FILED SENATE
Apr 5, 2023
GENERAL ASSEMBLY OF NORTH CAROLINA
S.B. 639
SESSION 2023 PRINCIPAL CLERK
S D
SENATE BILL DRS35149-NB-122
Short Title: Youth Health Protection Act. (Public)
Sponsors: Senators Hise, B. Newton, and Sanderson (Primary Sponsors).
Referred to:
1 A BILL TO BE ENTITLED
2 AN ACT TO PROTECT MINORS FROM ADMINISTRATION OF PUBERTY BLOCKERS
3 AND CROSS-SEX HORMONES AND OTHER RELATED ACTIONS, PROCEDURES,
4 AND TREATMENTS.
5 Whereas, the State of North Carolina has a compelling government interest protecting
6 the health and safety of its citizens, especially vulnerable children; and
7 Whereas, the sex of a person is the biological state of being female or male, based on
8 sex organs, chromosomes, and endogenous hormone profiles, and is genetically encoded into a
9 person at the moment of conception, and it cannot be changed; and
10 Whereas, some individuals, including minors, may experience discordance between
11 their sex and their internal sense of identity, and individuals who experience severe psychological
12 distress as a result of this discordance may be diagnosed with gender dysphoria; and
13 Whereas, the cause of the individual's impression of discordance between sex and
14 identity is unknown, and the diagnosis is based exclusively on the individual's self-report of
15 feelings and beliefs; and
16 Whereas, this internal sense of discordance is not permanent or fixed, but to the
17 contrary, numerous studies have shown that a substantial majority of children who experience
18 discordance between their sex and identity will outgrow the discordance once they go through
19 puberty and will eventually have an identity that aligns with their sex; and
20 Whereas, as a result, taking a "wait-and-see" approach to children who reveal signs
21 of gender nonconformity results in a large majority of those children resolving to an identity
22 congruent with their sex by late adolescence; and
23 Whereas, some in the medical community are aggressively pushing for interventions
24 on minors that medically alter the child's hormonal balance and remove healthy external and
25 internal sex organs when the child expresses a desire to appear as a sex different from his or her
26 own; and
27 Whereas, this course of treatment for minors commonly begins with encouraging and
28 assisting the child to socially transition to dressing and presenting as the opposite sex. In the case
29 of prepubertal children, as puberty begins, doctors then administer long-acting GnRH agonist
30 (puberty blockers) that suppress the pubertal development of the child. This use of puberty
31 blockers for gender nonconforming children is experimental and not FDA-approved; and
32 Whereas, after puberty blockade, the child is later administered "cross-sex" hormonal
33 treatments that induce the development of secondary sex characteristics of the other sex, such as
34 causing the development of breasts and wider hips in male children taking estrogen and greater
35 muscle mass, bone density, body hair, and a deeper voice in female children taking testosterone.
36 Some children are administered these hormones independent of any prior pubertal blockade; and
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1 Whereas, the final phase of treatment is for the individual to undergo cosmetic and
2 other surgical procedures, often to create an appearance similar to that of the opposite sex. These
3 surgical procedures may include a mastectomy to remove a female adolescent's breasts and
4 "bottom surgery" that removes a minor's healthy reproductive organs and creates an artificial
5 form aiming to approximate the appearance of the genitals of the opposite sex; and
6 Whereas, for minors who are placed on puberty blockers that inhibit their bodies from
7 experiencing the natural process of sexual development, the overwhelming majority will
8 continue down a path toward cross-sex hormones and cosmetic surgery; and
9 Whereas, this unproven, poorly studied series of interventions results in numerous
10 harmful effects for minors, as well as risks of effects simply unknown due to the new and
11 experimental nature of these interventions; and
12 Whereas, among the known harms from puberty blockers is diminished bone density;
13 the full effect of puberty blockers on brain development and cognition is yet unknown, though
14 reason for concern is now present. There is no research on the long-term risks to minors of
15 persistent exposure to puberty blockers. With the administration of cross-sex hormones comes
16 increased risks of cardiovascular disease, thromboembolic stroke, asthma, COPD, and cancer;
17 and
18 Whereas, puberty blockers prevent gonadal maturation and thus render patients taking
19 these drugs infertile. Introducing cross-sex hormones to children with immature gonads as a
20 direct result of pubertal blockade is expected to cause irreversible sterility. Sterilization is also
21 permanent for those who undergo surgery to remove reproductive organs, and such persons are
