Why the American Academy of Pediatrics opposes North Carolina’s transgender “bathroom law”

Claire McCarthy, MD

Senior Faculty Editor, Harvard Health Publishing

We’ve been hearing a lot about the North Carolina law that says that transgender people who haven’t taken surgical or legal steps to change the gender on their birth certificate can’t use the public restroom of the gender with which they identify. It has caused a firestorm — and has even led to companies like PayPal and Deutsche Bank cancelling plans for expansion in the state, and many entertainers cancelling appearances there.

One group that has come out squarely against the law is the American Academy of Pediatrics, a nonprofit organization representing 64,000 pediatricians across the United States. Their reason is very simple: discrimination against transgender youth can cause real harm.

No matter what anyone believes or feels about being transgender, the fact is that there are many adolescents who clearly identify as transgender — that is, they feel very strongly that the gender on their birth certificate is the wrong one. For these adolescents, and for their families, this is as true about them as the color of their eyes or skin — and just as unchangeable.

It’s also a fact that for any adolescent, being bullied and feeling unsupported leads to mental health problems. Lesbian, gay, bisexual, and transgender (LGBT) adolescents are not only often bullied or unsupported, they are often victims of violence. According to the Centers for Disease Control and Prevention (CDC), studies show that as many as a quarter of LGBT adolescents have been threatened or hurt with a weapon on school property. These adolescents have a high risk of depression and suicide, about twice that of their heterosexual peers; among transgender adolescents, in particular, the risk of depression and suicide appears to be even higher. LGBT adolescents, when rejected by their family, often find themselves homeless; a 2012 study found that 40% of homeless adolescents were LGBT.

Laws like the North Carolina law and other similar measures working their way through state legislatures across the country make things worse by, as AAP CEO Dr. Karen Remley says, “creating a hostile environment for transgender adolescents, all implying the same message: ‘You’re different, something is wrong with you, you need to change in order to fit in here.’”

Our message to transgender adolescents, says Dr. Remley, should be that we support them and will stand up for them.

Which should be our message to all adolescents, no matter what. That’s our responsibility as a society, after all: to take care of all of our adolescents. When we discriminate against any group, it undermines our ability to protect anyone. The AAP points out that this law could also have unintended effects on adolescents with gender-related genetic disorders or children with disabilities who need a different-sex parent to help them in the bathroom. That’s the thing: laws that discriminate put us on a very slippery slope.

Those who support the law cite concerns about privacy and safety, and we certainly want to protect privacy and safety. But there are ways (like bathroom stalls, which most bathrooms have) to do that without causing harm to transgender adolescents and adults.

Just last week, a federal appeals court said that a Virginia transgender teen can sue his school for refusing to let him use the boys’ bathroom, because requiring transgender students to use a bathroom that corresponds with their biological sex violates Title IX, which prohibits sex discrimination at schools that receive federal funding. This ruling will make the North Carolina law very difficult, if not impossible.

“Pediatricians in North Carolina and across the country know what children need,” said Dr. Remley. “They need the stability and support of nurturing adults, they need the acceptance and compassion of their peers and community, and they need to feel safe where they live and where they learn.”

That is what all children need. Every last one.


  1. Alvin H Hartness, MD, FAAP

    Please note I feel that AAP has taken a stand which will continue to undermine the stability of children and families and bring about more confusion in our already confused society. Whenever federal edicts tell our parents and children how to behave, how to go to the bathroom, etc, and then threaten and punish them and the schools and the states, then who are the worst of the abusers, bulliers and harassers??
    Individuals who have these trans issues certainly need more accepting and help, but there on those who are pushing to bring all this attention on them unfairly. To do so points to the whole issue of self advancement for unhealthy publicity. That’s why we have health professionals for their counseling and help. Not the federal government!!!
    How many more freedoms will we lose for the sake of less than 1% of society taking their political agendas just for their own selfish interest and their rights to the detriment of the rest of society rights?
    We must stand up against this tyranny of our federal government and I hope our AAP will take a more sober look at this issue.

