North Carolina’s gender law, House Bill 805, redefines sex under state law as strictly biological male or female, bars state funds from paying for gender-affirming surgery, puberty blockers, or cross-sex hormones for minors and incarcerated people, changes how amended birth certificates are issued, and sets new rules for public schools. It was enacted as Session Law 2025-84 after the General Assembly overrode Governor Josh Stein’s veto on July 29, 2025. Different sections took effect at different times, with the core definition of sex applying to all state rules and policies beginning January 1, 2026.1North Carolina General Assembly. House Bill 805
How HB805 Defines Sex
The statute (N.C. Gen. Stat. ยง 12-3.3) defines “biological sex” by “sex chromosomes, sex hormones, gonads, and nonambiguous internal and external genitalia present at birth.” “Gender identity” is defined as “an individual’s self-declared identity” and is “not to be treated as legally or biologically equivalent to sex.” From January 1, 2026, every North Carolina administrative rule, regulation, and public policy must recognize only two sexes.2Wake Forest Law Review. HB 805: North Carolina Law Says Boys Will Be Boys3UNC School of Government. H805 Bill Summary
One downstream effect legal observers have flagged: because the “assault on a female” Class A1 misdemeanor enhancement applies only when a male at least 18 years old assaults a female, defining transgender women as legally male removes them from that protection. The same definition may also generate equal-protection challenges around public facilities and identification documents.2Wake Forest Law Review. HB 805: North Carolina Law Says Boys Will Be Boys
Birth Certificates
Beginning December 1, 2025, when someone changes the sex listed on their North Carolina birth certificate, the State Registrar must attach the new certificate to the original and preserve them as a single multi-page document. Every certified copy issued afterward has to include the full multi-page version. State Senator Graig Meyer has warned that this format could complicate job applications, passport applications, and other processes that rely on the birth certificate as identification.4North Carolina General Assembly. H805 Enrolled Text5ABC11. NC Gender Identity Law Takes Effect
State Funding for Gender-Affirming Care
HB805 prohibits the use of state funds, directly or indirectly, for surgical gender transition procedures, puberty-blocking drugs, or cross-sex hormones for minors. The same ban applies to anyone incarcerated in a state prison, held under the Statewide Misdemeanor Confinement Program, or otherwise in the custody of the Department of Adult Correction. A narrow exception permits state funds to treat “medical complications resulting in imminent physical harm,” including infections, injuries, or disorders caused by previously performed or privately funded transition procedures.6North Carolina General Assembly. H805 Enrolled Text
The Department of Adult Correction has reported that some incarcerated people receive hormone replacement therapy, but no state funds had ever paid for gender-affirming surgeries before the law passed.7North Carolina Health News. NC Senate Republicans Seek to Define Biological Sex
The State Health Plan
HB805 initially exempted the State Health Plan for Teachers and State Employees from the funding ban, but the exemption was written to expire 30 days after the injunction in Kadel v. Folwell was vacated or no longer in force. That injunction had required the State Health Plan to cover transition-related care. On June 30, 2025, the U.S. Supreme Court vacated the underlying Fourth Circuit ruling and remanded the case in light of its decision in United States v. Skrmetti. The Fourth Circuit then vacated the district court’s original order, and the State Health Plan reinstated its exclusion of transition-related treatments.8NC State Health Plan. Decision in Kadel Case9North State Journal. State Health Plan Ruling Vacated by SCOTUS
Malpractice Rules for Gender Transition Procedures
The law sets a 10-year statute of limitations for malpractice actions related to gender transition procedures, prohibits medical professionals from seeking liability waivers, and exempts these claims from the noneconomic damage caps that ordinarily apply to medical malpractice suits in North Carolina.3UNC School of Government. H805 Bill Summary
Public School Provisions
Public school units must adopt policies prohibiting students from sharing sleeping quarters with a member of the opposite biological sex during school-authorized overnight events, unless the students are immediate family members or a parent has given written permission. Parents may request that a child be excused from classroom discussions, activities, or readings that burden religious beliefs or invade student privacy. Local school boards must also provide searchable online catalogs of library books, and parents may restrict their child from borrowing specific titles.3UNC School of Government. H805 Bill Summary
The Other Half of the Bill: Online Pornography
HB805 is titled “Prevent Sexual Exploitation/Women and Minors,” and a separate section enacts the “Prevent Sexual Exploitation of Women and Minors Act.” That part requires operators of online platforms to verify that people depicted in pornographic images are at least 18 and have given explicit written consent, sets up removal procedures for images upon request, and imposes civil penalties of $10,000 per day per image for violations. This section has no connection to the gender-identity provisions but is part of the same law.3UNC School of Government. H805 Bill Summary
The Federal Lawsuit Over Prison Care
