Nine Years After HB2, Trans North Carolinians Wonder Who Is Looking Out For Them

One week after Donald Trump’s second inauguration, Kate went to Planned Parenthood in Wilmington for her quarterly checkup. She usually had the lobby to herself. But that day, she had trouble finding a seat.

“There were, like, twice as many people in the waiting room,” said Kate, a 25-year-old trans woman who asked to use a pseudonym for this story due to fear of persecution. “Everyone was trying to get their prescriptions and refills before any new legislation went into effect.”

Approximately 80,000 of North Carolina’s 10.5 million residents are transgender, according to an estimate from UCLA’s Williams Institute. And following Trump’s re-election, Kate is one of the thousands of trans people nationwide scrambling to get their affairs in order: changing the gender marker on her IDs, stockpiling hormones, even brushing up on self-defense. 

Amid federal efforts to undermine trans rights and limit health care, many state governments have stepped up to the plate. Virginia and Colorado have passed various protections for trans health care, while other states, like Iowa and Minnesota, now include gender identity in their nondiscrimination policies. Three states have challenged Trump’s executive order banning gender-affirming care for trans people under age 19, while over a dozen state attorneys general have ordered hospitals to continue providing care. 

North Carolina, a state once defined by its stance on transgender rights, has not. Nine years ago, the state passed House Bill 2, which required people to use the bathroom corresponding with their gender assigned at birth. The state faced nationwide backlash for doing so, including an economic boycott that analysts estimate cost the state between $450 million and $630 million in investment. 

But now, many trans North Carolinians say they have not felt the same popular support in response to the recent federal actions. Part of that is due to the Republican-dominated General Assembly, which partially repealed HB2 and later allowed it to sunset in 2020, but has passed several more laws restricting trans rights in recent years. But state Democrats, even those who made their names from vocal opposition to legislative transphobia, have seemed reluctant to touch these issues today. 

Now, Kate doesn’t really feel like anyone stands between her and the federal government. 

“In the past, you could rely on other people to back up our cause,” she told The Assembly. “But I feel like at this point, it’s kind of like we just have to do everything ourselves.”

A Ripple Effect

While Planned Parenthood is best known for offering reproductive health services like abortions and testing for sexually transmitted infections, the Wilmington office, which opened in 2005, also fulfills another vital role: It’s one of the few transgender health clinics in the region. 

“In Wilmington, there’s only Planned Parenthood or one other [doctor],” Kate said. “Like, that’s what it is.”

Planned Parenthood South Atlantic, the regional division covering the Carolinas, Virginia, and West Virginia, estimates there are closer to six or seven medical professionals offering gender-affirming care in Wilmington. But the clinic’s willingness to serve uninsured or underinsured trans people, as well as its emphasis on telehealth, has made it the regional hub for trans health care. Natalie Frazier, who runs Planned Parenthood South Atlantic’s gender-affirming program, said their reach goes well beyond Wilmington.

“We end up having patients from South Carolina coming this direction,” she said, “and the entire eastern side of North Carolina.”

North Carolina’s gender clinics are currently awaiting a court ruling on a lawsuit challenging an executive order banning federal funding for gender-affirming care to trans youth. If the ban is successful, trans youth would no longer be able to use Medicaid to cover hormone replacement therapy or gender-affirming procedures. 

Frazier told The Assembly that the Wilmington clinic would likely continue operating if the ban is imposed, as they don’t receive direct federal funding. Still, 25 percent of the clinic’s trans patients rely on Medicaid, which the clinic would no longer be able to accept. 

The Wilmington clinic has endured similar measures before: In 2023, state Republicans passed House Bill 808, which prohibited hormone replacement therapy and gender-affirming surgeries to trans people under the age of 18. Trans kids already receiving care could be “grandfathered” in, but Frazier said many hospitals stopped offering services to minors altogether, even before the ban went into effect. Some of those patients ended up at Planned Parenthood. 

