This story originally published online at NC Health News.
Orange County mother Katie Jenifer, like all parents, has always wanted her two children to be happy and healthy.
She said it hasn’t been easy, especially of late, given the large number of bills targeting transgender people that lawmakers have recently introduced in North Carolina and beyond.
In 2023, 497 bills have already been introduced in 49 states — including North Carolina — that erode student confidentiality with school personnel and seek to restrict trans people from receiving gender-affirming care and participating in sports that align with gender identity. This year, just through April, already marks the fourth consecutive record-breaking year for the number of anti-trans bills considered in the United States, according to Trans Legislation Tracker.
Jenifer’s daughter Maddie, 15, is transgender. She transitioned nearly 10 years ago — first socially at the age of 6, and later when she received gender-affirming care, including puberty blockers, at Duke’s Child and Adolescent Gender Care Clinic. The clinic provides care to transgender youth across the state.
“The thing that her dad and I have always said since the day she transitioned was, ‘Mommy and Daddy aren’t going to let anything bad happen to you,’” Jenifer said. “It gets harder and harder to keep that promise.”
The transition was no doubt the right decision for Maddie, Jenifer said. Her child had been depressed and withdrawn for two years. She became “full of light” once her gender identity was affirmed.
But the transition also produced its own obstacles — mostly from outside forces. Jenifer said her daughter has been ostracized for her gender identity and was excluded from playing on a parks and rec softball team for girls 8 years old and younger. She was affected by the state’s now-repealed House Bill 2, which prohibited her from using bathrooms that aligned with her gender identity in public agencies and schools.
Amid the controversy over HB2, Jenifer decided to go to law school so she could equip herself to be Maddie’s legal advocate. She knew legislation aimed at people like Maddie wouldn’t stop, and it hasn’t. This month, state lawmakers filed six bills in one week that would restrict the rights of trans youth in sports and health care.
That’s alarming for Jenifer, who has seen her daughter benefit from both.
Restricting participation in sports
After unsuccessfully trying to pass legislation in 2021 to ban trans students from participating in school sports that align with their gender identities, state lawmakers are trying again.
North Carolina House Speaker Tim Moore ultimately dismissed the 2021 bill as a solution in search of a problem, saying transgender athletes competing in North Carolina wasn’t an issue. At the time, fewer than 10 trans athletes had sought to play high school sports.
This time, though, while introducing Senate Bill 631 and House Bill 574, titled the “Fairness in Women’s Sports Act,” in a news conference on April 6, legislators cited an example they say illustrates why participation rules need to change to protect the safety of athletes from biological differences in strength and to maintain the fairness of women’s sports.
During a volleyball match last fall, a transgender athlete at Highlands School in Macon County spiked a ball that injured an opposing player from Cherokee County’s Hiwassee Dam High School.
“This is common sense legislation,” said Sen. Joyce Krawiec (R-Kernersville), a primary sponsor of the bill, during the news conference. “Forcing girls to play against biological males is denying female athletes fair competition. There are physical advantages that cannot be ignored.”
It’s true that the injury occurred, but Que Tucker, the commissioner of the North Carolina High School Athletic Association, said the incident is overblown.
“If the legislation in North Carolina is based on this one incident, then that’s unfortunate,” Tucker said, adding that the trans athlete had played in previous seasons without a problem.
Tucker, who previously coached volleyball and basketball, said that injuries are a potential risk of sports — no matter who is playing.
“I had two or three young women on my high school volleyball team that when they hit the ball in a spike or kill — the way it came across that net, if it had hit me, I probably would have been injured,” Tucker said. “I think the speed at which volleyball players can hit the ball now — anyone can be injured. I’m not trying to minimize the fact that this young lady sustained a concussion … it was just unfortunate.”
Research on transgender athletes is sparse
Kendra Johnson, executive director at Equality NC, agrees. She believes what would have been a fairly common sports injury became overblown, including receiving coverage in the national news, only after learning the athlete’s gender identity.
“If I hit someone’s car accidentally because I was distracted or a bee flew in, and then the accident became about me being a Black person as opposed to a routine traffic accident — that’s the analogy for me,” she said. “Accidents and injuries in sports happen all the time. It has nothing to do with the identity of the person who was playing. The ball wasn’t hit malicious. She was in competition.”
The latest data from the National High School Sports-Related Injury Surveillance Study found an overall injury rate of 1.97 injuries per 1,000 athletic exposures among U.S. high school athletes playing 24 sports. During the 2018-19 school year, 20 percent of volleyball injuries sustained during competition were concussions.
Nonetheless, supporters of legislation banning trans athletes from participating on teams that match their gender identity assert that a competitive advantage exists that could make competition unfair.
“Transgender participation in middle school and high school sports should be denied,” Sherry Norris, who coached basketball, volleyball and softball at Chapel Hill High School, said during the news conference. “It is not an equal playing field. The difference in strength and the size of males, when compared to females, creates a lot of advantages, and it is a safety issue that needs to be addressed.”
Twenty-one states have passed laws banning transgender athletes from participating in school sports consistent with their gender identity, according to the Movement Advancement Project, which tracks LGBTQ+-related legislation. North Dakota is the latest state to pass such a bill.
However, there is little research on the performance of transgender athletes, and no research has conclusively found that transgender athletes have a competitive advantage over cisgender athletes.
