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“There’s robust scientific evidence that allows us to anticipate what some of the effects of these bills will be,” said psychiatry professor Sarah Wilson. “We can anticipate that these bills are very likely to increase the risk for poor mental health outcomes like depression and anxiety, and increase the risk for suicide among not only LGBTQ+ youth in North Carolina but adults as well.”

In a virtual briefing for journalists, Wilson and two colleagues discussed gender-affirming care, the role schools play in that play, and the potential consequences of the two laws under consideration.

ON SENATE BILL 43, RESTRICTING GENDER-AFFIRMING CARE IN NORTH CAROLINA

Dr. Deanna Adkins, M.D., Director, Duke’s Child and Adolescent Gender Care Clinic

“This is a group of individuals, a small portion of the population, only about 3 percent of those under 18, and they are a quite vulnerable population. It would limit their access to potentially life-saving treatments that we have excellent evidence within the medical literature that this helps these patients in many ways. It decreases their suicidality, it improves their overall mental health, it decreases self-harm as well.”

“The kids have a number of risk factors we are really able to help a lot with, with the care we are providing. Even in some cases decrease their suicidality to the level of their peers. In this group of adolescents, it’s the second or third leading cause of death -- suicide. If we can reduce that in this group, we really are attacking an important part of what is taking the lives of our young people.”

“I am quite concerned that a lot of these kids, if they don’t have access to this care, or if their care is interrupted, will fall back into these high-risk categories. And this includes substance use and self-harm.”

ON THE PROPOSED ‘PARENTS BILL OF RIGHTS’

Dane Whicker, assistant professor and clinical health psychologist

“Ultimately, we do not have any evidence that the current practices, the care that we provide, are causing youth to adopt LGBTQ+ identities. That’s a big myth that seems to be coming up over and over.”

“There are no interventions or practices that can stop youth from having LGBTQ+ identities. In reality, what these types of bills, the impact they’re going to have is on concealment – people hiding really important parts of their identity and depriving them of the support they need to navigate those really critical pieces that affect their health and trajectory in life.”

ON THE SIGNAL THESE BILLS SEND TO WIDER LGBTQ+ POPULATION

Sarah Wilson, assistant professor, psychiatry and behavioral sciences

“There is a high likelihood that this bill – both of these bills – would have reverberating effects that will have impacts on the health of LGBTQ+ children and adults throughout North Carolina. We know from past legislation and national studies of legislation across states, that those who live in states with anti-LGBTQ+ legislation have worse mental health.”

“When legislation like this that is anti-LGBTQ+ is enacted, we see decline in mental health.”

ON THE ROLE OF SCHOOLS AS A SAFE SPACE

Dane Whicker

“Working with schools has been a really important part of our clinic’s practice. Working with the parents to help them advocate for safe environments for transgender and non-binary children. We want to make sure we that are able to get to work with our educators and our principals and administrators.”

ON WHETHER PROPOSED LAWS BANNING CARE ARE SUPPORTED BY SCIENCE

Sarah Wilson

“Nearly every medical association in the United States supports access to the type of gender-affirming medical care for youth (we) are talking about.”

“There really is a prevailing consensus in the medical community about the benefits of gender-affirming care for youth and the benefits of openness around LGBTQ+ identities in schools. There really isn’t instruction that is age-inappropriate that’s happening. We don’t have any evidence that there is age-inappropriate instruction occurring currently.”

ON THE BENEFITS OF GENDER-AFFIRMING CARE

Deanna Adkins

“Two in three transgender youth or non-binary youth report symptoms of major depression. Three out of four … report generalized anxiety disorder in the last two weeks.”

“Sixty percent of these individuals are engaging in self-harm in the last 12 months. One in five have attempted suicide in the last 12 months.”

“When we look at treating these individuals with gender-affirming care we find that the rates of suicide are cut in half, the rates of depression reach, oftentimes, the rates of their peers who are not transgender, there is an 80 percent risk reduction in suicidal ideation. And when we have parent support and educator support we improve resilience and have much better mental health outcomes.”

ON BULLYING, STIGMA AND AFTERMATH OF THE 2016 HB2 ‘BATHROOM BILL’ IN NORTH CAROLINA

Sarah Wilson

“It’s hard to truly characterize the pain and grief that these kinds of legislations cause. It is an incredibly deep pain to know there are people in this state who want to deny freedom for folks so much.”

“In North Carolina after HB2 … we saw gender identity-motivated hate crimes actually increased in the state. So there can be these larger cultural effects of the legislation that can adversely affect LBTBQ+ individuals by normalizing stigma. Where there is stigma, oftentimes there is increased violence.”

