By Rachel Crumpler
Katie Jenifer, an Orange County mother, has navigated what she said feels like endless restrictions on her transgender daughter, now 17, who transitioned about 10 years ago — first socially at the age of 6, and later when she received gender-affirming medical care.
The first restriction was North Carolina’s 2016 “bathroom bill” — the now-repealed House Bill 2 — which prohibited Jenifer’s daughter from using bathrooms that aligned with her gender identity in schools and public agencies. Then came a wave of state laws restricting sports participation, discussions of gender identity in school and access to gender-affirming care for minors.
Now a flurry of executive orders signed by President Donald Trump adds another layer of restrictions Jenifer’s family has to contend with as Trump has moved swiftly to limit the rights of transgender Americans — a population of roughly 1.6 million out of a national population of more than 335 million.
In North Carolina — a state with 10.5 million residents — an estimated 8,500 youth ages 13-17 identify as transgender, as do 71,300 adults, according to a 2022 report by UCLA’s Williams Institute, which researches sexual orientation and gender identity law and public policy.
On the first day of Trump’s second administration, the president issued an executive order recognizing only two biological sexes — male and female — declaring that a person’s sex is established at birth and that it cannot be changed.
A series of other executive orders followed, seeking to limit the rights of transgender Americans, including banning transgender athletes from women’s sports, restricting transgender people from serving in the military, prohibiting the recognition of gender identity in schools and directing federal agencies to withhold funding from hospitals that provide gender-affirming care to people younger than 19.
These orders — many of which have been swiftly met with lawsuits — have spiked fear and anxiety among transgender and nonbinary people in North Carolina and their families. Many are scrambling to understand the impact on their lives and grapple with new attacks on their identities.
Trump and his allies say the orders are reining in “gender ideology” and “protecting women,” but transgender youth and their families say they will only make their lives harder.
“We’ve got targets on our kids’ backs,” said a Moore County mother who has a transgender daughter and asked not to be named for fear of being targeted. “Of all the things, is this really a population that you have to marginalize further? Parenting is hard enough. Do you have to add all of this to it?”
The Moore County mother said she and her daughter had been counting down to her 18th birthday on Jan. 26 — when they thought she’d be free of some of the restrictions they had navigated for years, particularly around gender-affirming care.
That relief was short-lived. Two days later, Trump issued his executive order aimed at limiting gender-affirming care for youth 19 and younger.
As the result of yet another executive order, her daughter can’t obtain a U.S. passport with her correct gender marker after the State Department stopped allowing people to change the gender listed on their passport to reflect their gender rather than the sex assigned at birth.
“It’s like this constant barrage that folks have been under,” said Adam Polaski, communications and political director at the Campaign for Southern Equality, an LBGTQ+ advocacy group based in Asheville. “Families in North Carolina — they pivoted, they adapted, they figured out how to deal with the state-level restrictions and are suddenly being put through that fight again. They now have to reconsider and relitigate and retalk to their providers, think about their school safety, and think about their family’s ability to survive here.
“It’s mentally taxing for a lot of folks.”
Bracing for a more restrictive environment
Transgender youth in North Carolina have already faced restrictions accessing gender-affirming health care, participating in sports and exploring gender identities at school after Republican state lawmakers passed a trio of laws in August 2023 over the veto of then-Gov. Roy Cooper.
In addition to the practical difficulties created by state and federal policies, transgender advocates point out the harms of the harsh language and tone of Trump’s executive orders, which they believe are seeking to undermine the legitimacy of a transgender identity.
The executive orders have described transgender people as “mutilated” and put a transgender identity on equal footing with mental health conditions that disqualify one for military service. The orders also called gender-affirming care “a stain on our nation’s history.”
“Just because somebody says there’s no such thing as my child doesn’t make it true,” Jenifer said. “Hearing your identity just talked about nonstop is hard, especially because what they’re really talking about is whether or not your identity is valid and whether you are valid.”
Polaski emphasized that executive orders do not change laws, just the enforcement of policies and indicate the policy preferences of the Trump administration. He said that organizations around the country are mounting legal cases.
“It’s clear that the place [the Trump Administration would] like to go is a future where it is harder to be LGBTQ, where the federal government is not there to support you and where the government is taking steps to actively make it harder for you to be able to participate fully in public life,” Polaski said.
Challenges accessing gender-affirming care
One of Trump’s executive orders takes aim at gender-affirming care for transgender people age 19 and younger — medical care that has grown increasingly divisive in recent years.
Over the last four years, 26 mostly Republican-led states — including North Carolina — have banned gender-affirming care for minors, while 16 states have passed laws protecting the rights of youth to access such care.
That’s even as gender-affirming care for transgender adults and minors is considered medically necessary and often lifesaving by major medical organizations like the American Academy of Pediatrics, the Endocrine Society and the American Medical Association.
Trump’s executive order does not institute a federal ban on gender-affirming care for minors. Instead, he is seeking to cut off access to that care by putting medical providers and hospitals in a bind by directing federal agencies to withhold funding if they continue to serve this population.
In response, some hospitals have paused or eliminated their gender-affirming care programs — a development celebrated by the White House.
Advocates say hospitals that have done so are acting prematurely or over-complying with the executive order, leading to disruptions in needed care.
A federal lawsuit filed Feb. 4 is challenging the executive order. A different federal lawsuit, filed in October 2023, argues that North Carolina’s state law banning gender-affirming care for minors is unconstitutional because it discriminates on the basis of sex and transgender status and infringes on parents’ rights to make medical decisions for their children. That case is ongoing in U.S. District Court.