“When you start talking about federal funding … it really affects those bigger hospital systems that have a broader patient base that really rely on federal funding to do their services,” Frazier said. “So if they’re not able to do [gender-affirming care] anymore, then it just creates a much smaller network of providers who are able to do that.”

She anticipates that a federal ban could create an even greater ripple effect on trans health care in North Carolina.

“We’re going to take care of all the patients we can take care of,” she said. “But there are only so many hours in the clinic day.”

Toby Wood began taking testosterone at 15, just days before HB808 went into effect.

“My therapist was like, ‘Well, there’s a problem. Next week, they’re signing this funny little law,’” Wood, now 17, told The Assembly. “I literally was grandfathered in the day before it happened.”

His provider agreed to continue providing transition services to Wood. But he still faced difficulties obtaining his prescription. The longest he had to go without testosterone was about two months. 

“I would be on the phone with the pharmacy, the doctor’s office, insurance,” he said. “They had to do so many prior authorizations.”

“We’ve had to change pharmacies before because they were outright transphobic,” said his mother, Mandy Wood. 

Kate, who’s currently a patient at Planned Parenthood, has faced similar complications. 

“Literally every time I pick up my prescriptions, [the pharmacy] will not refill my estrogen,” she said. “I have to call them and be like, ‘Hey, I have refills. What’s going on?’” 

“I’ve had it happen at least half a dozen times,” said Nicole Starr, a 37-year-old trans woman. “And then, you know, like the doctor doesn’t want to just issue more, like they have questions then, right? So it’s tremendously difficult. And, you know, fucking go through menopause every time you run out.”

After a few years of these frustrations, Starr decided to move from licensed medical professionals to DIY treatment. Instead of having to do battle with doctors and pharmacies, she’d source and administer her own hormones. 

“I gave up and was like, I need a secure supply because this is incredibly disruptive to my life if I keep running out all the time,” she said. 

Frazier told The Assembly that a lot of the hoops that trans patients have had to jump through with hospitals, pharmacies, and insurance providers boiled down to risk aversion. Over the past few years, hundreds of bills limiting access to trans care have been introduced throughout the United States. Under these circumstances, providing hormones and other gender-affirming care can look less like a necessary medical practice and more like a legal liability. 

“When you have a larger portion of your services that isn’t related to gender-affirming care, and you really rely on federal funding, then I can see those systems being a bit more risk-averse,” Frazier said. “On a central level, [providers’] attorneys say, ‘You know, this is just too high-risk, and we’re going to stop doing it.’”

Planned Parenthood also has had to weigh the legal consequences of prescribing hormone therapy during the second Trump presidency. Ultimately, it decided it could continue to operate in North Carolina. Frazier said Planned Parenthood remained resolute on providing care for trans people. 

“Unless it’s illegal, we will be doing it,” she said. 

A Wedge Issue

State Rep. Deb Butler (D-New Hanover) is one of the few out LGBTQ+ elected officials in North Carolina. Since Trump’s election, she told The Assembly that she’s been busy trying to rally support for new legislation protecting LGBTQ+ people. This year, she’s sponsored bills to repeal the gender care ban and add gender identity and sexual orientation to state nondiscrimination policies. She also wants to ban the trans panic defense, or the legal maneuver to justify violent crimes against trans people by blaming the victim’s gender identity.

Butler knows they won’t get far in the Republican-dominated General Assembly. But she thinks it’s important to do something.

“These are messaging bills until the public gets behind them fully and demands that they get a hearing,” she said. “That’s how issues come to the fore, is when the public demands it. And it honestly may take a couple more election cycles to get people’s attention on some of these issues.”

Butler, who represents most of Wilmington, was appointed to the state House in 2017, the year after HB2 first passed. The law was deeply unpopular: A 2016 Elon University poll showed only 40 percent of North Carolina voters supported HB2, and 60 percent said it had hurt the state’s reputation. Later that year, Gov. Pat McCrory, who signed HB2 into law, lost his race for re-election to Roy Cooper, who, as attorney general, pledged not to defend HB2 from legal challenges and called it “a national embarrassment.” 

