. And I, I wanted to speak to the hard work that the people put into that study and hours and hours that they put in, in trying to inform us as a body. I don't know how to speak as a mom or as a doc or as a senator in this moment, but I just really would like to convey to the folks who are impacted by this that I know it's been so hard to feel unheard and to feel unloved and to feel uncared for. And if there's any way that I can convey onto those people who are feeling othered by this, that please let me assure you, you still are so treasured. You still are so loved, you are so adored, you and your family. And, um, I, I see the writing on the wall, but I need them to know that from I think my heart and other hearts in this room, we still treasure and love you that I will be a no

Thank you Mr. President. Um, this is, um, this procedure is something that I'm confused by I don't understand sometimes. And, um, I act cautiously when I don't understand something. And I have family friends who have come to me and said, without this type of treatment, my child would've committed suicide. And so I find it hard for us to make decisions about other people's kids and about other people's welfare. Uh, I I never met somebody that transitioned growing up, but in my last recent years, I've met numerous people who have transitioned and their lives have been so much more enriched and they've been so much happier and I've actually seen them change. And so, uh, as, as a mom speaking to another mom says that this is something that saved their kids' life, I cannot say with all certainty that I would not have done the same thing for my kids. So I am a no Thank you.

Summation and a motion. Thank You President. I'll move that. Uh, Senate bill, or sorry, house Bill 1 74. Be read for a third time.

Yes. So, um, we met with, uh, you know, we met with people. We've working with lots of different people to make sure that the bill accomplishes the sponsor's objectives and at the same time isn't retroactive and doesn't put anybody in a position where they have to stop taking, um, you know, uh, hormone blockers or taking, um, you know, other sex therapies, uh, as a result of the bill, uh, and not make it backward looking. And so what we've done, uh, is we've refined the dates in the second substitute to make it such that from the effective date of the bill, uh, no new people will be added, but that people that are, uh, that are 16 after the, or, you know, before the effective date of the bill, can then continue through their treatment so that that isn't interrupted by, uh, by this bill.

Thank you very much. Um, we, you know, discussed this bill earlier this week, and, uh, I think what this will effectively do is it will take, um, what we had in statute before and effectively draw a brighter line for when the ban takes place, uh, as it, uh, relates to hor hormonal transgender treatments for minors, uh, and discontinue that practice. Uh, with that, Mr. President, I'm happy to yield the questions.

You know, I, I don't know. You, You're right. Pardon me. You're right. So, So why don't I circle it again?

I'll make a motion to circle and we'll catch up the fiscal note and probably run it tomorrow. How's

Yes. Thank you. Uh, let's see.

Thanks, president. The, uh, fiscal note caught up with the substitute that we debated last night, and so, uh, figured we'd, uh, try to move it on from third. Um, but as a reminder, uh, this sets on line 44. It sets up again on, depending on January 28th, 2027, seven, healthcare provider may not provide a hormonal transgender treatment to a patient who is a minor patient, minor, if the patient would be younger than 16 years old of the, as of the effective of the date of this bill, or has not received any cross-sex hormones as of the effective date of this bill. So it will make it so that those who are, you know, gonna be over the age of 16, they will be able to continue, uh, on their, uh, on their medical, with their medical treatment. And those that are, uh, that haven't begun as of the effective date of this bill and haven't started a treatment that they can then, uh, also, um, that they won't be able to start as of the effective date of this bill that Mr. President, happy to yield for questions if there'd be. Thank you. Uh, looking for question, additional discussion of the bill.

Thank you, Mr. President. Um, this is an interesting bill for me to have run through the mental gymnastics on because I actually personally and as a physician, believe that gender related care is essential care, all of it. And it's, it's such a challenge to try to figure out how we negotiate the spaces where we as policy makers interact with the communities and those who also in, in ga enact engage in care spaces. I think, um, I I just want to say one more time, um, that the moratorium that was put in place by the former Senator Kennedy and the study that was done as of a part of it, informed us greatly. And it does bother me a bit that this policy goes directly against that. Um, I, I hope that as we move forward in these spaces, that we will be mindful and thoughtful about when we ask for studies. Are we asking for them to actually educate and inform us or is it for something else? So maybe just tuck that away in our brains that when we ask for studies, they, they often are good to inform us. So the, the dialogues will go on and I thank you for the opportunity to speak. Thank you.

Sponsor yield. Senator McKay, will you yield? Yes.

Yes. Yeah. Just a, a question to clarification really. Um, you know, I'm looking at the per provision where the, if they're 16 at the time of the signing of the, of the bill, and then those others that aren't, if there's some there, then how long of a ramp at ramp down do they have?

