Gender-affirming medical care is once again up for debate in the Utah legislature. Rep. Rex Shipp, R-Cedar City, has reintroduced a bill, HB 127, that would prevent transgender and nonbinary youth from accessing gender-affirming medical care. It’s been assigned to the House Health and Human Services Committee but hasn’t had a hearing yet. The bill died last year, but Shipp revived it for the 2022 legislative session. The push comes despite scientific organizations like the Endocrine Society condemning legislation that restricts this kind of care.
The society’s condemnation is based on mounting evidence that treatments like puberty blockers significantly decrease suicidal ideation among transgender youth — and it follows a 2020 survey by LGBTQ advocacy group the Trevor Project that showed more than half of transgender and nonbinary youth said they’d seriously considered committing suicide in the past year.
Candice Metzler, executive director of Transgender Education Advocates of Utah, a licensed clinical social worker and veteran advocate and therapist for LGBTQ+ youth joined Pamela McCall to discuss the debate over gender-affirming medical care and their own transition.
Warning: This interview contains discussion of suicide. If you or anyone you know is struggling with suicidal thoughts, help is available through the National Suicide Hotline at 800-273-8255.
This interview has been edited for length and clarity.
Pamela McCall: Tell us about your personal experience. What did you go through?
Candice Metzler: People often ask, when did you know. Well, there was no point where I really knew. There was knowing that I was different and that no matter how much I tried to make it go away, I never really found a way to do that, that this always was part of me.
PM: Make what go away?
CM: Who I am. I think that's really at the heart of this. There was a part of me crying to be recognized. There was a point in my life where I had a profound sense that I could live and die, and the people around me would never know who I was.
PM: Tell us a bit about your transition.
CM: So I was assigned a male sex at birth and I identify as nonbinary, now more than I used to. But I transitioned to female, if you will. That's the closest thing, at least socially, that we have to describe my gender. So my transition was really a turbulent time for me. I ended up in a very dark place with losing my job, having to separate from my family for a period of time, and becoming homeless. I was not able to continue on as a home inspector after I came out. And so when I started school at the University of Utah, I was sleeping on the streets of Salt Lake City.
PM: Why did you lose your job?
CM: I lost my job when people started finding out about my transition, people stopped using our inspection company.
PM: What year would that have been?
CM: That was 2007. That was a really turbulent year for me. I lost my father that year. I was disinherited that year. I became homeless that year, lost my transportation because I couldn't keep up with the loan payments and things like that. So it was a downhill slide. And at the end of it, I traveled to Colorado to have reassignment surgery, and I would say it saved my life. I can tell you when I lost my insurance and I had waited for over a year, I climbed up a 280-foot cliff with no ropes and sat at the top for a couple of hours and questioned how I was going to jump off. And ultimately, I thought of my children. I could not leave them that way. I made the decision to climb down off of that cliff and that I would never be silenced. That I would speak up on this issue, and I have ever since then.
PM: If you'd had access to gender-affirming treatment when you were younger, how would that have changed things?
CM: I certainly would have avoided several close calls with suicide if I would have had that kind of support and access when I was younger.
PM: What are some of the current gender-affirming treatments that trans and nonbinary minors can access?
CM: We often focus on the medical, but an intervention is choosing a name that affirms your sense of self. When we work with people, we try to move from things that are maybe less permanent to things that will have more permanence and more consequences. We look at puberty as a time that we see a lot of people recognizing their distress around their gender, and so puberty blockers can buy that time. If people have been on that and it's been helping them, when they get to around 16 years of age, that's usually an important time to switch people over to something like hormone replacement therapy. Those are things that can help and often do decrease some of what is described as gender dysphoria.
PM: The World Professional Association for Transgender Health released new draft health guidance in December. It says transgender youth should have questioned their gender identity for several years and get a comprehensive assessment by a mental health professional before receiving gender-affirming drugs or surgery. Some experts praised the guidance, but others said it creates unnecessary barriers. What do you think the process should be for young people who want to transition?
CM: These protocols need to be in place to help ensure that we are making the best decisions to help our clients achieve the goals that they're setting for themselves. And it's always been important for my clients to understand the risks that they're taking.
PM: In the hearing in the legislature last year, bill sponsor Rep. Rex Shipp said 80% to 90% of kids who say they're transgender change their minds when they grow up, among other claims. He said, “Puberty blockers and cross-sex hormones are harmful and cause permanent, irreversible damage in these kids.” How do you respond to that?
CM: It's like any body of research. You can usually go out there and find research to hold your point. But I think in terms of peer-reviewed research, some people do change their mind in terms of medical transition, but it's, to my understanding, fairly rare. And usually, we're talking about puberty blockers, which the literature that I've seen suggests that if you stop taking puberty blockers, you essentially go through puberty at that point.
PM: My understanding is that 86% of LGBTQ+ youth said recent politics have negatively impacted their well-being. What effect does this kind of public debate have on transgender and gender non-conforming youth?
CM: It would make sense that young people would feel in the spotlight. All of us have been under a lot of pressure with this pandemic. I can't imagine a worse time to put this much pressure on these young people. For our politicians, at a time where we're already calling out the government on making forced medical decisions on behalf of the American people. Maybe people can identify with how frustrating it is to have the government getting involved, standing in between parents, a doctor and their child. We, as a society, need to stand up and say our youth are not political pawns.