Even Trump, who was running for his first term as president at the time, criticized the bill during a nationally televised town hall, saying lawmakers should have “[left] it the way it is.” But in the decade since, trans inclusion has become a wedge issue. Nationally, voters have grown much more divided on trans rights: A 2022 NPR poll, for example, showed 63 percent of Americans supported the exclusion of trans women in women’s sports. It’s a similar story in North Carolina, where a recent Meredith College poll found that 57 percent of likely North Carolina voters want to regulate public bathrooms based on biological sex. 

In 2024, Republicans leaned into the debate over trans rights, pouring millions of dollars into anti-trans advertising in the weeks before the election. But where Republicans have gotten loud about the issue, many Democrats have kept mum. 

Take Jeff Jackson. The new state attorney general has long been one of the most vocal advocates for trans rights as a state senator and member of Congress. He sponsored bills in 2016 and 2017 to repeal HB2 and later proposed a plan to combat suicide and homelessness among LGBTQ+ youth. 

“I’ve seen repeated attacks—from HB2 to recent anti-trans legislation—from legislators who think they can score a few points by demeaning people,” Jackson wrote in 2021. “I am never, ever going to give those guys an inch.”

Jackson went on to beat Dan Bishop, the author of HB2, in the 2024 state race for attorney general. Jackson lambasted Bishop’s role in passing the bathroom bill on the campaign trail. But his own approach to securing trans inclusion in North Carolina was less clear. NC Health News asked Jackson whether he would defend laws that “generated controversy” in the state—specifically, the bans on gender-affirming care for trans youth, trans kids’ participation in girls’ sports, and the discussion of LGBTQ+-related topics in the classroom. Jackson stressed that he opposed anti-trans laws but said he would still defend them as AG. 

“[O]ne of the core responsibilities of the Attorney General is to represent the state,” he said. “It would be my obligation to do so even in matters in which I personally disagreed unless a law involves a clear violation of the Constitution.” 

Jackson has challenged several of Trump’s executive orders, including the attempt to ban birthright citizenship and introduce a federal funding freeze. Following the administration’s January order on gender-affirming care for young people, 15 state attorneys general signed a joint letter directing hospitals to continue providing that care. Jackson was not one of them. 

Jackson declined requests for comment and an interview from The Assembly. So did Gov. Josh Stein and Department of Health and Human Services Secretary Devdutta Sangvai. 

Butler said she remains confident that the party is “poised and ready to understand the rights of every person.”

“I can’t speak for [the Governor],” she told The Assembly. “But I know that there’s so much energy going into recovering the western part of the state. I think that’s predominating a lot of their time right now because we have a $50 billion need there at a minimum.”

HB2.0

On a warm Saturday evening in April, about 50 trans people and allies gathered on the front steps of Wilmington’s city hall. The event was billed as a protest but felt more like a cookout. Kids leaned on the Roman pillars watching Bluey on their parents’ iPads. Teenagers swapped friendship bracelets and took photos of each other’s signs. Motorists on Third Street honked and waved at the crowd, who responded with cheers.

Despite the camaraderie, there was still a noticeable tension in the air. It had been only a few days since Republican state Sen. Vickie Sawyer filed the Women’s Safety and Protection Act, or SB516, which would revive the bathroom ban and prohibit trans people from changing their gender markers on official documents. 

Cheyanne Dos Santos, a 22-year-old trans woman who organized the event to honor Trans Day of Visibility, said the bill would have a devastating impact.

“It is trying to lock out the ability for [us] to publicly and socially transition in any way that could keep us safe,” she told The Assembly. 

After the first bathroom ban, musicians canceled concerts, corporations backed out of scheduled expansions, and other states banned employees from traveling or spending money here. The NCAA, which has since barred trans women from competing in women’s sports, relocated seven championship events from North Carolina, and threatened to ban the state from hosting entirely if it didn’t repeal HB2. It was a popular movement against transphobia unlike anything seen in the United States. 

But Kate, who was then a high schooler, said she doesn’t think it’ll happen again. 