On February 12, 2026, the ACLU of North Carolina and Emancipate NC filed Kwiatkowski v. Dismukes in federal court, challenging Section 3 of HB805 on behalf of five incarcerated people diagnosed with gender dysphoria: AJ Kwiatkowski, Ashlee Inscoe, Pumpkin Snuggs, Lulubell Frazier, and Tremayne Izzard. The complaint argues that the ban on state-funded gender-affirming care in prisons violates the Eighth Amendment, because the state is constitutionally required to provide medically necessary care to people in its custody. The plaintiffs have moved for a preliminary injunction and requested class certification.10ACLU of North Carolina. Advocates Seek to Reinstate Gender-Affirming Care for Incarcerated People in NC11Emancipate NC. Challenging Section 3 of HB 805
On March 19, 2026, a U.S. magistrate judge granted top legislative leaders the right to intervene in the case to defend the statute. Legislators argue the law is a valid exercise of appropriations authority, is rationally related to legitimate government interests, and should be dismissed on procedural grounds.12Carolina Journal. Prisoners Seek Injunction, Class Action in NC Gender Transition Suit
Related Laws Already in Effect
HB808: Ban on Gender-Affirming Care for Minors
House Bill 808 (Session Law 2023-111) took effect August 16, 2023, after the General Assembly overrode Governor Roy Cooper’s veto. It makes it unlawful for medical professionals to perform surgical gender transition procedures on minors or prescribe puberty blockers or cross-sex hormones to them, with license revocation as the penalty. Minors who were already undergoing treatment before August 1, 2023, are exempt. A patient has a 25-year window, measured from the age of 18, to bring a civil action against a provider who violates the ban.13North Carolina General Assembly. HB808 Enrolled Text14North Carolina Health News. Transgender Youth Dealing With Medical Whiplash
Lambda Legal and the National Health Law Program filed a federal challenge on October 11, 2023. The Supreme Court’s June 2025 decision in United States v. Skrmetti, which upheld Tennessee’s similar ban against an equal-protection challenge, weakened the legal footing of such suits. As of mid-2026, 25 state bans on gender-affirming care for minors remain in effect nationwide, with only Montana and Arkansas holding active court injunctions on different legal grounds.15KFF. Gender-Affirming Care Policy Tracker
HB574: Transgender Sports Ban
The “Fairness in Women’s Sports Act” was enacted on August 16, 2023, also by veto override. It prohibits transgender female athletes from playing on women’s teams at the middle school, high school, and college levels. Participation is limited to teams matching biological sex at birth, though female athletes may play on male teams. Intramural sports are excluded.16North Carolina General Assembly. HB574 Ratified Text
The law covers public schools, charter schools, regional and laboratory schools, and any private school that belongs to an organization administering interscholastic athletics. At the college level, it reaches UNC system institutions, community colleges, and private colleges. A student who loses an athletic opportunity because of a violation may sue for injunctive relief and actual damages, including compensation for psychological and emotional harm.16North Carolina General Assembly. HB574 Ratified Text
SB442: Parents Protection Act
Senate Bill 442 is the one recent gender-related bill Governor Stein signed rather than vetoed. Effective July 3, 2025, it prohibits child abuse or neglect petitions based on a parent “raising a juvenile consistent with the juvenile’s biological sex.” Both the misdemeanor and felony child abuse statutes now specify that referring to a child by their biological sex, or making mental health and medical decisions based on it, does not constitute abuse, and that raising a child consistent with biological sex does not constitute “serious mental injury.”17North Carolina General Assembly. Session Law 2025-59
The law also bars adoption and foster care agencies from denying placements based on a prospective parent’s refusal to support a child’s gender transition. It applies retroactively to petitions and placements filed before, on, or after the effective date. Stein said he signed the bill because he believes “parents have the right to raise their children as they deem best,” while vetoing HB805 the same day.18WHQR. Governor Stein Signs Parents Protection Act
How Providers and Federal Policy Are Shaping Access
The practical availability of gender-affirming care in North Carolina has narrowed beyond what state law alone requires. Advocate Health, which operates Atrium Health, restricted gender-affirming care for patients under 19 in August 2025. UNC Health began notifying patients of service discontinuation in September 2025. Both cited concerns about the federal regulatory environment under the Trump administration. Duke Health has kept its policy unchanged but reports significant appointment backlogs from increased demand.19NC Newsline. Trans Youth Under 19 Left With Few Options for Gender-Affirming Care in NC
The federal Department of Health and Human Services has proposed further limits on access to gender-affirming care for minors. North Carolina Attorney General Jeff Jackson has not joined the multi-state federal lawsuit challenging those actions, so providers and patients in the state are not covered by any active injunction against them.19NC Newsline. Trans Youth Under 19 Left With Few Options for Gender-Affirming Care in NC
North Carolina has no statewide nondiscrimination law covering gender identity. Local ordinances in Durham, Greensboro, Charlotte, Asheville, Chapel Hill, Winston-Salem, and other jurisdictions prohibit discrimination on that basis in employment, housing, or public accommodations, though enforcement is local and their constitutionality has not been formally tested.20Brooks Pierce. North Carolina Municipalities Pass Anti-Discrimination Ordinances