New push comes even as ignorance, state-sanctioned discrimination persist
On Thursday, Democratic state lawmakers filed three bills designed to protect LGBTQ North Carolinians from discrimination , outlaw harmful “conversion” therapy  that targets them and fully repeal HB2  — the infamous law that cast an international spotlight on the state as a battleground for transgender rights.
“As a transgender woman I know that the bills filed today will have a very real impact on the lives and legal equality of LGBTQ North Carolinians,” said Allison Scott, director of policy for the Campaign for Southern Equality.
“So many attacks on the LGBTQ community are linked, rooted in the desire to wave us away,” Scott said. “The company that fires someone because of who they are, the business that refuses to sell something to a same-sex couple, the so-called ‘conversion’ therapist who tries to force someone to change a core part of themselves. The North Carolina lawmakers who try to tell me that I can’t use the women’s restroom.”
For some North Carolinians, arguments over “bathroom laws” are already a dim memory — forgotten as the white hot glare of international media attention moved on to other things. But for LGBTQ North Carolinians — especially those who are transgender — each day brings new struggles and indignities.
A transgender woman held in a men’s prison , sent to solitary confinement rather than transferred for her own safety.
State employees and their families denied coverage under the state health plan, which excludes treatment for transgender people  that their doctors call life-saving.
Transgender North Carolinians unable to get accurate ID cards and drivers’ licenses, even under revised DMV guidelines .
These are just the latest headlines in what has been, for many transgender people, a lifetime of navigating the enormous gap between how they, their doctors and science understand the reality of their lives and how policy makers insist they must live them.
“It is frustrating and humiliating, really dehumanizing to have people making decisions about your life and your health who know nothing about your life,” said Candis Cox , a transgender activist who has become one of the state’s most prominent LGBTQ voices. “But for most of us, that’s the way we’ve lived our entire lives — someone telling us who we should be, how we should be and telling us that we’re wrong.”
“You’re never enough”
This week Kanautica Zayre-Brown, a 37-year-old transgender woman, spent 25 days in solitary confinement at Harnett Correctional Institution in Lillington.
Zayre-Brown is serving a sentence for insurance fraud and obtaining property by false pretense.
But as a transgender woman, she felt unsafe showering and sleeping among men. Though many transgender people elect not to have any surgical procedures related to their transition, Zayre-Brown has had her breasts augmented and genitals altered as part of gender confirmation that also included hormone therapy. She and her husband, Dionne Brown, fear this will make her a target for harassment, assault or rape.
Despite this, the state has so far refused to recognize her gender change and continues to use her male name, which she has had legally changed. They have denied her request for transfer to a women’s prison, saying that she has “not completed” her transition.
For Cox, who has spoken with Zayre-Brown as activists and the ACLU work to secure her transfer, it is a painful reminder of the government’s fundamental misunderstanding of transgender lives.
“Not everyone who is transgender decides to have surgery,” Cox said. “I chose to do so. But I was no less a transgender woman on the day before I had my surgery than I was the day after. It is who I am. Not everyone has access to surgery. Not everyone can afford it. Not everyone wants to do it. But for our government, right now, that is how they are deciding who is transgender.”
Even Kanautica — who did have surgeries, legally changed her name and has lived for years as a woman — is not being treated as one by the prison system, Cox said.
“Kanautica is a beautiful woman,” Cox said. “She is head turning, drop dead gorgeous. And I say that only to say — what saving grace do you have? If you meet someone’s definition, society’s definition of an attractive woman, will you be safe? No. You’re still not safe. You do even the things that they say you have to do in order to be who you are, to be enough for them — and they tell you that you’re never enough.”
It’s a feeling Cox herself knows intimately.
In 2002 she went to Thailand to have gender confirmation surgery — which was then still rare in the U.S. The surgery and recovery were physically painful and mentally and emotionally taxing, she said. But when she returned home, she found she had to face a whole new struggle — getting the government to acknowledge her gender change.
“The worst part of my transition should have been going through the surgery I chose to do,” Cox said. “But after coping with all of that, I had to walk around with this letter that was very graphic — that began with ‘upon the removal of the gonads…’ and I had to present this letter to a Republican senator’s aide who was looking at me…it was awful. I had to do all this to try to get the help I needed to change my gender marker.”
Ultimately, she said, she knew she had to do it to protect herself — in case I had a run-in with law enforcement, in order to one day get married. But it felt like begging for permission to be who she was from a government that made little or no accommodation even for transgender people who “checked all the boxes.”
“I think the worst part of all of that was knowing I had to do all of that to be seen a a woman,” Cox said. “I already did all of these things to be seen as a woman — and now I had to go through all this red tape and jump through these other hoops.”