“They’re operating on stereotypes and fear-mongering that is not rooted in fact or reality,” Johnson said. “We’re not talking about elite athletes. This is not the role of the legislature. The fact is we have sports regulatory bodies — we have high school athletic associations — that are experts in this area and can follow the science and the recommendations of the people who are involved on a daily basis with athletes.”
Johnson said if legislators are concerned about fairness in women’s sports, she would instead like them to ensure that women’s and men’s teams are funded equally and have access to the same resources.
Current state of play
In 2019, the North Carolina High School Athletic Association adopted a policy to allow transgender athletes to play on teams that align with their gender identity, after several years of research and consideration. Students who identify as a gender different from what’s listed on their birth certificates must complete a Gender Identity Request form that includes providing documentation from the student, loved ones and a health care professional demonstrating the student’s consistent gender identification.
Tucker said 18 requests have been filed since the policy was implemented; only two of the total requests have been trans females. For the 16 approved requests, Tucker noted that the association has not tracked whether that translated into the athlete making a team and participating.
The past four years of allowing transgender athletes to compete have gone smoothly, Tucker said. Out of the 180,255 students competing in high school athletics during the 2021-22 school year, there were 16 or fewer trans athletes who participated.
“Trust me, if there were issues, or if it had been negative, if it had caused negative incidents or if it wasn’t the right thing to have allowed those individuals to play, we would have heard it,” Tucker said. “Our schools do not let us pass policies and procedures that adversely affect them. If they believe it adversely affects them, they let us know.”
Research shows there is a multitude of benefits to youth participating in sports, including improved physical health from regular exercise, higher self-esteem and confidence and stronger teamwork and social skills. The same benefits apply to transgender youth.
Jenifer’s daughter Maddie, a 10th-grader, has enjoyed playing sports in middle school and high school. It’s been a great way for her to be physically active and forge friendships, and Jenifer said her participation hasn’t caused any problems.
“We have felt nothing but support from the administration, the teachers, coaches, students,” she said. “It’s been a nonissue — she’s just been a regular old middle schooler, a regular old high schooler. Probably the biggest problem they have with her at school is phone usage.”
Tucker said no lawmakers reached out to discuss how the gender identity inclusion policy was working before introducing the legislation. If passed, the legislation would overrule the high school athletic association’s current inclusion of transgender athletes.
That’s not what Tucker would like to see happen.
“It is my hope that the NCHSAA will always be about inclusion and that we will always try to find ways to include any student who goes through the front door of a member school to participate in our program regardless of who they are, how they identify, what they look like or where they live,” she said.
Limiting gender-affirming care for youth
In addition to restricting participation in school sports, lawmakers introduced bills this month that would limit access to gender-affirming care for transgender youth. Gender-affirming care includes a range of social, psychological, behavioral and medical interventions intended to support and affirm individuals’ gender identities.
Senate Bill 560, entitled the “Medical Treatment for Minors Act,” seeks to restrict gender-affirming care for minors, ban telehealth visits for gender-affirming counseling and treatment and prohibit medical providers giving gender-affirming care from receiving public funds.
Senate Bill 639, entitled the “Youth Protection Act,” also outlaws gender-affirming care for minors, including receiving puberty blockers or hormone therapy and certain surgeries to align with gender identity.
Deanna Adkins provides gender-affirming care at Duke’s Child and Adolescent Gender Care Clinic. She said the care is life-saving, and she has seen the benefits play out repeatedly in the more than 750 youth treated at the clinic since it launched in 2015.
“You can prevent the death of a human being on this planet with gender-affirming care,” Adkins said. “No ifs, ands, buts or questions about that. The literature is clear.”
Studies have found that transgender youth are more likely than other youth to suffer emotional distress and depression, experience bullying and harm themselves or attempt suicide.
Limiting access to gender-affirming care will only further ostracize a vulnerable population, Adkins said. Jenifer has similar concerns.
“Maddie has said to me on more than one occasion that she doesn’t know if she’d still be around without the health care that she’s received.”
Sixteen states have passed laws banning gender-affirming care up to age 18, according to the Human Rights Campaign Foundation.
Adkins said gender-affirming care is provided with thoughtful consideration and tailored to each individual. She said most kids who identify as trans before they start puberty do not receive any medical treatment. For those kids, it’s parental and psychological support that makes the biggest difference. For youth who do seek care at the onset of puberty, she said only a small group take medications to pause puberty.
But puberty blockers can be a useful tool to allow a young person time to sort through their gender identity before the onset of permanent sex characteristics, Adkins said. Sometimes people move onto gender-affirming hormones. Others don’t. She worries about the implications of taking away the ability to prescribe puberty blockers.
“Those folks are going to suffer permanent changes to their body that cannot be undone without surgery,” Adkins said. “We’re basically going to be forcing them into having surgery down the road that they may not have needed. And a lot of them, when they start seeing those changes, have self-harmed and will start to self-harm again.”
Jenifer urges lawmakers to speak to more transgender folks before proposing legislation that will affect their lives.
“These horrendous actions being taken by state legislatures, they’re not going to stop them from being trans,” Jenifer said. “They’re just going to make it so much harder for them.
“No matter what they do in North Carolina, my daughter is not going to not be trans anymore.”
North Carolina Health News is an independent, non-partisan, not-for-profit, statewide news organization dedicated to covering all things health care in North Carolina.
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