Transgender North Carolinians file federal lawsuit challenging gender-affirming care ban for minors

The family of a transgender boy in North Carolina is suing state health officials to block implementation of gender-affirming care restrictions that they say will force their son to undergo a traumatic wrong-gender puberty.

A federal lawsuit filed Wednesday in U.S. District Court alleges the new state law violates the Equal Protection Clause of the 14th Amendment by denying treatment access to transgender youths and undercuts parents’ rights to make medical decisions for their children.

The North Carolina lawsuit closely follows the playbook of other successful court challenges to gender-affirming care bans that have swept Republican-controlled states this year. At least 22 states have enacted laws restricting or banning common treatments for transgender minors, and legal challenges have delivered mixed results. But court victories in states like Arkansas, where a federal judge struck down a state ban as unconstitutional, mapped out what Lambda Legal attorney Omar Gonzalez-Pagan views as a winning strategy for transgender North Carolinians.

Transgender youth in the Tar Heel State immediately lost access to gender-affirming medical treatments on Aug. 16 when Republican supermajorities in the General Assembly overrode a veto of the ban by the Democratic governor. State law now bars medical professionals from providing hormone therapy, puberty-blocking drugs and surgical gender-transition procedures to anyone under 18, with limited exceptions.

Minors who had begun a course of treatment before Aug. 1 are able to continue receiving that care under the new law if their doctors deem it medically necessary and their parents consent. But providers say it remains unclear whether they could face retribution for transitioning a minor patient from puberty-blocking drugs to cross-sex hormones because the law does not specify whether that would constitute a different course of treatment.

Representatives from Lambda Legal and the National Health Law Program say they also plan to file a motion for a preliminary injunction to block enforcement of the law while the court challenge proceeds. Other plaintiffs include a North Carolina family physician who serves transgender patients and several local and national LGBTQ+ advocacy organizations. The family of the 9-year-old transgender boy is listed pseudonymously to protect their privacy, attorneys said.

The complaint alleges the law discriminates against transgender patients because it does not create a blanket ban on hormone therapies and other treatments, but rather prohibits them only when performed “for the purpose of ‘gender transition.’”

“There is not one treatment that is offered to transgender patients in North Carolina that is not also offered to the rest of the patients in their care, and yet that very same care would remain perfectly legal for all other patients,” said Alex Sheldon, executive director of GLMA: Health Professionals Advancing LGBTQ Equality, an organization involved in the lawsuit.

The offices of Republican General Assembly leaders did not immediately respond to emails seeking comment. Jean Fischer Brinkley, a spokesperson for the North Carolina Medical Board, declined a request for comment. Board CEO Thomas Mansfield is named as a defendant for his role overseeing licensing for medical professionals in the state.

North Carolina law also prohibits using state funds to support the provision of gender-affirming care. This prohibition excludes the North Carolina State Health Plan for government employees and their families, which is under a court order to cover those procedures while a federal appeals court considers a related case.

Medical professionals like Dr. Riley Smith, the physician who is a plaintiff in the lawsuit filed Wednesday, would have their licenses revoked if they violate the law. Families of minor patients who receive the banned treatments would also have a right to sue the doctors who perform those procedures.

Smith said the law interferes with his ability to follow evidence-based protocols at the expense of his most vulnerable patients.

Gender-affirming care is considered safe and medically necessary by the American Academy of Pediatrics, the American Medical Association and the Endocrine Society. While trans minors very rarely receive surgical interventions, they are commonly prescribed drugs to delay puberty and sometimes begin taking hormones before reaching adulthood.

Supporting young patients through gender-affirming treatments is “the most incredible, challenging, beautiful, gut-wrenching and heartwarming part of my job,” Smith said. “When I say that gender-affirming care can be lifesaving, that is not hyperbole. And the politicians who voted for this law have no idea what it means to take that care away.”

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