Taxpayer Philanthropy: North Carolina paying trans nonprofit despite ban

North Carolina state law strictly forbids body-altering gender treatments on children younger than 18, including puberty blockers, hormones, and surgeries. Health and Human Services says the grant only covers adult mental health services, but it has not explained how that's being policed. The agency also has not produced any oversight records.

"Under the age of 18," reads text on the Charlotte nonprofit’s website, "medical providers coordinate care with mental health providers to support youth and families in making decisions about timing, puberty suppression, or initiating hormone therapy."

Other information on the website suggests children as young as infants and toddlers can be treated with "gender-affirming care" – which critics of pediatric gender medicine say likely means steering them on a pathway where drugs and surgeries would be eventual options. The site even lists healthcare providers for kids.

"It's shocking," said Tami Fitzgerald, executive director of NC Values Coalition, a conservative Christian nonprofit that was instrumental in passing the 2023 ban law and lobbied for other anti-transgender measures passed by North Carolina. "It's obvious from the latest bills from the General Assembly on this topic that this violates the spirit of these laws and the public policy of the state."

Charlotte Transgender Healthcare's executive director, and several of its doctors, did not respond to interview requests from The Center Square.

Health and Human Services refused to make any of its officials available for interviews, answering questions only through a spokesman, and only by email.

Asked how the state ensures grant money isn't intermingled with the nonprofit's outreach to children, spokesman James Werner sent a statement saying in part, "This contract is subject to the Department’s standard business practices for administrative and financial oversight of contractors providing community-based services to help ensure services are provided and funding is used in accordance with the contract terms."

The contract terms say performance will be monitored through reviews of required reports and site visits. Werner did not respond to a question about whether the state has conducted any such reviews or site visits.

Message to the public

On its website, Charlotte Transgender Healthcare, which also goes by Charlotte Trans Health, describes itself as "a compassionate collective of healthcare providers" dedicated to advancing "health equity for transgender and gender diverse individuals through education, advocacy, and accessible, affirming care." The site has a "Find a Provider" directory that connects people with doctors, psychologists, therapists, counselors and other health professionals.

"On the website, it was alarming that they actually have a drop-down box for age categories, so you can look up your provider according to what age the patient is," Fitzgerald said. "And I was shocked to see that they have children included there, because we have outlawed gender transitioning for minors in North Carolina."

Fifty-three healthcare professionals in the directory, including four medical doctors, have profiles saying they have "gender-affirming care competency" for patients ages 17 and younger. Twenty-one say they see patients 10 and younger. Six, including one medical doctor, say they serve ages 0 to 3.

The nonprofit's executive director, psychologist Holly Savoy, declined to explain to The Center Square what kind of gender-affirming care toddlers and elementary school-aged children might receive.

Savoy's own website profile says she has advanced competency for treating youth ages 11 to 17, plus adults over 18. Among her listed services are "Transition/Affirmation Letters for Hormone Therapy," "Transition/Affirmation Letters for Surgery," and "Therapy for Parents."

Savoy did not respond to phone messages or an email with detailed questions.

Source of funds

North Carolina's Republican-controlled General Assembly passed its ban on child gender transition treatments, House Bill 808, in 2023. The governor at the time, Democrat Roy Cooper, vetoed the bill, but the legislature overrode him by a vote of 27-18 in the Senate and 74-45 in the House.

That put North Carolina among 27 states that have enacted laws which, to varying degrees, ban youth access to medical gender treatments.

The new law made it illegal for medical professionals to perform surgeries on minors or prescribe puberty-blocking medications or hormones. The penalty is revocation of medical license, and the law lengthened civil liability for harm to patients to 25 years past their 18th birthday, or four years after discovery of injury.

In a clause aimed at preventing the state health insurance plan from paying for any such procedures, the bill added that, "No State funds may be used, directly or indirectly, for the performance of or in furtherance of surgical gender transition procedures, or to provide puberty‑blocking drugs or cross‑sex hormones to a minor."

The very next year, with the executive branch still under Gov. Cooper, the North Carolina Department of Health and Human Services took applications for community-based mental health block grants. The grants come from a pot of federal funds from the U.S. Substance Abuse and Mental Health Services Administration, or SAMHSA, which gives North Carolina about $29 million per year, Werner, of Health and Human Services, told The Center Square in emails.

Charlotte Trans Health received three years of funding, starting with $780,000 paid in fiscal years 2025 and 2026, and another $500,000 slated for payment in 2027, Werner said.