NC Health News is so far not aware of any changes in care among North Carolina providers. Because of the state’s ban on gender-affirming care that is in effect, only minors who initiated care before Aug. 1, 2023, are continuing to receive care in the state, as allowed by a clause in the law.
Logistical hurdles get higher
Other transgender youth in North Carolina who start gender-affirming care must travel out of state. They say they’re already experiencing disruptions. Virginia and Washington, D.C., have been among the top destinations for North Carolinians seeking gender-affirming care, but those options are now shrinking.
A family in Charlotte with an 11-year-old transgender daughter who had an appointment at Children’s National Hospital in Washington, D.C., on Feb. 3 told NC Health News they received a message three days before that the hospital could no longer initiate any gender-affirming care.
The family, who asked not to be named for fear of being targeted, nonetheless made the six-hour drive for an evaluation and for ideas about other providers who could prescribe puberty blockers.
Based on testing at the appointment, the mother learned that her daughter has a bit more time before puberty begins, giving them more time to plot a way forward.
Less than two years ago, the family said they would have sought care locally in Charlotte. That would have saved them time and headaches, but the mother said the family is willing to persist because they know the care is medically necessary for their daughter.
“Our daughter is the first trans person we ever met but, like anyone who meets her, it should be obvious, like, she is who she is,” the mother said. “No one would question she’s a girl and she lives as a girl and she’s accepted as a girl. For her to have to go down another path with her development would just be devastating.”
For now, they’ve got an appointment booked in Minnesota, and the mother said she will be monitoring the patchwork of access closely.
The Moore County mother, who NC Health News is also not naming, said her daughter started gender-affirming hormones at age 16 and has “blossomed” as a result. She said her daughter was previously so distressed by her body that she developed an eating disorder and attempted suicide. Now, she reports being much happier, feeling more comfortable in her skin and can focus on being her authentic self, the mother said.
“It has been the best thing for her mental health,” the mother said. “She’s told me she’d be dead if it weren’t for gender-affirming care.”
Gender-affirming care still accessible
Campaign for Southern Equality hosted an emergency town hall on Feb. 5 in response to a deluge of questions and concerns about accessing gender-affirming care.
Polaski said more than 1,700 people registered for the virtual event — an indication of just how desperate people were for information. Other town halls with strong showings have generally attracted about 300 people.
During this time of uncertainty, Polaski said he wants people to know that gender-affirming care is still accessible, but he acknowledged it will likely be more logistically complicated and more expensive.
One source of assistance is the Campaign for Southern Equality’s Trans Youth Emergency Project, which launched in January 2023 after the proliferation of gender-affirming care bans across the country. Patient navigators provide families with one-on-one support in identifying providers, and they offer direct grants to cover some expenses.
To date, the project has helped 1,200 families in 25 states and distributed about $600,000 in direct grants. Polaski said about 100 families in North Carolina have received logistical assistance and a total of $50,000 in funding.
The Campaign for Southern Equality expects increased demand for assistance in the wake of the executive order, and Polaski said they are ready to meet the moment.
In the 12 hours after the town hall, Polaski said the Trans Youth Emergency Project received nearly 100 new applicants.
“Our guiding principle is that when the government acts to restrict access to gender-affirming care for trans young people, we will act to support their families and help them identify safe, legal pathways to care,” said Jasmine Beach-Ferrara, executive director at the Campaign for Southern Equality.
Mental health toll
Noah Granade, a transgender psychotherapist practicing in Charlotte who works with many transgender adolescents, is already seeing the Trump administration’s actions take a toll on his patients’ mental health.
“I’m seeing lots of trauma-type symptoms — hypervigilance, inability to sleep, nightmares, trouble concentrating, trouble eating, crying spells,” Granade said.
The wave of executive orders will compound the mental health struggles he’s already witnessed patients experience in response to state-level restrictions.
“Suicidal ideation has increased, a lot of anxiety has increased, a lot of depression,” Granade said.
His anecdotal knowledge is supported by a 2024 study published by The Trevor Project in the journal Nature Human Behavior that found suicide attempts by transgender and nonbinary teenagers increased by as much as 72 percent in the years after the passage of anti-transgender laws.
The Trevor Project’s 2024 U.S. National Survey on the Mental Health of LGBTQ+ Young People found that 46 percent of transgender and nonbinary young people seriously considered suicide in the past year. The organization explained that their gender identity does not inherently put them at higher suicide risk, rather it’s the stigma in society that adds to the risk.
Transgender adults also report higher rates of mental distress.
Jenifer said over the years she’s tried to shield her daughter from the rhetoric lobbed at transgender people, but it still seeps through. She said it’s especially tougher now that her daughter is older and is on social media.
When Jenifer’s daughter went to see her gender care specialist in mid-November, they performed a mental health evaluation — as they do every visit. This time, Jenifer said her daughter’s score was the lowest it had ever been.
That was a wake-up call. The national conversation about transgender rights was taking a toll, but so was planning for her safety.
“The idea of thinking, like, ‘I may have to leave my country, I may have to leave all my friends, I may not be able to graduate with my class, I might not be able to graduate from my high school. I might have to leave everybody and everything that I know behind to stay safe and alive,’” Jenifer said. “It was just too much.”
Jazmynne Cruz, communications director at Equality North Carolina, said LGBTQ+ advocacy organizations plan to provide safe spaces where people can be their authentic selves to help push back against negative messaging.
“We survive this by getting through it together,” Cruz said. “It’s honestly about not giving up hope, not giving up that space where you exist, because once you concede something, once you acknowledge that this is a lost cause, that’s when things get worse.”
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