Content warning: This article contains references to self harm and suicide. Please take care when reading. If you need mental health support, call or text the national suicide and crisis lifeline — 988 — or check out our mental health resource page.
By Rose Hoban
Deanna Adkins remembers one of her former patients, a 17-year-old who was struggling to come out to their parents as transgender.
“The parents were struggling with understanding what was going on, and the child did come out to them themselves, of their own accord,” she recalled in a recent interview. “And then the parents were very upset and very verbally abusive, and the patient became very distraught and self harmed in a very extensive manner.”
The teenager didn’t feel safe at home and decided to leave. They ended up living on the streets, Adkins said.
The parents reached out to Adkins, who leads the Child and Adolescent Gender Care Clinic at Duke Health where the child was being treated. They were desperate to find their child, but even working together, they were unable to reach them.
That was three years ago.
“The child never returned home, and we don’t know what happened to them. They’re still missing,” she recalled.
These are the kinds of stories that come to mind when Adkins thinks about a bill that’s been moving quickly through the North Carolina senate this past week. The proposed legislation would limit how schools could respond to students seeking advice and counseling around their gender identity and would require schools to tell parents if their child asks to use a different name or pronouns at school.
The bill, called a Parents’ Bill of Rights, revives a bill from the previous legislative session that would restrict instruction and discussion about gender identity, sexual activity or sexuality in kindergarten through fourth grade classrooms unless a child asks a question about it in the context of classroom activity.
Advocates such as Adkins say that these types of laws hurt LGBTQ students by forcibly outing them to their families, even if those families are not accepting of their identities. Those same advocates are organizing opposition to another proposed bill filed last week in the House of Representatives that would forbid gender-affirming treatment in anyone younger than 18.
Nathan Copeland, a Duke child and adolescent psychologist, said providers had been bracing for such bills.
“I’m shocked this came so early in the legislative year, that this was the first priority,” he said.
School is a safe place
A lot of kids questioning their gender identity begin talking about it with their friends at school or a trusted adult before they talk to their parents, explained Mary Evers, a clinical psychologist who has worked with adolescents who are exploring their sexuality and gender identity. Many times that trusted adult is a school counselor or teacher, she said.
Evers and other providers who work with teens say that kids often need some space away from their parents to experiment and work things out before they approach even supportive parents. Having a law that would require notification of parents before the young person is ready would, “disrupt their process,” she said.
“Talking to their parents is much more anxiety-provoking, even for the kids who know their parents will be supportive,” Evers said.
She explained that relying more on peers and people outside the family is part of adolescent development, where kids are becoming more independent of parents. She said it’s also because these young people want to be more sure of themselves and have a better handle on their desires before talking to parents.
“They don’t really want to do the exploring with their parents,” she said. “They want to be able to tell their parents.”
Evers, Adkins and others also worry about families that might not be supportive of kids who are grappling with these issues for themselves.
“There can be physical abuse, where parents become physically violent toward their kids who’ve come out as transgender,” or they can be emotionally abusive, verbally abusive, said Will Hall, an assistant professor at the UNC Chapel Hill School of Social Work. Hall researches mental health issues among LGBTQ kids.
“There’s mental health consequences there in terms of depression, anxiety, suicidality — and then a lot of kids will run away from home,” she said. And the research supports this.
“Three quarters of trans and nonbinary youth report generalized anxiety disorder symptoms in the past few weeks,” Adkins said, quoting statistics from a survey done in 2020. “Sixty percent of transgender and nonbinary youth engaged in self harm in the past 12 months. One in five trans and nonbinary youth have attempted suicide in the past 12 months. And they are two and a half to four times higher risk for substance use disorder.”
She also noted that transgender and nonbinary youth are at higher risk for eating disorders.
Adkins said these statistics are not a function of the kids being mentally ill so much as they reflect kids’ reaction to the stigma and shame. They struggle with anxiety and their feelings about how they’ll be accepted, and they worry about what their families will say and do.
About 9 out of ten transgender and nonbinary youth say recent debates around such legislation have negatively impacted their mental health, according to polling done by the national advocacy organization The Trevor Project.
“In particular, policies that require schools to tell a student’s parent or guardian if they request to use a different name or pronoun at school make 67 percent of trans youth feel angry, 54 percent feel stressed, 51 percent feel scared, 46 percent feel nervous and 43 percent feel sad,” Gabby Doyle from The Trevor Project said in a statement.
Meanwhile, Adkins pointed to research showing that transgender people with strong family and community support have about the same suicide risk as non-transgender people.
Generational shifts in acceptance
More people in “Generation Z,” born between 1997 and 2003, identify as LGBTQ than in previous generations. Most of those respondents told a 2022 Gallup poll that they identified as bisexual. A little more than 3 percent of Gen Z respondents told Gallup that they identified as transgender or at some “other” place along the gender continuum.
