Credit: Unsplash

North Carolina House Bill 43, if passed, would make it illegal for any medical professional to provide gender-affirming medical or surgical care to any minor in the state of North Carolina. This bill also provides a civil penalty for providers who perform such care. This bill goes against the current medical standard for these patients, and I strongly oppose it. 

Research has continually demonstrated that gender-affirming care of adolescents is vital and lifesaving work. Suicide is the second leading cause of death in all young persons, and LGBTQ youth are four times more likely to attempt suicide compared to their peers.

Clayton Alfonso is an obstetrician and gynecologist at Duke Health.
Credit: Duke Health

The Trevor Project’s 2022 National Survey on LGBTQ Youth Mental Health showed that 45 percent of LGBTQ youth seriously considered attempting suicide in the past year, with nearly one in five transgender and nonbinary youth having attempted suicide. The Trevor Project also showed that rates of attempted suicide are significantly lower for LGBTQ youth who are provided with gender-affirming spaces and health care. Statistics like this, which show improved outcomes of our youth, make me question why our North Carolina legislature would want to ban this lifesaving care for my patients. 

The Trevor Project’s 2022 survey also demonstrated that more than 75 percent of transgender and nonbinary youth experienced significant anxiety, and nearly 66 percent experienced significant depression. In 2021, an article published in the Journal of Adolescent Health examined mental health among transgender and nonbinary youth who received gender-affirming hormone therapy. This survey evaluated nearly 12,000 youth and showed that the use of gender-affirming hormone therapy was associated with lower odds of depression and anxiety compared with youth who wanted, but could not obtain, gender-affirming hormone therapy. 

Other similar surveys have affirmed these results, as well. The World Health Organization in 2021 affirmed its stance on adolescent mental health, stating that “the consequences of failing to address adolescent mental health conditions extend to adulthood, impairing both physical and mental health and limiting opportunities to lead fulfilling lives as adults.” Again, I ask myself the question: Why is our legislature trying to legislate against our adolescents?

Every major medical association in the United States—the American Medical Association, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the Endocrine Society, and the American Psychiatric Association, among others—has repeatedly affirmed its statements that this care is medically necessary and has noted the harmful effects of not providing these services. 

Gender identity and expression are all a part of human development, and we should be supportive of our youth and expand their access to care, not limit it. It is imperative that these youth be given the ability to meet with healthcare professionals who can provide them with an evidence-based evaluation and care to best support them. This care is LIFESAVING. 

North Carolina is not that far removed from House Bill 2, the “bathroom bill” that several years ago that was shown to have impacted revenue and business recruiting for the state, with cancellations in national conferences, major sporting events, and concerts, to name a few. Continued harmful bills, like the new HB 43, are also likely to have a significant negative economic impact on the state.

As an OB-GYN, I have seen firsthand the positive impact that gender-affirming care has on our youth. Laws like HB 43 have no place in our state, and I believe that all medical decisions should be left up to healthcare professionals, patients, and their families. I would implore our legislature to put politics aside and leave the practice of medicine to professionals who devote their careers to providing lifesaving care.

Clayton Alfonso is an obstetrician and gynecologist at Duke Health.

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