22 likely to suffer through a lifetime of complications from the surgery, infections, and other
23 difficulties requiring yet more medical intervention; and
24 Whereas, several studies demonstrate that hormonal and surgical interventions often
25 do not resolve the underlying psychological issues affecting the individual. For example,
26 individuals who undergo cross-sex cosmetic surgical procedures have been found to suffer from
27 elevated mortality rates higher than the general population. They experience significantly higher
28 rates of substance abuse, depression, and psychiatric hospitalizations; and
29 Whereas, minors, and often their parents, are unable to comprehend and fully
30 appreciate the risk and life implications–including permanent sterility–that result from the use of
31 puberty blockers, cross-sex hormones, and surgical procedures; and
32 Whereas, it is of grave concern to this legislature that the medical community is
33 allowing individuals who experience distress with their biological sex to be subjects of
34 irreversible and drastic non-genital gender reassignment surgery and irreversible, permanently
35 sterilizing genital gender reassignment surgeries, despite the lack of studies showing that such
36 extreme interventions have benefits that outweigh their risks or chances of cure. In fact, they may
37 increase the risk of suicide; and
38 Whereas, for these reasons, the decision to pursue a course of hormonal and surgical
39 interventions to address a discordance between the individual's sex and sense of identity should
40 not be presented to or determined for minors who are incapable of comprehending the negative
41 implications and life-course difficulties attending to these interventions; Now, therefore,
42 The General Assembly of North Carolina enacts:
43 SECTION 1.(a) Chapter 90 of the General Statutes is amended by adding a new
44 Article to read:
45 "Article 1M.
46 "Youth Health Protection Act.
47 "§ 90-21.140. Definitions.
48 The following definitions apply in this Article:
49 (1) Government agent. – Any agent, employee, volunteer, or contractor of a
50 public child services agency, private child placing agency, court, or school
51 district.
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1 (2) Medical professional. – Any physician, surgeon, physician assistant, nurse,
2 clinical nurse specialist, nurse practitioner, anesthetist, psychiatrist, or
3 medical assistant licensed under this Chapter.
4 (3) Mental health care professional or counselor. – Any licensed medical, mental
5 health, or human services professional licensed under this Chapter, including
6 any psychologist, social worker, psychiatric nurse, allied mental health and
7 human services professional, licensed marriage and family therapist, certified
8 rehabilitation counselor, licensed clinical mental health counselor, or any of
9 their respective interns or trainees, or any other person designated or licensed
10 as a mental health or human service professional.
11 (4) Minor. – Any individual who is below 18 years of age.
12 (5) Political subdivision. – Any division of local government, county, city,
13 assessment district, municipal corporation, special purpose district, board,
14 department, commission, or any division of local government delegated the
15 right to exercise part of the sovereign power of that subdivision.
16 (6) Sex. – The biological state of being female or male, based on sex organs,
17 chromosomes, and endogenous hormone profiles, without regard to an
18 individual's psychological, chosen, or subjective experience of gender.
19 "§ 90-21.141. Prohibition of certain practices and health care services.
20 (a) Notwithstanding any other provision of law, it shall be unlawful for any medical
21 professional or mental health care professional or counselor to knowingly engage in any of the
22 following practices upon a minor, or cause them to be performed for the purpose of attempting
23 to alter the appearance of or affirm the minor's perception of his or her gender or sex, if that
24 appearance or perception is inconsistent with the minor's sex:
25 (1) Performing surgeries that sterilize, including castration, vasectomy,
26 hysterectomy, oophorectomy, orchiectomy, or penectomy.
27 (2) Performing surgeries that artificially construct tissue with the appearance of
28 genitalia that differs from the individual's sex, including metoidioplasty,
29 phalloplasty, and vaginoplasty.
30 (3) Performing a mastectomy.
31 (4) Prescribing, administering, or supplying gonadotropin releasing hormone
32 analogues or other synthetic drugs used to stop luteinizing hormone and
33 follicle stimulating hormone secretion, synthetic antiandrogen drugs used to
34 block the androgen receptor, or any drug to suppress or delay normal puberty.
35 (5) Prescribing, administering, or supplying testosterone, estrogen, or
36 progesterone to a minor in an amount greater than would normally be
37 produced endogenously in a healthy individual of that individual's age and
38 sex.
39 (6) Removing any otherwise healthy or nondiseased body part or tissue.