  2. Suresh Bhave

    There are several mistaken notions around.
    Firstly, the notion that non-profit organizations are, somehow, intellectually superior. The fact is that the members of these organizations are well-heeled and need no profit. What they need is free publicity.
    Secondly, the idea of personal freedom extends to being different from the vast majority of the people. That certainly is not so.
    Thirdly, the governments are always oppressive and every move the government makes must be opposed.
    Obviously, the second and third ideas are not always incorrect, but that must be decided on the merit of each case.
    If a boy thinks he is a girl or vice-versa, the physical facts notwithstanding, the pediatric specialists must work to remove the boy’s or girl’s mistaken notion.

  3. Lynda Hash Peoples

    I value my privacy and I hope that there is a peaceful resolution to this problem.
    Right now, I am deeply troubled by the fact that there are those who believe that all Christians are alike and are prejudiced against transgender people. Nothing could be farther from the truth. You don’t know all of us, so please don’t lump us all together and try to be fair.
    In doing so, please remember that we all have rights.

  4. Burmese Days

    The American Academy of Pediatrics is a silly organization and this is reliable proof that no one should ever take them seriously on any subject whatsoever.

    Men who think they are women are not women, but are still men. Sorry, folks. It’s just basic reality. People who can’t see that are simply not thinking people.

  5. PC

    The statement “the fact is that there are many adolescents who clearly identify as transgender” is misleading to say the least. Show me the fact, please. What is the statistics or research that led you to make that conclusion?

  6. janice

    Your message to women is that you don’t give a dam about our safety or our lives.

  7. Nancy Corley

    While HB2, passed in a rushed special session by NC conservatives, attempts to pre-empt many federal civil rights laws, Part II of the bill removes many labor/employment protections. This and the pre-emption of powers of local goverments in NC are the real reasons for this law. The “bathroom,” provisions were put in as a smokescreen so that people wouldn’t notice the rest of the bill, which is quite egregious in giving control to a highly conservative, Koch-sponsored legislature. Local governments must now defer to the state ( legislature) on most issues. We are right to be concerned,not only for our children, but for ourselves.

  8. FL-NY

    If your child sees a transgendered person in the bathroom and asks why is she/he here, you can tell them exactly what my 9 and 11 year olds told me:”transgendered is when a boy is born with a boy’s body but his brain is a girl, and vice versa”. And that was it. Very accepting. Let’s learn with those who are young because they are kind and tolerant – unless we teach them otherwise that is.

  9. Karly

    The new laws are absurd as they say that anyone who merely “thinks” he or she really is of the opposite sex can use that shower room, locker room, bathhouse, or restroom of that sex.
    So a man who just sincerely “thinks” he is a woman can go into a bathhouse and undress in front of a couple of twin 11 year old girls and take a shower.
    You have to be pretty clueless and insensitive to women and children to allow that or similar situations.
    Restrooms and the like have never been a problem for 99.99% of people.
    Liberals and the LGBTQ community have dreamed up this crazy issue as part of a plan to wreck the social structure.

    • Syed

      absolutely agree

    • Jennifer Alcorta-Smith

      Well said!!!! But hey I’ve seen the parade and pickets thrown by this groups with all the indecent clothes, sexual behavior and tools out in public on the streets! They don’t care that our kids shouldn’t be exposed to such stuff so do we honestly think anyone would care about children’s safety?

  10. Shelagh Watkins

    There’s a straightforward and simple solution to the problem of who uses which bathroom. ALL male bathrooms should be reassigned unisex bathrooms. Any female, ALL trans folk — irrespective of their stage of transition — and all males would have access to the unisex bathrooms. Female bathrooms do not have urinals and male bathrooms have adequate stalls, so there would be no need for anyone other than females born as females to use the female bathrooms, removing any excuse for a male to enter areas designated female only. This solution would only cost the replacement of the male sign with a unisex one. Perfect!

    • Elizabeth Percival

      It would solve or at least help the long lines problem at the women’s bathrooms too.

      • Anessa

        As a trans woman, I’m not comfortable using the bathroom with men. The constant threat of assault is present (and has been a reality for me, unfortunately), and while I appreciate the thought behind your proposed solution, it’s not a viable one. I think the solution is single, unisex bathrooms anyone can access everywhere. Really, all I want to do is do my business and leave.

