NC trans sports ban and limits on gender-affirming care for minors pass into law
North Carolina’s lawmakers gave final approval to contentious proposals that affect transgender athletes and children, passing them into law and making them effective immediately.
One bill prohibits transgender girls and women from competing on most middle school, high school and college sports teams that align with their gender identity. The other bill bans gender-transition surgery for transgender children and forbids providing puberty blockers and hormones to minors.
While those in favor say the bills protect women and children, detractors say they are unnecessary and harm the LGBTQ+ community.
These new laws replicate national trends in Republican-led legislatures, with over 20 states having introduced similar transgender sports bans this year. Meanwhile, 17 states during their most recent legislative sessions passed restrictions on medical care for transgender people, according to The New York Times.
Both bills were brought to the table in the House in early April. They then passed both Republican-led legislative chambers by late June but were blocked by Democratic Gov. Roy Cooper.
In his veto message, Cooper said these bills, as well as a bill also passed into law Wednesday which limits instruction on gender identity in elementary schools, were harmful to vulnerable children, represented government intrusion and damaged the state’s reputation and economy.
On Wednesday, the House was first to override Cooper’s veto, with the Senate following later that evening. Both chambers have a Republican supermajority and voted on largely partisan splits, with all Republicans in favor. The supermajority gained this year allowed Republicans to push these bills with little fear of failure, with Cooper’s veto power essentially killed.
Both exceptions to the party-line votes were Democrats, with state Rep. Michael Wray of Halifax County and Rep. Garland Pierce of Scotland County voting in favor of both bills.
After Wednesday’s vote, Pierce told The News & Observer that between voting against both bills when they were before the House in June and voting to override the governor’s veto now, he spoke with constituents in his district who felt differently about these issues, particularly whether transgender athletes should be allowed to play on women’s sports teams, compared to the rest of his party.
“I was surprised by some of the folks who did not support the position of the Democrats on that bill,” Pierce said. “Very surprised. And some of these were Democrats.”
Transgender sports bill
The transgender sports bill, dubbed the Fairness In Women’s Sports Act, prohibits “students of the male sex” from playing on all “athletic teams designated for females, women or girls.” It at first applied to all public and some private middle and high schools. But following various committee hearings, the version passed also applies to all public and some private colleges and universities, those whose teams are a part of an “intercollegiate athletic program,” like the NCAA.
The North Carolina High School Athletic Association, which governs high school athletics in the state, has a policy allowing transgender athletes to play sports based on their gender identity after filling out a form. A committee reviews the form and other required documents and approves it if it finds that the “student genuinely identifies as the gender indicated in the request.”
The NCHSAA would remove that policy to comply with the law, said Brandon Moree, spokesperson for the association. He said in an email that the association “aims to support all student athletes and would prefer there be as few barriers to participation in education-based athletics as possible.”
Since the gender waiver request policy began in the 2019-20 school year, the NCHSAA has received 18 requests, Moree said. Of those, Moree said 16 were approved and 14 of those were transgender boys requesting to participate in male sports. The association does not track whether those student athletes made a team, he said. On average, since 2019, there have been about 175,000 student-athletes under the NCHSAA.
Sen. Vickie Sawyer, a Republican from Mooresville, has cited instances of women losing while competing against transgender females, as previously reported by The News & Observer. She said Wednesday that the state “must move to protect women and women’s sports.”
Democratic Sen. Julie Mayfield said Wednesday that the bill was an “unwarranted attack on transgender youth” that will make “vulnerable young people feel even more different than they already do.”
As “an outright ban on transgender girls and women participating in sports from middle school through college,” the bill “uses a sledgehammer when a scalpel is more appropriate,” she said.
Hazel Havens, who was watching the House debate from outside the gallery above lawmakers, said they were there to show lawmakers that there “are people that are watching that care about trans youth, that want them to continue to live and be able to be who they are.”
The sports bill, they said, “applied a blanket to a lot of situations that are more complicated,” with the bill affecting small children who may “just want to play sports with their friends.”
Gender-affirming care
The ban on certain gender-affirming care was no less contentious. This new law penalizes doctors who perform the treatments by revoking their medical licenses. It has exceptions for diagnosed sexual development disorder, for the treatment of infections and more.
Sponsors and those in favor of the legislation have argued that the bill protects children, saying that many who have undergone surgeries have regretted it. Meanwhile doctors, transgender kids and parents of trans kids who have gone to the General Assembly to speak out against the bill have said the bill is not about protection but control. They also said the bill would cause harm and would increase suicide risk for trans youth.
Sen. Joyce Krawiec, a Republican from Forsyth County, said Wednesday that state government “has an interest in protecting our children from long-term harm. That’s what this bill is all about.”
Sen. Lisa Grafstein, a Wake County Democrat, parried back that the bill “injects raw politics into these intimate, personal and family medical decisions.” After Grafstein’s comments were briefly cut short by another senator, a smattering of people in the gallery burst out shouting against the bill.
Niamh Crotty, who was watching debate from the gallery, said she was at the legislature because she has a daughter who is transgender “and I want her to have the same rights that my other two daughters who are cisgender have.”
“We have made all of our decisions for her health in coordination with many doctors and many therapists, and we are following what the American Academy of Pediatrics says to do. Without this health care, she would not be here. And that’s not hyperbole. She literally would not be here,” Crotty said.
She said getting this care for her child has not been easy, with “forms that have to be filled out, there’s insurance hoops to jump through,” and approval by multiple therapists required, she said.
A 2023 report by the Substance Abuse and Mental Health Services Administration found that trans youth thrive if they are supported and affirmed. Meanwhile, rejection, discrimination and bullying has led to a nationwide mental health crisis for trans youth, further exacerbated by “policies that seek to restrict their access to appropriate health care and inclusion at school,” says the report.
Major North Carolina hospital systems such as Duke Health, UNC Health and ECU Health provide gender affirming care but rarely or never conduct surgeries on minors.
▪ Duke Health had said earlier this year that hormone therapy was not provided to children prior to puberty and that gender-affirming surgeries were “except in exceedingly rare circumstances, only performed after age 18.” After the bill passed into law, Duke Health said that it would comply with new laws. The health system is proud of its “high-quality, compassionate, and evidence-based gender care,” which “is age-appropriate and adheres to national and international guidelines,” Duke Health officials wrote in a statement Thursday.
▪ Brian Wudkwych with ECU Health said in an email prior to the bill becoming law that “gender affirming primary care includes important services like mental health care, nutrition and social work,” and that they do not offer gender affirming surgery to minors. Puberty blockers are not offered and hormone therapy is only offered after puberty and in limited cases, he wrote.
▪ Alan Wolf with UNC Health wrote prior to the bill becoming law that they provide “age-appropriate, gender-affirming care to our patients and families based on national guidelines and standards of care. That includes behavioral health support.” He said that did not include surgical procedures on minors.
This story was originally published August 16, 2023 at 7:01 PM with the headline "NC trans sports ban and limits on gender-affirming care for minors pass into law."