40 (b) It shall be unlawful for any medical professional or mental health care professional
41 or counselor to knowingly engage in conduct that aids or abets the practices described in
42 subsection (a) of this section to a minor. This section may not be construed to impose liability on
43 any speech protected by federal or State law.
44 (c) A medical professional or mental health care professional or counselor who engages
45 in any of the practices identified in subsection (a) of this section or causes them to be performed
46 shall be considered to have engaged in unprofessional conduct and shall be subject to revocation
47 of licensure for a minimum of one year and other appropriate discipline by the medical
48 professional's licensing or certifying board. The medical professional shall also be subject to a
49 civil penalty of up to one thousand dollars ($1,000) per occurrence. The clear proceeds of civil
50 penalties provided for in this subsection shall be remitted to the Civil Penalty and Forfeiture Fund
51 in accordance with G.S. 115C-457.2.
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1 (d) This section does not apply to any of the following:
2 (1) The good-faith medical decision of a parent or guardian of a minor born with
3 a medically verifiable genetic disorder of sexual development, including any
4 of the following:
5 a. A minor with external biological sex characteristics that are
6 irresolvably ambiguous, such as a minor born having 46 XX
7 chromosomes with virilization, 46 XY chromosomes with
8 under-virilization, or having both ovarian and testicular tissue.
9 b. When a physician has otherwise diagnosed a disorder of sexual
10 development, in which the physician has determined through genetic
11 testing that the minor does not have the normal sex chromosome
12 structure, sex steroid hormone production, or sex steroid hormone
13 action for male or female sexes.
14 (2) The treatment of any infection, disease, or disorder that has been caused or
15 exacerbated by the performance of a procedure described in subsection (a) of
16 this section, whether or not the procedures were performed in accordance with
17 State or federal law.
18 (3) Any procedure undertaken because an individual suffers from a physical
19 disorder, physical injury, or physical illness that is certified by a physician and
20 that would place the individual in imminent danger of death or impairment of
21 major bodily function unless surgery is performed.
22 (e) Notwithstanding any other provision of law, it shall be unlawful for any health care
23 provider, as defined in G.S. 90-21.11, that receives State funds to furnish, provide, or perform
24 any health care service that constitutes the performance of or preparation for a gender transition
25 procedure to a minor.
26 "§ 90-21.142. Counseling.
27 A State office, agency, political subdivision of the State or local government, or any
28 organization with authority to license or discipline the members of a profession may not prohibit,
29 impose any penalty, or take any adverse action against any individual who gives or receives
30 counsel, advice, guidance, or any other speech or communication, whether described as therapy
31 or provided for a fee, consistent with conscience or religious belief.
32 "§ 90-21.143. Protection of parental rights.
33 (a) Parents, guardians, or custodians, in exercising the fundamental right to care for their
34 child, may withhold consent for any treatment, activity, or mental health care services that are
35 designed and intended to form their child's conceptions of sex and gender or to treat gender
36 dysphoria or gender nonconformity. The State, its agents, and political subdivisions shall not
37 infringe upon or impede the exercise of this right under this section.
38 (b) No government agent, nor any employee of this State, any political subdivision of this
39 State, or any other governmental entity, except for law enforcement personnel, shall encourage
40 or coerce a minor to withhold information from the minor's parent. Nor shall any such employee
41 withhold from a minor's parents information that is relevant to the physical or mental health of
42 their child and of a sort that parents interested in and responsible for the well-being of a minor
43 reasonably would demand and should be apprised of. Such conduct shall be grounds for
44 discipline of the employee, in addition to any other remedies provided to a parent under this
45 Article.
46 (c) If a government agent has knowledge that a minor under its care or supervision has
47 exhibited symptoms of gender dysphoria, gender nonconformity, or otherwise demonstrates a
48 desire to be treated in a manner incongruent with the minor's sex, the government agent or entity
49 with knowledge of that circumstance shall immediately notify, in writing, each of the minor's
50 parents, guardians, or custodians. The notice shall describe all of the relevant circumstances with
51 reasonable specificity.
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1 "§ 90-21.144. Whistleblower protection.
2 (a) No person shall be discriminated against in any manner because the person does any
3 of the following:
4 (1) Provided, caused to be provided, or takes steps to provide or cause to be
5 provided to his or her employer, the Attorney General, any State agency, the
6 United States Department of Health and Human Servi