"It's very simple," Fitzgerald, of the Christian conservative group, said of the contradiction between state law and the grant award. "We have a state legislature that is conservative and really has followed and sought to advance family values. And we have a governor that is a radical and has sought to advance every LGBT cause known to man," which she said goes for both former Gov. Cooper and current Gov. Josh Stein.

The payments represented a significant budget boost for the nonprofit. According to its publicly available Form 990s, revenues totaled $226,030 in 2023 and $737,611 in 2024. It's unclear if any portion of the North Carolina mental health services grant is included in the 2024 figure. The 990 says government grants totaled $573,234 that year, or 78% of revenue.

Contract 'complies with regulations'

Asked if the state grant complies with state law against gender transition treatments, Werner said in an email that the nonprofit has a contract with a limited scope of services—and it's only for treating adults.

The contract, which he provided, lists nine performance requirements. Among them: linking 60 people to support services for housing, employment, and financial assistance; providing 105 individual counseling sessions and 24 group counseling sessions; distributing educational materials to improve healthcare providers' understanding of transgender and gender-diverse issues; and buying $30 gift cards for community advisory board members who take part in focus groups to give feedback on the nonprofit's services.

"Funds allocated to Charlotte Transgender Healthcare Group are used for adult mental health services including case management, psychotherapy, and linkage to medical services limited to mental health counseling," the department's statement said.

There's a potential compliance issue, though, when it comes to President Trump's executive orders concerning federal funds, SAMHSA spokeswoman Danielle Bennett told The Center Square in an email.

"SAMHSA funds, including those provided to subrecipients of SAMHSA grants, cannot be used for any activities that violate federal law or the requirements set forth under applicable Executive Orders," she wrote. "This includes a prohibition on the use of funds to promote gender ideology or the provision of gender transition services."

An executive order from January 2025, called "Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government," contains the directive, "Federal funds shall not be used to promote gender ideology," and that each agency must "ensure grant funds do not promote gender ideology." The directive has come under legal challenge, though, with injunctions issued in Washington and Oregon.

The Center Square asked North Carolina Health and Human Services if the grant to Charlotte Trans Health conforms to the president's order.

"The Department’s contract with Charlotte Transgender Healthcare Group complies with all applicable federal and state laws and regulations, including those addressing the use of federal funds," the statement said. 

What does it mean?

Several profiles on the Charlotte Trans Health website that indicate a willingness to work with children belong to medical doctors.

Obstetrician and gynecologist Erin Cook's page says she has advanced-level gender-affirming care competency for serving children and youth ages 4 to 17. One of her listed services is "Hormone Replacement Therapy for Teens."

The page for family physician Carson Rounds says he has advanced gender-affirming care competency for youth ages 11 to 17, and intermediate competency for children 4 to 10. His list of services also includes hormone replacement therapy for teens, as well as "Puberty Suppression."

One medical doctor's profile on the site, for family medicine physician Rhett Brown, says he has advanced competency for ages 0-3, as well as youth up to age 17.

None of those doctors responded to messages from The Center Square seeking input for this story.

The website also has an "important notice" at the bottom saying it's "not designed to promote or endorse any medical or healthcare practice, program, or agenda, or any medical tests, products, or procedures. Nothing on this website should be construed by you to be a promotion, endorsement, or advertisement for any particular practice, provider, or procedure."

Leor Sapir, a senior fellow at the Manhattan Institute who has studied pediatric gender medicine in depth, skimmed the group’s website and said it’s not immediately clear if Charlotte Trans Health is performing any treatments on children that are banned by state law.

"Either they’re speaking out of both sides of their mouth, or they’re being deliberately vague," he said.

Social transition

Oregon pediatrician Julia Mason, a founding board member of the Society for Evidence Based Gender Medicine, called claims of competency in advising parents of babies and toddlers "disturbing."

There are no medical interventions normally offered to infants and prepubescent children, according to Mason, whose nonprofit argues that the use of hormones, puberty blockers and surgeries to treat youth with gender dysphoria lacks sufficient evidence of safety or efficacy.

The Charlotte nonprofit's website is likely alluding to socially transitioning young children, she said, which could mean telling them they were born in the wrong body and changing their names, hairstyles, clothing and pronouns to match the opposite sex.

"Social transition concretizes an identity that otherwise could have been temporary," Mason said. "So kids who are young enough to believe in Santa Claus will truly believe the parents and adults in their life who tell them that when they're older, the doctors will change their sex."

The Center Square reached out to several pro-LGBTQ groups for this story, but received no responses from ACLU of North Carolina, Equality North Carolina, Campaign for Southern Equality, Lambda Legal or the World Professional Association for Transgender Health.