Last week’s federal ruling blocking part of HB2  for three defendants in the ongoing lawsuit was seen as a victory for LGBT people and their advocates.
But beyond putting part of HB2 on hold, the fight over the injunction also revealed some of the essential motivations of the state, which has variously defended HB2 as “common sense,” as necessary for privacy and to protect women and young girls.
With the issue now before the court, the state has revealed its official position: There are no transgender people – just delusional, mentally ill people who shouldn’t be encouraged.
“The norm for human development is for one’s thoughts to align with physical reality, and for one’s gender identity to align with one’s biologic sex,” wrote the state’s expert, Dr. Quentin L. Van Meter. “Gender identity that does not match natal sex is a mental disorder, previously called Gender Identity Disorder.”
The term “Gender Identity Disorder” was changed to “Gender Dysphoria” in 2012, when the American Psychiatric Association stopped considering it a mental disorder.
Instead, the association’s Diagnostic and Statistical Manual of Mental Disorders now describes dysphoria as the distress that comes from “incongruence between one’s experienced/expressed gender and assigned gender.”
The APA also released guidelines for treatment of transgender patients that includes affirming rather than trying to change their gender identity and a statement affirming transgender care and civil rights.
But ignoring the APA’s official position – and the consensus of the scientific community on any number of important issues – isn’t an anomaly for Van Meter. It’s a calling.
Van Meter is vice president of the American College of Pediatricians, a group of a few hundred conservative doctors who split from the much larger and more widely respected American Academy of Pediatrics in 2002. That’s when the AAP issued a statement in support of gay and lesbian parents being able to legally adopt children, prompting an insurrection among its more socially conservative members.
It’s now legal for same-sex couples to marry and adopt in all 50 states – societal changes that were opposed by Van Meter’s group. The group has also promoted  “reparative therapy” programs designed to make lesbian, gay and bisexual people heterosexual. Those are now widely rejected by mainstream science.
In their crusades the group has repeatedly  been criticized  by scientists, including the National Institute of Health, who say the group distorts and misrepresents their work toward its own political ends.
The group regularly goes far afield of its claimed scientific expertise to make the sort of nakedly political arguments most scientific groups avoid.
In a brief in the Obergefell v. Hodges  case, which would lead to the legalization of same-sex marriage, the group argued it was concerned for “the stability of families, the safety of children and our constitutional republic.”
The well-being of our constiutional republic is generally considered outside the purview of pediatricians.
The group has been designated an “anti-LGBT hate group”  by the Southern Poverty Law Center, one of a number of organizations which helps the FBI identify groups that “attack or malign an entire class of people, typically for their immutable characteristics.”
But the state asserts that transgender people are not, in fact, a class with immutable characteristics. Their brief goes on to say the vast majority of children who experience gender dysphoria will grow out of it if they are not encouraged.
That flies in the face of the the latest scientific consensus, established professional guidelines for treatment of transgender people and the experiences of doctors who work with transgender patients.
Dr. Deanna Adkins helped establish Duke Child and Adolescent Gender Care at Duke University Hospital last year. She is providing expert testimony in the federal case against HB2.
Since she started working with transgender patients five years ago, she has helped more than 120 patients transition. Her team includes psychologists, psychiatrists, licensed clinical social workers and Family Practice doctors.
Adkins works with children, adolescents and teens experiencing gender dysphoria. While she waits until they are 16 before beginning hormonal transitioning, she said that in her experience feelings of dysphoria that begin in children almost always persist until they are addressed.
“The best medical literature shows that treating dysphoria and helping them to transition has a 70-80 percent efficacy,” Adkins said. “Why would we ignore that? Especially when forty percent of them attempt suicide and many more, I’m sure, succeed.”
What Adkins is able to do for those transitioning is, in some cases, delay puberty to prevent the development of secondary sex characteristics that would further contribute to dysphoria. She can also induce a sort of “second puberty” using hormone treatments that are already standard for cancer patients and those born without functioning ovaries or testes.
This helps transgender patients’ bodies align with the gender identity, alleviating dysphoria.
“It’s something I already do with a different population,” Adkins said. “It seems wrong to me – ethically wrong – not to treat someone in this sort of distress, someone who might die, if I can treat them.”
