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Deadline for legislation prohibiting sterilization and mutilation of children this week.

Updated: May 1

Several bills need action before Thursday's crossover deadline.

by: Sloan Rachmuth

In North Carolina, the number of clinics offering puberty blockers and hormones to children has skyrocketed, as has the number performing hysterectomies, mastectomies, and penectomies.

Meanwhile, European countries that pioneered the "gender-affirmative" model of care for children have dramatically halted the practice amid the growing voices of detransitioners and "regretters."

These opposing trends have led state lawmakers to propose legislation to restrict irreversible hormonal and surgical treatments for children wishing to change genders.


In 2015, Duke was the first clinic in the state to offer sex change treatments for children. The clinic was started by activist Dr. Deanna Adkins who was the medical expert in the legal challenge to North Carolina’s HB2.

Adkins says the clinic began with her and a couple of mental health practitioners. The practice now has over twenty-five providers offering hormonal and surgical treatment for parents unhappy about their child's biological sex, as well as children who wish to change genders.

The clinic reportedly serves transgender patients as young as two-year-old.

The state is now home to more than a dozen clinics that like Duke, target families in nearly every county with what they call "gender affirming care."

  • Western North Carolina Community Health Services provides surgery and hormones for minors regardless of their ability to pay. The center covers Avery, Buncombe, Clay, Cherokee, Cleveland, Graham, Henderson, Haywood, Jackson, Macon, Madison, Mitchell, McDowell, Polk, Rutherford, Swain, Transylvania, and Yancey counties.

  • Levine's Children's Hospital, specializing in everything from hormones, counseling, and surgery consults.

  • The Cosmetic Concierge, also in Charlotte, performs double mastectomies for girls as young as fourteen. After concerned citizens exposed the clinic for performing dozens of procedures on minors, it removed before and after photos boasting about their work.


Gender dysphoria is an identity disorder characterized by strong identification with the opposite sex and discomfort with one's own sex.

In 2010, European countries began to promote the "gender-affirmative model" of care for youth to treat gender dysphoria - even though just one in 50,000 people worldwide experienced the disorder. Through medical treatment, healthcare providers facilitate children's "authentic gender self."

A decade later, a growing number of Western European countries have recognized the significant concerns with the care model. In part, this is because of an avalanche of lawsuits filed by those who regret transitioning and claim they were “rushed into taking life-altering puberty blockers without adequate consideration or proper diagnosis,” caused by staff taking an “unquestioning affirmative approach.”

Young children are often pushed to consent to gender reassignment well before they are sexually active and can anticipate wanting to have children in the future (Duke starts at two-years-old, ECU starts at four).

Later, as sexual dysfunction becomes a recurrent experience in a person's life, regret appears. Reproductive regret can produce overwhelming , distress in adolescents as was evident in the data presented at a recent American Transgender Health Symposium.

Countries have also stopped using irreversible interventions because studies confirm they do not alleviate psychological suffering and have dangerous side effects.

Multiple medical reviews reported that improvements in mental health for children receiving hormonal treatment were "highly questionable." Based on their own systematic review of evidence, the Swedish health authority concluded that hormone risks outweigh the benefits for most adolescents. Both the Finnish and Florida health authorities came to similar conclusions after conducting their own systematic reviews.

Unsurprisingly treatment with puberty blockers and hormones, which are not FDA approved for use in children, may lead to suicide according to well-regarded studies.

As a result of these findings, several European countries, including Finland, Sweden, and England, have set new national health policies that prioritize mental health interventions as the first and often only treatment available.

The American College of Pediatricians has called on organizations to reconsider current protocols for gender dysphoric children based on the newly published data, and for US clinics to "shudder immediately."


Back in 2010, just 1 out of 50,000 people worldwide reported experiencing gender dysphoria. According to a Pew study last year, roughly 1 in 50 American report identifying as something other than their biological sex.

According to a 2018 study, teenage girls with mental health problems are suddenly declaring their transgender identity in friend groups and after prolonged exposure to social media.

Some opponents of the procedures blame Tik Tok videos. Kate Harris, of the LGB Alliance:

'It’s no coincidence that the growth of TikTok coincides exactly with the exponential growth of children presenting with gender dysphoria.’