“These young adults are coming of age, including coming to terms with their sexuality or gender identity, at a time when Americans increasingly accept gays, lesbians and transgender people,” the Gallup poll wrote in summation.
In 2021, Gallup found that about half of young adults say they know someone who is transgender, while only a quarter of people over 50 say they do.
“There’s a lot more acceptance” among younger generations, Evers said. For example, she explained, they have no trouble adjusting if a friend decides to change their pronouns.
“They’re just on it,” she said. “There’s no adjustment.”
Providers say that the number of young people making any transition is relatively small. In eight years at the gender care clinic, Adkins said she’s taken care of about 700 kids from all over the state.
“The vast majority of my patients are 16 and older,” she said. “There are more patients that are coming to me now than before between the ages of 14 and 16, because we have more scientific data.”
The House bill that would forbid any care that would affect an adolescent’s gender presentation before the age of 18 is an overreach, she said, because so few teens actually receive that kind of treatment.
“The number of kids that I have taken care of who are on puberty blockers, truly young kids… I’ve only had 10 to 15 patients,” she said. She said she’s treated even fewer kids younger than 18 with surgery — only about seven or eight.
“These are not like rash decisions that, you know, a child wakes up on Monday and decides they identify as a boy and they start hormones on Wednesday,” said Riley Smith, a family doctor from UNC Health who works with children and adolescents in this population. “That’s just not the reality.”
“What we look for, before we think about any medical interventions or permanent changes, is an identity that has been consistent, persistent and insistent,” for at least six months, he explained.
Providers could face fines, discipline
A bevy of national medical organizations has come out in opposition to bills similar to those introduced in North Carolina last week. In addition to affecting young people, these bills have ramifications for providers, they say.
The Parents’ Bill of Rights bill would fine providers who provide transgender-accommodating health care services to someone under 18 without a parents’ consent to a $5,000 fine and disciplinary action by their licensing board. The treatment ban bill would enact a $1,000 fine for providers who give care, even with parental consent, and disciplinary action from a licensing board.
The Parents’ Bill of Rights bill mentions, but leaves untouched, current provisions in North Carolina law that guarantee privacy rights and allow for kids under the age of 18 the right to consent to contraceptive services. Teens under 18 also currently have the right to consent to treatment for sexually transmitted infections and prenatal care without explicit parental consent. The state statute that gives young people those rights also gives young people the ability to seek out care for substance or alcohol abuse or for “emotional disturbance.”
But people younger than 18 already need a parent’s consent for accessing abortion services, as well as most other medical procedures
Neither bill would change any of these rights for teens.
Practitioners say they’re frustrated by these proposals because they can do an end-run around their work with kids to help them have more open and productive conversations with their parents and family.
In response, health providers are urgently organizing their opposition to the proposed legislation. Adkins said that she’s seeing more emails and having more conversations with providers about crafting formal statements and appearing in person at the legislature in the coming weeks.
Correction: This article initially stated that Riley Smith is a psychiatrist. He is a family medicine physician.
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NC Legislative members need to get out of the middle of what happens between people and their physicians. This is an incredible overreach into privacy where will it end if we invite the NC Legislature into our doctors appointments with us whatever the issue.
I fully agree with this Bill! Schools and school staff should not be in the business of dealing with health issues that need to be addressed. Currently their are school laws in place to HIDE transgender discussions with parents which is abhorrently wrong. This bill will remove the schools and government’s ability to interfere and persuade children into transgender treatment. These discussions are a health matter and should be dealt with by the family, their medical providers and the youth in question. There are multiple instances of teachers and school staff trying to coerce, promote and psychologically manipulate small children into LGBTQ activity. This is wrong in so many ways and I fear there are teachers and school administrations who are trying to manipulate children into certain lifestyles without the knowledge of parents OR their medical providers.
We don’t let 13 & 14year olds explore with Alcohol and drugs before telling their parents so why we would let them explore irreversible gender changing drugs or worse surgeries without telling parents! The cases of mental illness in children who have had gender changing experiences or have been influenced by friends, teachers or peers to explore gender transitions far more surpasses other mental illness cases. Please do your viewers a service and research the amount of mental illness cases caused by the promotion of gender identity promotion! This dysphoria is being promoted and pushed in the schools and parents have a right to know what is going on with their kids so they can help. This sort of discussion should not be hidden from parents period!!! Who knows the child best? The school, the friends, the provider or the parent?
Did you even read this article? This would require educators to tell parents when a child changes their name or pronouns at school. These are absolutely reversible things. I even changed my name legally as an adult and the process to change back is simple. Not to mention, minors already need parental consent to change their names legally. What is being discussed is even simpler than that. If a child wishes to have different pronouns or a different name used for them, those pronouns or names are used. It’s not being hidden. Teachers just do not need to inform the parents of these requests. If it were applied evenly, every time a kid wants to go by “Chris” instead of their given name of “Christopher” their parent would have to be informed.