Thank you. They'll have a year.

Would it be a year from that point or was there a specific date?

Help me clarify. Which group are you talking about? I apologize. So

I'm talking about the ones that are at the time of signing.

Sorry, Mr. President. I, sorry, I should have waited. Go ahead. Uh, the time of signing of the bill then those that are 16, if I understand it correctly, and help me, if I'm not, if they're 16 at the time, then, then they can continue on until they finish their treatment. Those that are younger than 16 would have to ramp down over a certain number of months. I just wanted to clarify how long a period that was.

Yeah, thank you. I'm just looking for the language in the bill to remind myself. I'm sorry. Maybe if I could rephrase the questions having talked to the originating sponsor, if I understand it correctly. Oh, go ahead, Senator. They would have until January, the January 1st, 2027, January 28th.

that's in the, uh, that's okay. Now I better understand your question as of Yeah, January 28th, 2027.

Okay, so they have a few months, I guess, essentially

Nine, yeah, ish.

Yeah, and I, I, I, I understand where we're at on it. I, I, I have to admit, I wish the the ramp down was, was longer, but I, I'll support the bill, but I just wish, I would wish that the ramp down was a little longer for those, and I don't know how many there are, to be honest with you. I really don't. But, uh, there are gonna be some kids that get caught in that. So I, I was, I wish that the ramp down was a little longer, but I, I certainly do support the bill. Thanks. Thank You. Thank you.

I don't see any further discussion, so I'm gonna go to you for a motion. Thank you very much. Uh, I'll waive summation to move that, uh, second substitute house bill 1 74 pass.

Thank you. Uh, I can't help but point out the irony of, of where we are right now. So recently, just a couple days ago, this body voted to remove the Universal Declaration of Human Rights from parts of our curriculum. Uh, it's a document affirming basic human dignity, the right to security in one's person. And today, uh, we are debating whether the government should step in and block families from accessing medically recognized care. I think that contrast should give us pause. Um, this legislature has said repeatedly that government should be limited, uh, that it should not overreach, that we should defer to science, to experts, to individual freedom. Uh, we've passed laws preventing our environmental regulators from going beyond federal minimum protections. Uh, and the argument was that government shouldn't take a heavy hand, that it shouldn't go further than necessary. And, and yet here we are, uh, I feel like doing exactly the opposite of that. So this bill inserts the legislature, uh, directly into private medical decisions. It overrides doctors, it overrides parents, uh, and it overrides patients. Um, every major medical authority, the American Academy of Pediatrics, the American Medical Association, uh, and the Endocrine Society recognizes that gender affirming care when delivered under established clinical standards is evidence-based. So, uh, this body, as we just heard, directed an exhaustive study on the effects of gender affirming care for minors. Um, the study was completed, reviewed findings were presented, and yet this bill completely ignores the research that was done. So families, doctors, and the evidence were all set aside in favor of ideology. Instead of trusting families and doctors, uh, this bill bans that care the families with means will leave the state to access care. Uh, others will be forced to delay care or worse turn to unsafe unregulated alternatives. Um, that doesn't protect anyone. It, it just creates more risk. Uh, and frankly, I'm, I'm kind of ashamed by the University of Utah leadership who preemptively complied with the provisions of this bill. So if we truly believe in, in limited government, uh, in science and freedom, those principles need to apply consistently. Government should not be stepping into exam rooms or making deeply personal decisions on behalf of families. We cannot claim to believe in life, liberty, and the pursuit of happiness while denying families the freedom to access medically recognized care. No.

Second Substitute house bill 1 74. Sex characteristic change treatment amendments by Representative Shipp.

Yeah. Thank you Mr. Speaker. I, I move to concur with the Senate amendments.

Uh, yes. Mr. Speaker. Uh, when we passed, uh, HB 1 74 on this floor, it allowed for, uh, transgender hor for hormones and puberty blockers to continue until January 28th, 2027, which is basically one year. What changed in the Senate was, uh, when the bail goes into effect, which will go into effect when the governor signs it. Uh, anybody that has is 16 or older at that time can continue with the, with the hormones and blockers. Uh, anybody else that's under 16, uh, has to taper off of hormones and blockers, uh, by January 28th, 2027. And that's the changes.

Yes. Uh, just need 50 votes, uh, so that it can have an immediate effective date of the bill.

Uh, yeah, Mr. Speaker, we, we passed this this morning, 48 votes where a lot of people are off the floor like to get 50 votes so we can get this on the, uh, uh, effective immediate, immediate effective date. And so, uh, that's, that's the request. Thank you.