The National Institute for Health (NIH) revealed a correlation between the prevalence of sex change providers in a geographic location and the volume of online searches of keywords like "transgender surgery," "puberty blockers," and "bottom surgery."

In its 2022 paper, the NIH noted that "increasing awareness of potential procedures may be of significant value" to states like Virginia and North Carolina who showed little demand in spite of available providers.

None of the proposed bills banning child sex changes are ready for "crossover." In order for a bill to be considered in the other chamber, it must pass through one chamber by the crossover date.A bill that does not meet the crossover date is usually considered dead for the session.

Senate Bill 560, Medical Treatment for Minors Act, introduced by the Senate Health Committee chairs will allow child sex changes for minors at privately-funded intuitions, but with enhanced protections.

It will cut off state and local funding to institutions providing child sterilization and mutilation services:

"Public funds shall not be directly or indirectly used, granted, paid, or distributed to any entity, organization, or individual that provides gender transition procedures to a minor."

The legislation requires children to be evaluated by licensed child psychiatrists and refer to independent physicians outside their networks. If passed, children and parents would be required to sign strongly worded disclaimers that point out the document the dangers of child sex change procedures:

"The use of cross-sex hormones in males is associated with numerous health risks, such as thromboembolic disease, including, without limitation, blood clots; cholelithiasis, including gallstones; coronary artery disease, including, without limitation, heart attacks; macroprolactinoma, which is a tumor of the pituitary gland; cerebrovascular disease, including, without limitation, strokes; hypertriglyceridemia, which is an elevated level of triglycerides in the blood; breast cancer; and irreversible infertility.
The use of cross-sex parts. Sweden, Finland, and the United Kingdom have conducted systematic reviews of evidence and conclude that there is no evidence that the potential benefits of puberty blockers and cross-sex hormones for this purpose outweigh the known or assumed risks.

The bill, cleared the Health committee on April 5th but needs to clear the Rules Committee before it receives a vote in the Senate. The bill is not on the calendar for Monday or Tuesday

Both chambers are also still reviewing the Youth Protection Act Senate Bill 639 and House Bill 808. This bill will make it illegal for healthcare providers to sterilize children or remove their healthy body parts, and stop mental health workers from "knowingly engaging in conduct that aids or abets" the practice.

The bill acknowledges the following:

  • the sex of a person is the biological state of being female or male, based on sex organs, chromosomes, and endogenous hormone profiles, and is genetically encoded into a person at the moment of conception, and it cannot be changed

  • some in the medical community are aggressively pushing for interventions on minors that medically alter the child's hormonal balance and remove healthy external and internal sex organs when the child expresses a desire to appear as a sex different from his or her own;

  • this course of treatment for minors commonly begins with encouraging and assisting the child to socially transition to dressing and presenting as the opposite sex. In the case of prepubertal children, as puberty begins, doctors then administer long-acting GnRH agonist (puberty blockers) that suppress the pubertal development of the child. This use of puberty blockers for gender nonconforming children is experimental and not FDA-approved

  • this unproven, poorly studied series of interventions results in numerous harmful effects for minors, as well as risks of effects simply unknown due to the new and 11 experimental nature of these interventions;

The legislation will make it illegal for clinics and organizations to penalize those who report healthcare workers for violating the law, because withholding the information endangers to public health and safety.

The State Attorney General, or any healthcare worker will be able to go before a court to get an injunction against clinics and doctors performing the services in violation of the law.

Children and their families will be able to sue clinics, health care systems, medical professionals who violate the law. Minors who are harmed by the treatments will have 20 years after the age of majority (18) to sue for:

  • Monetary damages, including psychological, emotional, and physical harm suffered.

  • Total costs of the action and reasonable attorneys' fees.

  • Any other appropriate relief.

The Bill is waiting for passage in the Rules Committee before being voted on by both chambers. The bill is not on the schedule to be heard on Monday or Tuesday.

Readers who are concerned that these bills may not pass should contact their state representatives on Monday and Tuesday and ask for a vote on the measures.

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