“As far as lawmakers, I think they’re scared to fight back on trans issues,” she said. “I don’t feel like it’s at the top of their agenda right now.” 

The North Carolina Democratic Party has criticized the bill. The Assembly reached out to Senate Democratic Leader Sydney Batch and House Democratic Leader Robert Reives with questions about SB 516. Reives did not respond, but Batch provided a statement stressing the importance of “real challenges North Carolina families face,” like inflation, public schools, and health care. 

“Senate Democrats believe every North Carolinian deserves the freedom to live with dignity and privacy, free from unnecessary government interference,” she wrote. “We are deeply concerned by any effort to use legislation to target individuals or communities, especially when it’s only being done to throw red meat to their political base.”

Still, the party is not entirely united behind trans rights. Democratic state Rep. Garland Pierce, who has represented Hoke and Scotland counties since 2005, voted in favor of a veto override for HB808. He was one of 11 Democratic representatives to vote for HB2 in 2016. 

North Carolina Republicans lost their veto-proof supermajority in the 2024 elections. But there are still 71 Republicans in the House, and they only need 72 votes to bypass Gov. Stein’s veto. 

It’s unclear whether the revived bathroom ban will progress. SB516, and its companion bill in the state House HB791, have yet to pass committee. For his part, Senate leader Phil Berger seemed ambivalent on the bill’s viability. Nevertheless, he told a press gaggle in March that while he hadn’t yet read the bill, he had noticed a sea change in public opinion. Other states had successfully passed bathroom bans with much less backlash. 

“The impression I’ve got is that the sort of reaction that we saw previously [to a bathroom ban] is not something that is taking place in those other places,” Berger said. “We’ll see what the caucus wants to do, and we’ll take a closer look at the bill and see where it goes.”

Even if the new bathroom bill stalls in committee, there is no shortage of anti-trans legislation to take its place. HB560, or the Parents’ Protection Act, would protect adoptive parents from abuse petitions if they intervene in a minor’s transition. HB519, or the Parents’ Medical Bill of Rights, would give parents the ability to access all of their child’s medical records, including those that their child may want to keep private. HB606 would make it easier for detransitioners, or people who choose to stop or reverse medical transition, to sue doctors who helped them transition. It would also prohibit the use of state funds for prisoners’ gender-affirming care. All three bills will likely see action in the House this week. 

Starr told The Assembly that she’s not confident that Democrats will stop anti-trans legislation.

“[With HB2], the Democratic Party was fulfilling their requirement to the voter public by gasping and covering their mouths so that they could still seem like the party of inclusivity,” she said. “[Now], I feel like [Democrats] are doing even less gasping and mouth covering and just like fully decided on their own that they had no interest in protecting trans youth. Because that was too scary of an issue.”

But she says that trans people will take care of each other no matter what. 

“None of it can erode the incredible, powerful, important effect of representation and exposure that we have enjoyed over the last decade and has saved incredible untold numbers of lives,” she said. “We know what we need, and our ability to provide it for each other has never been better.”

Dos Santos, standing with arms akimbo on the steps of Wilmington City Hall, said she wasn’t sure what the future held for trans people in North Carolina. But the lesson she learned from HB2 was that no amount of legislation or rhetoric could erase the state’s trans community.

“They think this rhetoric is going to stop trans people from existing,” she said. “I exist because of HB2. I found out what trans people were because of HB2. My partner found out what trans people were because of HB2. You’re not stopping trans people from existing by stopping us from doing things.”

Update: A spokesperson for Rep. Reives reached out to The Assembly after publication to provide the following statement: “The focus of this General Assembly’s majority continues to be finding ways to intrude on the private lives of our citizens. People should not be used as political pawns.”

Clarification: This story has been updated with more specific details about the partial repeal and later sunsetting of HB2.

Nikolai Mather covers rural politics for WHQR Public Radio in Wilmington. His work has also appeared in Teen Vogue and on NPR. He is from Pittsboro, North Carolina. Reach him at nmather@whqr.org.