      • Jennifer Alcorta-Smith

        Anessa my daughters and me are females born females and we are not comfortable nor safe with men using our bathroom!!!! I’ll tell you one thing tho. I’d rather be raped 100x over than any child once!!! I wouldn’t dare set up a child for danger! In which you are asking to happen by allowing men rights to go in with babies and women!! Get over yourself!! There’s more important issues than you or even me. CHILDREN

    • Joan Masover

      I’d feel kinda sorry for guys standing at the urinal when a woman walks into the unisex bathroom. I don’t really have a smart idea about this other than to say that the laws seemed to be attempting to solve a problem that didn’t exist. If I’ve seen trans women when I’m in the ladies’ room, I haven’t even noticed it.

      • Mary Horn

        I was shocked when at a club in Dallas, TX, I went into a unisex restroom without doors. But no problem! I did my business regardless of who was there and it was no problem. This was at least 22 years ago. I have not been damaged by this experience and I continued to frequent said club weekly. No issue. I was born female and see myself as female, but I am very protective and compassionate of transgendered people. Yes, straight people have rights as do LGBTQ people. I hope that as a society we can stop looking at how to keep another group down so that one group can reign supreme. We are not Hitler, folks. Relax already and get over your sense of entitlement!


    The American College of Pediatricians issued a sharply worded statement warning against any policies that condition children to accept transgenderism as normal.

    “Conditioning children into believing a lifetime of chemical and surgical impersonation of the opposite sex is normal and healthful is child abuse,” the statement said.

    One of the statement’s three co-authors is John Hopkins Medical School professor Paul McHugh. The former chief psychiatrist at John Hopkins Hospital, McHugh has long warned that sex-reassignment operations ignore and even worsen a patient’s underlying problems. Monday’s statement made a similar point: “Facts — not ideology — determine reality.”

    “When an otherwise healthy biological boy believes he is a girl, or an otherwise healthy biological girl believes she is a boy, an objective psychological problem exists that lies in the mind not the body, and it should be treated as such,” the doctors went on to say.

  12. Sue Limmer

    Well, it does give more reason to take your healthy child to a doctor doesn’t it? The American College of Pediatricians states that gender ideology harms children.

    • Jennifer Simonds

      The American College of Pediatricians is a small group that was formed in 2002 to protest the AAP’s endorsement of gays being able to adopt children. IOW, the ACP is a social-conservative protest group.

      More pertinently, their recent position paper on the transgendered is filled with bald assertions backed up with outdated data and half-truths.

  13. Ben

    What a fuss!
    Personally I don’t go around in rest rooms looking at men’s privates to see what they are biologically. If they have the plumbing use it. If not sit on a throne like I do. (I just cannot pee in public so to speak).
    Undoubtedly many are genuinely concerned about inappropriate sitautions arising, but let’s get our brains in gear and sort out the practicalities so posed. Many places already have unisex toilets so what is the big deal? Perhaps schools and the like just don’t want to spend the money providing for suitable facilities? I suspect though that much of this has to do with hysteria brought on by a selfish and uncaring attitude and that is really poor.
    In case anyone is wondering about me, and much as I dislike labels I will use some jargon to give you some idea. I am a Born Again, Bible believing Evangelical, Spirit filled 60 year old male Christian and Jesus said “Love one another” so that is what I do.


      It is NOT you anyone is worried about …..it is about exposing CHILDREN to what they should never be exposed to

      • Mary Horn

        Santa Fe Sue,

        European sexuality is so less taboo than it is in our country and I doubt you would consider them a group of countries that are degenerates or perverts.

        How did it come to be that the people who are LGBTQ are considered child molesters and dangers to society’s children. Likely it was propaganda put out by our government or religious groups or conservatives who have no clue of what they are talking about. It may be of interest to you that we (I am bisexual) like adults for our sexual partners as well as for flirting, dating and marriage. Perverts are found all over the world in straight and non straight people.