Before transgender patients make it to Adkins or the small number of other physicians in the state who currently do transgender work, they begin with counselors, therapists and licensed clinical social workers.
Tavi Hancock  is one such social worker.
But Hancock doesn’t just work with transgender patients. Hancock is also transgender.
Assigned female at birth, Hancock now identifies as non-binary transgender, neither male nor female. Hancock prefers the pronouns “they/their/them” to “she” or “her.”
Hancock saw their first transgender patient in 2008. Now almost all of the 20-25 patients they see in a week are transgender or gender non-conforming. That’s at least partially because those patients feel more comfortable talking with someone who has themselves transitioned, Hancock said.
Too few therapists and social workers have training or experience in dealing with transgender patients, Hancock said. Even fewer are themselves transgender.
Hancock began their own transition four years ago. Working with transgender patients helped them get in touch with their own gender identity and helped them to come out – first to their family and friends and then to everyone.
It was a scary decision, Hancock said – it wasn’t clear what it would mean for them personally or professionally. But ultimately embracing their true gender identity helped them both personally and in their practice, which now treats patients as young as 9 and as old as mid-60s.
Ignoring or waiting out gender dysphoria doesn’t work, Hancock said – and in their experience with transgender patients, it can often have disastrous results.
“I haven’t seen anyone yet who could successfully ignore it,” Hancock said. “I have talked to people who tried to repress it, who tried to change things within themselves because they were afraid of what it would mean to try and live as their authentic selves. It takes a huge toll.”
Shana Gordon-Cole, a Licensed Professional Counselor-Supervisor with Tree of Life Counseling  in Greensboro, agrees.
“I’ve seen an Army Ranger come to me saying that they tried to repress these feelings, tried to go way into a whole other, masculine direction,” Cole said. “I’ve seen people come to me saying they thought they were just a tomboy or a butch lesbian, but in the end they have to deal with that dysphoria.”
Transgender people are often already struggling with inner turmoil over their identity, Hancock said. They may also be experiencing family and peer pressure and are disproportionately likely to be victims of violence and sexual assault. Laws like HB2 seem like just another assault, Hancock said.
People who are now supporting the law – and the doctors who are arguing for it – will likely realize their error eventually, Hancock said.
“They clearly have an agenda that isn’t based on science and this is the same exact approach and strategy was used against gay and lesbian people,” Hancock said. “I think that most people now realize that was wrong. I know that they’ll realize this is false too – I just hope it happens sooner rather than later.”
That sort of social acceptance may take a while. But legally speaking, the days of laws like HB2 may be numbered.
In his 81-page ruling last week, federal Judge Thomas Schroeder concluded those challenging HB2 “are likely to succeed” in arguing HB2 violates Title IX, the federal law against gender discrimination in public education.
The judge also cast doubt on one of the key arguments advanced by conservative state leaders in defense of HB2 – that it is a “common sense” measure necessary to protect women and young girls from potential predators who would, if transgender people were allowed to choose the bathroom consistent with their gender identity, have free rein.
“And although Defendants argue that a preliminary injunction will thwart enforcement of such safety laws by allowing non-transgender predators to exploit the opportunity to cross-dress and prey on others,” Schroeder wrote “… the unrefuted evidence in the current record suggests that jurisdictions that have adopted accommodating bathroom access policies have not observed subsequent increases in crime.”
That didn’t keep conservative leaders from declaring victory.
They celebrated that the injunction only pertains to the three defendants in the current suit – Joaquin Carcaño, a transgender man employed at UNC-Chapel Hill, Hunter Schafer, a transgender woman who is a student at the UNC School of the Arts High School in Winston-Salem and Payton McGarry, a transgender man who studies at UNC-Greensboro.
LGBT advocacy groups like Equality NC said the injunction was effectively the death knell for HB2.
“Today’s decision is an important step towards rectifying the harm HB2 has done to North Carolina — specifically the LGBTQ people that call North Carolina home,” said Equality NC Director of Advancement Matt Hirschy in a statement following the ruling.
“Judge Schroeder’s decision confirms that HB2 is a blatant attack on the transgender community,” Hirschy said. “The preliminary injunction will provide much-needed relief to the brave plaintiffs, and we are confident that this is just the beginning in an unfortunately long journey towards a full repeal of the worst anti-LGBTQ law in the nation.”