And ultimately, Cox said, cases like Zayre Brown’s show that for transgender people, even “doing everything right” doesn’t guarantee your government or society will accept you for who you are. This is especially true for transgender women of color like she and Zayre Brown, Cox said, who as a group experience the most violence, poverty and negative health outcomes of any LGBTQ people.
“A lot of these policy makers, what I see is they are okay with wrapping their head around concepts — especially when we start talking about minorities — if they are willing to play the game and ask very little of the system, contribute and be something that they can point to as some shining example that is a white-washed version of something,” Cox said. “But when we start talking about people who are navigating the actual systems of our society — like the prison system — they’re just another black criminal. They’re no longer people.”
“It makes no sense”
The process for changing gender markers has gotten a bit easier since Cox experienced it. But for some it is still complicated, difficult to understand, expensive and frustrating.
Shana Gordon is a therapist and gender specialist who has worked with transgender patients since 2008. She’s worked with more than 2,000 transgender people — helping many to begin their transition through Tree of Life Counseling in Greensboro, which she founded in 2012.
She’s acted as an advocate for some transgender people trying to change their gender markers, helping them navigate a process that she said should be simple, but still doesn’t reflect how many transgender people live.
“Trying to get people to understand this, you get all kinds of things,” Gordon said. “You get parents asking you if it is a fad, you get people talking about surgery like that is what makes you transgender. It’s difficult enough to deal with families who are really trying to understand it — dealing with people who make laws right now, trying to get them to understand gender identity and then create a system that actually works for trans people…that’s another thing.”
“It’s not insurance companies, because insurance companies want to cover this treatment,” Gordon said. “It’s not doctors and nurses — Wake Forest just brought me in to train their ICU nurses on some of this stuff. They want to help people. They want to understand. For the state to opt out of this coverage, it makes no sense.”
It’s a frustration shared by Dr. Deanna Adkins.
Adkins is a pediatric endocrinologist who helped establish Duke Child and Adolescent Gender Care at Duke University Hospital last year. With more than 300 transgender patients now being treated at her clinic, Adkins is one of the most widely-sought medical experts on the issue in the state.
“It’s very frustrating,” Adkins said. “The government is saying they can’t possibly be transgender if they haven’t ‘completed’ their transition by having a surgery — and many of these surgeries are not available because they’ve been excluded from coverage in their health policies.”
“They have to pay for all of this out of their own pockets and they don’t even have access to simple medications that are very inexpensive that could treat their dysphoria,” Adkins said. “Because it’s written off as, ‘Oh, that’s going to be too expensive.’ It’s much cheaper than having them in-patient somewhere being treated at $5,000 a week because you didn’t treat their dysphoria.”
Talking about transition only in the way in which it relates to surgery is not a scientific conversation, Adkins said. Those who work with transgender patients recognize that the issue is much more complicated.
“Everyone’s path is different,” Adkins said. “Your path may wander many different ways compared to other people. You may take different roads. You may take the hormone split when you’re 17, the top surgery split when you’re 20. But everyone’s path is different along the way. Peoples’ lives change, surgeries change — how do we tell these people they can’t be transgender unless they have certain surgeries and have certain surgeries right now?”
Beyond the gap
Many advocates talk with frustration about a gap in understanding of transgender issues that leads to bad policy.
Kendra Johnson, executive director of LGBTQ advocacy organization Equality NC, rejects that idea.
“It’s discrimination,” Johnson said. “There no gap in knowledge. The information has been out there. It’s clear. Policies have been set in other places. It’s a struggle. But there’s an opportunity to do the right thing. So it’s simply discrimination.”
People who are state employees should have access to the full range of care under their health plan, regardless of whether they or their dependents are transgender, Johnson said. Transgender people in prisons should be safe and treated with dignity. Their identities should be respected. It’s that simple, she said.
Cox agrees, though she said it’s far clearer for the young people now fighting for equality than the generation making laws and policies.
“I already see a lot of differences in generations between like the millennials and even younger kids coming up now who are dealing with their gender identity and expression,” Cox said. “They are seeing the LGBTQ community mainstreamed, seeing acceptance like never before.”
“I didn’t grow up with RuPaul’s Drag Race,” Cox said. “Even though I’m not a drag queen, that has really opened up people to having a greater understanding of gender, gender expression, the LGBTQ community. People are having discussions they never had before.”
From there, she said, it’s about more informed leaders — and voters putting those people into positions to create change
“The real progress is getting progressive people into positions where they’re making the laws,” Cox said. “They already get it.”