North Carolina, Are You Better Than This?
On the heels of recent legislation forcing people to use the public restroom that corresponds to their sexual organs rather than their gender identity and bars cities from passing ordinances that say otherwise, the backlash is growing in North Carolina. Organizations important to the state—including American Airlines, Apple, PayPal and others—are voicing their opposition to the new law vigorously. And prominent individuals like Roy Cooper, North Carolina’s attorney general, have stated in public, “We’re better than this.”
Whether Mr. Cooper and other North Carolina residents who believe in inclusiveness will eventually prevail remains to be seen.
There are a variety of angles from which the new law just doesn’t make sense. We won’t venture into the political or religious space—plenty of people cover those arenas already. We can’t resist commenting on the utter stupidity angle, though, at least briefly, on our way to discussing a medical aspect of this new development.
One bit of so-called reasoning behind the law is to protect women born female from transgender women (presumably people who appear to be female but have male genitalia) who are hell bent on rape. Hmmm. So people who go through all the angst to undertake a transition from male to female are inclined to rape other women? Do they change their gender identity specifically for the increased opportunities to rape? Why not just dress as a woman and sneak into the restroom?
Maybe the North Carolina legislature was also concerned that men who simply claim to be transgender would enter women’s restrooms and locker rooms with nefarious plans. Wouldn’t the ostracism those guys face in many situations be enough of a deterrent? And if not, if people aren’t around to observe what’s going on, couldn’t a guy just barge in anyway? We fail to see much in the way of increased safety here.
Under the new law, there is one portion of the transgender population allowed to use the restroom that corresponds to their new gender: those who have undertaken genital surgery and petitioned the court to change their birth certificate. This provision fits the “utter stupidity” angle too, because many who consider themselves transgender do not elect surgery for a variety of sensible reasons, including:
- Sex change surgery—bottom surgery—is expensive, and even with insurance coverage there are often very significant out-of-pocket expenses
- While techniques are constantly improving, genital surgery is still in its infancy and results may or may not meet individuals’ expectations
Possibly the leading reason people cite for bypassing genital surgery is that being able to live authentically is enough. That is, being recognized and accepted as the gender they know themselves to be allows them to be satisfied with their lives. A recent article in the Huffington Post referenced a report in Time magazine last year that stated only about a third of transgender individuals seek surgery.
Society is gradually learning that sexuality spans a spectrum of possibilities rather than being the binary condition once thought. For many transgender individuals, simply changing their outward appearance is enough. Dressing differently and taking hormones are often choices that bring increased satisfaction. Some transgender individuals seek “top surgery” – meaning breast enlargement for male to female and breast reduction for female to male people. We have increasing opportunities to consult with transgender people in New York about these plastic surgery options, as well as facial feminization, liposuction and other cosmetic procedures that may be appropriate.
But here’s the point we wanted to make all along, and it’s that the North Carolina law can have an adverse impact on the health of transgender individuals. It’s no secret that transgender people tend to experience mental health challenges, drug abuse and a suicide rate that’s higher than for the rest of society. One reason is that these citizens must often live in ways that invalidate who they really are—from children and teens being forced to wear clothing that’s not right for them to people of all ages having their choice of restroom mandated.
Shouldn’t our goal as a society be to explore the truth behind what it means to be transgender and to help in ways we can? In our plastic surgery practice in New York, none of us is transgender. But we are excited to be learning and finding ways to help—including counseling patients about whether surgery is right for them, helping them understand what different procedures entail and even finding financing if needed. We are proud to be able to play a role for some people on this critical journey.
So, North Carolina, what do you say? Are you proud to be the “Pioneer in Bigotry” the New York Times christened you last month? Or can you make the decision to learn and to find ways to help instead of creating legislation that harms your own citizens? Are you really better than this?
