The passage of two bills by the North Carolina General Assembly has drawn condemnation from some elected bodies in Orange County and local pediatric health experts alike for their anti-LGBTQ+ elements.

The bills’ sponsors say the elimination of gender-affirming medical care for those under 18, as well as the requirement of educators to alert parents of a child’s preferred pronouns or names, reflects the need for such decisions to come from adults. Critics, however, point to exacerbating mental health issues in North Carolina’s adolescents and say prevention of safe school environments or medical care could further harm them.

Like other groups across the state, the Carrboro Town Council and Chapel Hill-Carrboro City Schools Board of Education shared statements against House Bill 43 and Senate Bill 49. Carrboro’s resolution condemned the national examples of violence and hatred against the LGBTQ+ community and said it opposes “all legislation that erodes the safety, health, civil rights, and/or bodily autonomy of LGBTQ+ people, including minors.” Meanwhile, CHCCS board members read a recognition affirming they “unambiguously celebrate and support the presence and rights of LGBTQIA+ individuals in our schools and community,” and shared their “strong opposition” to the two bills.

During a February 8 panel, a trio of Duke Health experts shared their professional thoughts on potential health impacts and isolation the pair of measures could cause.

Dr. Deanna Adkins, a pediatric endocrinologist at Duke Health, says that LGBTQ+ identifying youth are a significant part of those experiencing mental health struggles.

“Two in three transgender or non-binary youth [self-report] symptoms of major depression [in the last two weeks],” said Adkins. “Three out of four report symptoms of generalized anxiety disorder [in the same time period]. Sixty percent of these individuals are engaging in self-harm in the last 12 months, while one in five have attempted suicide in [that span]. They are 2.5 – 4 times higher to use substances and have higher rates of eating disturbance that interfere with their overall health.”

Adkins, who is also the director of the Child and Adolescent Gender Care Clinic at Duke, said passing House Bill 43 into law could hurt those statistics even more. She said for some youth, gender-affirming care – which includes things like hormone therapy or surgeries – is critically important to their mental health. Adkins also pointed out that such treatments only come with parental consent, meaning House Bill 43 would force transgender or non-binary youth to not receive treatment until they turn 18.

Duke psychiatrist Sadie Wilson said the lasting mental wellness impact could reflect other anti-LGBTQ legislation previously passed in North Carolina: House Bill 2. She brought up a two-year assessment in the wake of the 2016 law dubbed “the Bathroom Bill.”

“That impact assessment found that suicidal ideation increased among transgender and gender non-conforming North Carolinians after HB2 was passed,” said Wilson. “So, it would not be very surprising at all – and in fact is very likely – that these bills would have similar, if not worse, effects. [They] would affect not only the health and wellbeing of our youth in North Carolina, but also our adult LGBTQ+ population.”

Wilson also cited a statistic of three out of five LGBTQ+ youth report their home environment not being affirming of their gender identity – finding school as a safer space instead. The other measure, Senate Bill 49, could change that. If signed into law, educators would be required to alert parents to changes in students’ preferred name or pronouns at school. It would also ban any discussion of gender identity by educators to students younger than sixth grade.

North Carolina state Sen. Amy Galey, an Alamance County Republican, speaks to reporters at a news conference in the Legislative Building in Raleigh, N.C., on Wednesday, Feb. 1, 2023. Galey said she was baffled that her Parents’ Bill of Rights, which seeks to bar instruction about sexuality and gender identity in K-4 classrooms, is seen as divisive. (AP Photo/Hannah Schoenbaum)

Dane Whicker, a clinical health psychologist for LGBTQ+ adolescents and adults, said he believes the measure is in reaction to concerns that are non-existent in classroom settings.

“We do not have any evidence that the current practices of the care we provide causing youth to adopt LGBTQ+ identities,” he said. “I think that’s a big myth that seems to be coming up over and over.

“The other reality,” Whicker added, “is there are no interventions or practices that can stop youth from having LGBTQ+ identities. In reality, the impact [of these types of bills is] going to be about concealment: people hiding really important parts of their identity.”

Wilson said based on the effects of HB2, these new bills may lead to people delaying their healthcare needs based on fear of stigmas. As a leader in Duke’s Sexual and Gender Minority Health Program, she added that another ripple effect could be further stratification between those who have resources to receive care elsewhere and those who do not.

“There is a real concern among the professional community that there may be even worse outcomes linked to this kind of legislation for those who are either Black, Latinx or low-income,” said Wilson. “It’s really concerning to me to think about not only the direct effects for all transgender youth and LGBTQ+ individuals in our state, but especially those who have other identities that might put them at greater risk.”

In the short-term, Adkins said the effects on LGBTQ+ North Carolinians are already clear. She’s been flooded with comments from patients, ranging from concern over losing medical care and general fear for their safety.

“I’ve had some patients say, ‘I’m really struggling to avoid self-harm right now, and it’s getting worse,’” shared Adkins. “I’ve had some patients leave the state – more than one family decide to leave North Carolina.”

No action on either bill has been taken since February 7. House Bill 43 is still in the committee phase after passing its first reading, while Senate Bill 49 is waiting to be heard in the House.


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