“There are downstream effects of that increased exposure to stigma, violence and hate crimes where North Carolinians who are LGBTQ+ reported feeling increased depression and anxiety.”

“This is a group that already faces disproportionate rates of discrimination, harassment, stigma, and these bills serve to potentially have an amplifying effect for these inequities we already see.”

“Suicidal ideation increased among transgender and gender non-conforming North Carolinians, and hate crimes increased. Depression and anxiety among transgender North Carolinians also increased. We saw these reverberating effects throughout people’s lives. We saw people delaying health care because of these bills because there was a concern over general attitudes towards transgender and non-binary folks.”

Dane Whicker

“With HB2, a lot of our patients also had physical problems from dehydration. They weren’t drinking all day long during school and would have complications from that. They were having kidney problems. It really is linked to so many things. It does come back to this concealment -- forcing people to hide who they are, which also has really problematic mental health impact.”

ON PATIENT CONCERNS OVER PROPOSED LAWS

Deanna Adkins

“It’s definitely something I’m hearing from my patients. Every patient I see in my clinic and through my emails and my in-basket have been flooded with, ‘What are we going to do if we can’t receive our care? How are we going to manage?’ ”

“I am very afraid. I’ve had some patients say, ‘I’m really, really struggling to avoid self-harm right now. This is getting worse.’ I’ve had some patients leave the state. I’ve had more than one family leave North Carolina.”

Sarah Wilson

“In a 2022 national survey, 93 percent – a vast, vast majority -- of transgender youth worried about being denied access to medical care due to state or local law. This is something that, while not particular to North Carolina, is very pervasive among youth.”

“They are really concerned about this, not only for themselves … but for their peers in other states who may be having care taken away that they have relied on.”

ON LONG-TERM HARM OF LOSING OR DELAYING CARE

Deanna Adkins

“If you are so depressed you can’t get out of bed, you can’t go to school. If you can’t go to school, you can’t graduate from high school, you can’t get a job, you can’t get insurance.”

“The longer you put this off, the worse their struggle is with their mental health. It continues to impair their everyday life.”

“The timing of treatment is based on the best time for that patient. What is their need, how urgent is it, what is going to be the best benefit? We use our multi-disciplinary team to make sure that happens at the right time.”

ON IMPORTANCE OF SUPPORT FOR LGBTQ+ YOUTH

Sarah Wilson

“We know the majority of LGBTQ+ youth report their home is not LGBTQ+ affirming. Three in five. The rates are actually a little bit higher for schools. There are more LGBTQ+ who report their school is an affirming place than report their home is an affirming place.”

“Similarly, the majority of LGBTQ+ youth live in a community that is not accepting.”

“But we also know it is incredibly powerful to have to have people in your life who love you and affirm you for who you are. We know ... having people who say, ‘No matter what, I will be there for you, I will care about you,’ just one person, can make a huge difference.”

“Youth and adults turn to friends, teachers, other people in the community to be able to gain that acceptance and willingness to support the person regardless of their sexual orientation or gender identity.”

“The issue is, particularly with the Parents Bill of Rights – SB 49 -- we see an erosion of the school’s ability to do that. And schools have been incredible in trying to make rapid change to do this. I know teachers who have tried to do this, who have told me it has made a difference in the lives of their students. The issue is, when the legislature comes in and dictates to schools that they cannot do that for their students any longer, and if a student says, ‘I would like to try out a new name,’ then by law, if this law passes, by law the teacher cannot do that. A school counselor cannot do that. They cannot try out a new name. They would have to tell the child’s parents.”

A MESSAGE TO TRANS YOUTH

Sarah Wilson

“Transgender lives are sacred. Your life is important. We here believe your life is important and you deserve everything. You deserve to have a beautiful life you feel good about and you’re happy about. You deserve to grow up and live all of your dreams. I think it’s really important for those who have trans, nonbinary and other LGBTQ+ folks in their lives … to really take this time right now to listen to those around you who might be telling you what they need. I would also encourage anyone who doesn’t have anyone in your life to think about why that might be. Why do you think you can’t think of anyone in your life who is LGBTQ+? We know that 9.5 percent of youth are LGBTQ+. If you think there isn’t anyone, there’s a high likelihood there’s someone in your life who is afraid to tell you.”

Dane Whicker

“I wish (lawmakers) could get a glimpse of what it is like when we provide gender-affirming therapy. To see the smiles on our patients’ face. To see their grades improve. To see them have friends. To see them engage in activities. This care really can improve lives. They feel they can actually be themselves instead of just a shell.”

“It’s just a magical experience.”

Participants

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