As to medical, not social transition, parental consent is already required as well and surgeries are exceedingly rare. Hormone blockers are already used on kids who are not trans to postpone early puberty. Hormone blockers are effective and reversible. They are mainly used with trans children to give them time to consider and decide if medical transition is right for them before irreversible changes are made to their bodies by puberty. Major health organizations, like WHO, base their conclusions on rigorous peer reviewed research. WHO and others support gender affirming care for trans people, both medical and social transitions, because of the science and best outcomes for patients. Let medical professionals instruct best care for children, not parents or legislators trying to dictate religious or prejudiced beliefs to children.
Ugh, this groomer talk again. Nobody’s making kids trans. Or gay. Because you can’t make someone trans or gay. We just are, okay? I know, as I am both. No choice in the matter. Also, being trans (or gay) is not a bad thing. Figuring out that I was trans later in life has been the best thing to happen to me. My mental health has never been better. I’m happier than I’ve ever been.
I know there is this idea that kids are all stupid and easily persuadable, but even kids have a pretty damn good sense of what gender they are. 97%+ of them? Their gender aligns with the sex assigned at birth. But there are those who aren’t like that, and a lot of them know it very early on. In a sense, I’m glad I didn’t. Because I can’t imagine knowing that I was trans then and knowing full well I was going through the wrong puberty. I came from another time when it would’ve been unheard of to transition early in life, and I certainly wouldn’t have had parental support (I still don’t at nearly 43). It’s bad enough I have to deal with the repercussions of that wrong puberty plus the decades of harm testosterone did to me (my voice is too deep, I’m bald, etc.). It would probably have been so traumatic I may not be here today to discuss it. I don’t want that for any trans child. The idea that they would not even be able to take hormone blockers, even if they are in a household with supportive parents, to not have to go through that is monstrous. Oh, hormone blockers have side effects? So does any other drug you take. But often the tradeoff is a kid not committing suicide.
The result of passing this law isn’t “saving” kids from being “coerced” into a trans identity, the result will be dead trans kids. Anyone who votes for it will have their blood on their hands.
What is transgender? What does it mean? Does it mean born in the wrong body? Does it mean refusal to adhere to a set of stereotypes typical of “gender?” If the former…I need to understand where the “right” body is. If the latter – which I suspect – why is this new? What is new about gender nonconformity? Are we back to women don’t wear pants? If women do wear pants, are they men? What if a child isn’t given their gender feeling by age 8? Age 12? Age 15? How do YOU know you are a boy or a girl? If a girl wants to play with boy toys and “feels” like a boy, should we make her a boy? If a boy wants to wear nail polish and date other boys, do we make him a girl? What if being a girl makes it easier for him to not tell his parents that he is gay – instead he is a girl trapped in a boy’s body. My daughter had a secret name. The therapist lied to us. Her internet “family” told her we were evil. The abusive parents in this story? I was told I was also abusive. My abuse? Telling my daughter that we love her and she has the choice to date anyone she wants, male or female, at any time. That her body is perfect and changing and that one day she may want to make changes, but for now she can be comfortable knowing she is perfect as she is, what she likes, who she likes, how she dresses, and how she cuts her hair. NONE of this made her a boy – because none of it makes her a girl. She is a girl biologically and that is it – the rest is personality. I am a progressive, liberal voter. We are not religious. If you have not been through this as a parent I would suggest that you may want to talk to parents. So how did it end for us? When we cut off social media and got involved in sport of her choice and she grew a little in age she left all of it behind.
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Please give statistics for the dead trans kids. Where are they all? Surely with the laws being passed we should see a rise in the numbers, no? What effect does the increase in pornographic content have on kids? Adults? Do you agree with male bodies in female spaces?
This is deeply distressing to hear, though I am glad it’s being discussed. I am nonbinary and if this bill had been passed when I was in school, there is a good chance I would not be here today. I sincerely hope this bill does not become law. The amount of anti-trans legislation being introduced across the country is frightening. It will not stop us from existing. It will only push many of us into hiding or get us killed in one way or another. More and more talk on this subject from the anti-trans crowd is sounding genocidal.
To the younger generation of my community, hang in there. This too will pass and we won’t stop standing up for our rights. Just please know we’re in this together. Stay strong and beautiful.
I am a therapist in NC and i am so concerned about the effects this will have for LGBTQ+ children in this state.
School has never been a “safe space” for middle and high schoolers–bullies abound, and if you appear odd or different, you will be shamed. Often unmercifully. Sometimes you find a friend at school, but for many , safe space must be developed in the family. For qualified therapists and medical personnel to abandon that concept in favor of the almighty dollar is shameful.