        If you are religious, check out the Catholic Church and how they handle finding out one of their priests is abusing children. They MOVE THEM TO ANOTHER CHURCH rather than REMOVE THEM FROM THIER RIGHT TO LEAD and THEY ALLOW SAID PRIESTS TO CONTINUE TO HAVE ACCESS TO CHILDREN in a role that should be safe for children to be alone in their company.

        Another note on religious perspective, since when is behaving in such an ugly manner toward the LGBTQ community or individuals any type of similar to “WHAT JESUS WOULD DO,” if He were here today? Oh that’s right, He would sit and dine with them and make them feel comfortable. This is in direct contrast to how the Church folks treat homosexuals and other members of the LGBTQ community today, all in the name of good old Christianity.

        If homosexuality is in fact a sin, and I am not convinced it is, since when did it become the number one sin of this century? Doesn’t the Bible say that all sins are equal? Yet, church leaders are preaching from the pulpit to hate these individuals and are focusing in on this as the number one agenda item of this century. I wonder why? Is Christianity in fact a cafeteria plan where you all get to pick and choose what items from the Bible you have to obey and which you can get away with breaking and still feel upright as you walk around calling yourselves Christians? To me you all act like the Pharasees and not Jesus-like at all. If Jesus came back here, would He toss you out of the church as well for what evil and hatred is in your heart (and evident in your actions)? Or would He be proud to call you one of His followers? Look at the PLANK in your own eye before you go around scowling at the SPLINTER in anyone else’s eye!

  14. C.E.

    I’m willing to bet that those saying it’s ok for Trans people to go to RR of choice and that choice included locker rooms/showers they would not be so quick to say That was okay

  15. steve

    One pRobles- there isnt, nor has there ever been, any discrimination against transgenders. This is a made up controversy by the bat-chit crazy lib crowd, half of which are housed at the Harvard Institute.

    • Sally Sue

      Cue Cis gender privilege. Zero clue to the existence and denial of an actual problem. I imagine you probably are white as well. So white male privilege=completely clueless. I’d say educate yourself but we all know that isn’t going to happen. Just stay in your bunker and never leave. The rest of us would appreciate it.

      • Saitlykitiz

        Man, I’m sure glad I’m not a white male in today’s society. Those poor guys can’t say anything right unless they agreed with the liberal left.

  16. KD

    Kathleen, I think you don’t actually know what transgender means. My trans friends who transitioned from female to male are big dudes with full beards. Are you saying little girls in the ladies room would think – ” oh yes, those big bearded guys belong in the girls bathroom with me because they were assigned female sex at birth.”
    The function of the law is to bully trans people and invade their privacy. There are ZERO cases of trans people assaulting someone in a bathroom. People who want to assault women – usually cisgendered men- will do so. And we already have laws against assault, right??
    If you are looking at someone’s genitalia in the ladies room, I think you are the unsafe person. I typically only see people washing their hands, myself.

  17. Kathleen Rosing

    What about the trauma to a child seeing a person of the “opposite sex” in their “sex assigned” bathroom??? What is wrong with having “sex neutral” bathrooms to we can be sensitive to all persons! Why is it ok to discriminate against mainstream but not others….

    • Ann

      HI Kathleen,

      Someone who is transgender is not going to appear to a child to be a person of the opposite sex in the bathroom with them. Based on the trans people I know, it would be far more shocking for a child to see a trans person in the bathroom corresponding with the what is on their birth certificate. If a little boy, or any male, saw a trans woman in the men’s room, that person might feel uncomfortable about using a urinal in front of her.

      • KB NP

        That is exactly right. Each person should decide which is the most comfortable, appropriate and safe restroom for them in a given place on a given day. For those who present very much as one gender or the other, it would most likely be uncomfortable for all and quite possibly dangerous to enter the restroom of the opposite gender just because that was the sex assigned at birth.

    • C.E.

      Might work to have instead of traditional restrooms and stalls, to have that equal number of single hole “closets” lined up in a row on one or two walls, and a Shared hand washing station. Then nobody knows anything, nor “sees” anything

      • KB NP

        Indeed, in the Netherlands, each stall is an actual tiny room, with walls to the floor and ceiling. This affords additional privacy. We should be providing privacy for all students anyway, to reduce chances of bullying for all reasons.

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