Update May 4: After debate on the House floor Wednesday evening, lawmakers voted 74-44 to pass the bill. Two Democrats joined all Republicans in voting in favor of the legislation.
By Rachel Crumpler
Sean Radek, 17, said he’s proof that people under the age of 18 need the ability to access gender-affirming surgery.
A year ago, at the age of 16, he got top surgery to remove his breast tissue.
He said it wasn’t a rash decision. It was contemplated over a span of years.
“I did not wake up one morning and just decide I’m going to get top surgery,” Radek said. “I did not walk into a random plastic surgery place and say give me this surgery. I spent years fighting for it.”
Radek came out as transgender at the age of 11 and said he knew even then that he would be waking up one day and looking down at a flat chest. He put on his first chest binder at age 13, to flatten out then-growing breasts. Then, he started gender-affirming hormones at age 15.
Before he had his surgery, Radek saw dozens of medical and mental health professionals. He said he came to the decision thoughtfully, knowing it was important for his body to align with how he felt.
However, House Bill 808, which advanced in the House Health Committee Tuesday, would prohibit people younger than 18 — like Sean — from accessing gender-affirming surgeries.
While most transgender people do not embark upon gender-affirming surgeries until adulthood, Radek said age restrictions matter. He knows that personally.
“If I had to wait two more years, I know I wouldn’t be here,” he said. “I would have honestly taken my own life. I know it. I was at that point already where I was very much considering it because of the way I look. When I looked in the mirror, when I woke up, or after a shower, I hated it. I hated it because I saw what I know wasn’t meant to be there.”
‘You can’t get a tattoo’
House Bill 808 was originally filed as a ban on all gender-affirming care, including hormone therapy and puberty blockers. But before Tuesday’s committee hearing, lawmakers introduced a substitute bill in the committee limiting it to a ban on surgical procedures for people under 18.
Rep. Hugh Blackwell (R-Valdese), the bill’s primary sponsor, spoke about the need for age restrictions on gender-affirming surgeries.
“If you are under the age of 18 in North Carolina, you cannot get a tattoo at all, even with your parent’s consent,” he said. “You can’t get a body piercing other than for earrings without parent consent. But we allow these surgical procedures that in many instances maybe are irreversible and life-changing for children who have not arrived at 18 years of age.”
The bill would restrict medical professionals from providing gender-affirming surgery to people under the age of 18 and from referring them to that care. It does outline six exemptions, including for people with a diagnosed disorder of sex development, treatment of infections and breast reduction procedures for females.
The bill also prohibits any state funds — which include Medicaid funding and the State Health Plan — from being used for gender-affirming procedures.
More than 660 health care professionals across the state have signed an open letter opposing North Carolina legislation aimed at restricting gender-affirming care.
“Any legislation restricting or banning life-saving care represents dangerous governmental intrusion into the practice of medicine and will be detrimental to the health of transgender and gender-diverse North Carolinians, including youth,” read the letter, which noted that the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, the Endocrine Society, the American Medical Association and other medical associations oppose such bans.
The House Health Committee passed the bill without questions or debate. There was also no public comment, to the dismay of many in attendance who drove to Raleigh to speak in opposition to the bill. They showed up in such volume that there was not enough room in the committee room for everyone.
Executive Director Tami Fitzgerald of NC Values Coalition, a right-wing advocacy group, supported the legislation in a statement.
“Medical transitioning of minors is done in the name of equity and diversity, not based on sound science, and their comorbidities are recklessly being ignored to fast track medicalization,” the statement read. “Children are being irreversibly damaged at the hands of medical and trans activists.”
Kendra Johnson, executive director at Equality NC, denounced the bill in a statement.
“North Carolina lawmakers have no business interfering with private medical decisions made between transgender youth, their parents and their medical care team,” she said. “Ignoring the many health care providers who have condemned gender-affirming bans as dangerous and unnecessary, legislators continue to put forward discriminatory legislation attacking trans kids.
“Everyone deserves access to the health care they need, and gender-affirming care bans threaten the lives of our most vulnerable youth.”
After the votes were tallied and the meeting adjourned, opponents of the bill burst into boos, shouting phrases like, “Let us speak,” “Blood on your hands” and “Listen to health care professionals.”
Waits may be too long
While the bill isn’t as expansive as some originally feared, it will still result in harm, said Leo Street, a transgender, disabled man. He says he benefited from gender-affirming care at a young age.
That care involved years of psychological therapy and then additional gender therapy. He eventually started taking testosterone at age 15. Two years later, at 17, he got top surgery.
It was a thoughtful decision — one he said he was capable of making as a minor and does not regret.
“I was having major crises over my chest and its appearance and over the lack of being able to feel like myself,” Street said. “Since accessing [the surgery] I’ve been able to go on to be a childcare educator. I’ve been able to go through college. I’ve been able to live my life, and without that I would not have been able to.”
For some transgender youth like him, Street said, waiting until age 18 isn’t an option.
“I was so strongly affected by the way that my body was that I was not able to function,” he said. “I was almost bedridden from depression and wanting to harm myself over the thought of having my breasts on my body.”
Now, Street is worried about his 15-year-old sister, who is also transgender and would be affected by this legislation. She’s taken puberty blockers and estrogen, but a gender-affirming surgery could also be in her future. If the legislation passes the House floor later this week, she might not have that option for three more years.
Nicia Carla, the mother of a 16-year-old transgender boy from Charlotte, also worries about how the legislation will affect her son. She said he’s ready to have top surgery, but instead may need to wait a year and a half.
“I just know that so many trans kids are not going to make it to the surgery,” Radek said. “It’s such an emotional burden on them to just feel so different than the way you look. I know firsthand how that feels.”
Other transgender bills introduced this session:
- Senate Bill 631 and House Bill 574, Fairness in Women’s Sports Act, would prohibit transgender athletes from participating in sports consistent with their gender identity.
- Senate Bill 636, School Athletic Transparency, is a wide-ranging bill that involves high school athletics. It includes biological participation requirements.
- Senate Bill 560, Medical Treatment for Minors Act, would prohibit health care providers from providing gender-affirming procedures to any person under 18 years of age unless certain criteria are met. The criteria includes visits to a psychiatrist for at least six months and the signatures of both parents.
- Senate Bill 639, Youth Health Protection Act, would prohibit the health care and mental health care professionals from providing gender-affirming care.
- Senate Bill 641 and House Bill 819, Medical Ethics Defense Act, would allow a medical practitioner, health care institution or health care payer not to participate in or pay for any health care service that they object to on the basis of conscience, including religious, moral, ethical or philosophical beliefs.