No. 16-273
`
`IN THE
`Supreme Court of the United States
`GLOUCESTER COUNTY SCHOOL BOARD,
`Petitioner,
`
`v.
`G.G., BY HIS NEXT FRIEND AND MOTHER, DEIRDRE
`GRIMM,
`
` Respondent.
`On Writ of Certiorari to the United States Court of
`Appeals for the Fourth Circuit
`
`
`BRIEF FOR THE WORLD PROFESSIONAL
`ASSOCIATION FOR TRANSGENDER HEALTH
`ET AL. AS AMICI CURIAE SUPPORTING
`RESPONDENT
`
`
`
`
`
`THOMAS M. HEFFERON
` Counsel of Record
`GOODWIN PROCTER LLP
`901 New York Ave., N.W.
`Washington, DC 20001
`thefferon@goodwinlaw.com
`(202) 346-4000
`
`Counsel for Amici Curiae
`
`(Additional Counsel Listed On Signature Page)
`
`March 2, 2017
`
`
`
`

`

`
`
`TABLE OF CONTENTS
`
`PAGE
`INTEREST OF THE AMICI CURIAE ....................... 1
`SUMMARY OF ARGUMENT ..................................... 4
`ARGUMENT ............................................................... 5
`I. Medical Science Recognizes The Reality
`Of Transgender
`Identity And The
`Importance of Supporting Transgender
`Persons
`In Living Healthy Lives
`Consistent With Their Gender Identity. ......... 5
`II. Gender Transition
`Is The Only
`Recognized Safe And Effective Treatment
`For Gender Dysphoria. ..................................... 8
`III. The School Board’s Policy Conflicts With
`The Standards Of Care And Harms
`Transgender Students. ................................... 13
`CONCLUSION .......................................................... 17
`
`
`
`
`
`

`

`ii
`TABLE OF AUTHORITIES
`
` Page(s)
`
`Cases
`De’Lonta v. Johnson,
`708 F.3d 520 (4th Cir. 2013) ................................ 10
`Fields v. Smith,
`712 F. Supp. 2d 830 (E.D. Wis. 2010),
`aff’d 653 F.3d 550 (7th Cir. 2011) ....................... 11
`Soneeya v. Spencer,
`851 F. Supp. 2d 228 (D. Mass. 2012) ............. 10, 11
`
`Other Authorities
`Am. Med. Ass’n House of Delegates, Resolution
`122 (A-08) Removing Financial Barriers to
`Care for Transgender Patients (2008), avail-
`able at http://www.tgender. net/taw/ama_ res-
`olutions.pdf .......................................................... 10
`Am. Med. Ass’n, Policy No. H-160.991, Health
`Care Needs of the Homosexual Population
`(2012), https://searchpf.ama-assn.org/
`SearchML/ searchDetails.action? uri=%2
`FAMADoc%2FHOD.xml-0-805.xml ................... 8, 9
`Am. Psychiatric Ass’n, Diagnostic and Statistical
`Manual of Mental Disorders (5th ed. 2013) .......... 7
`
`
`
`

`

`iii
`Am. Psychological Ass’n, Guidelines for
`Psychological Practice with Transgender
`and Gender Nonconforming People, 70 The
`Am. Psychologist 832 (2015) available at
`https://www.apa.org/ practice/guidelines/
`transgender.pdf .............................................. 5, 6, 8
`Am. Psychoanalytic Ass’n, Position Statement on
`Attempts to Change Sexual Orientation,
`Gender Identity, or Gender Expression
`(2012), http://www.apsa.org/content/2012-
`position-statement-attempts-change-sexual-
`orientation-gender-identity-or-gender .................. 9
`Am. Psychological Ass’n, Report of the APA
`Task Force Report on Gender Identity and
`Gender Variance 52-53 (2009), available
`at https://www.apa.org/pi/lgbt/resources/
`policy/gender- identity-report.pdf ..................... 6, 10
`Am. Psychological Ass’n & Nat’l Ass’n of Sch.
`Psychologists, Resolution on Gender and
`Sexual Orientation Diversity in Children
`and Adolescents in Schools (2015),
`http://www.apa.org/about/policy/orientati
`on-diversity.aspx .................................................... 6
`Am. Sch. Counselor Ass’n, The School
`Counselor and LGBTQ Youth 37-38 (2016),
`https://www.school counselor.org/asca/med
`ia/asca/PositionStatements/PS_LGBTQ.pdf ........ 9
`
`
`
`

`

`iv
`Peggy T. Cohen-Kettenis et al., The
`Treatment of Adolescent Transsexuals:
`Changing Insights et al., The Treatment
`of Adolescent Transsexuals: Changing In-
`sights, 5 J. of Sexual Med. 1892 (2008) ....... 6, 7, 10
`Hilary Daniel & Renee Butkus, Am. College
`of Physicians, Lesbian, Gay, Bisexual,
`and Transgender Health Disparities: Ex-
`ecutive Summary of a Policy Position Pa-
`per from the American College of Physi-
`cians, 163 Annals Internal Med. 135
`(2015), available at http://annals.org/
`article.aspx?articleid=2292051 .............................. 9
`Wylie C. Hembree et al., Endocrine Treatment
`of Transsexual Persons: An Endocrine Soci-
`ety Clinical Practice Guideline, 94(9) J.
`Clinical Endocrinology & Metabolism 3132
`(2009), available at http://bit.ly/2lmCmfO ......... 10
`David A. Levine & Committee on Adoles-
`cence, Am. Acad. of Pediatrics, Technical
`Report, Office-Based Care for Lesbian,
`Gay, Bisexual, Transgender, and Ques-
`tioning Youth, 132 Pediatrics e297 (2013),
`available at http://pediatrics.aappublicat
`ions.org/content/ pediatrics/132 / 1/
`e297.full.pdf .................................................. 6, 7, 10
`Mohammad Hassan Murad et al., Hormonal
`therapy and sex reassignment: a systemic
`review and meta-analysis of quality of life
`and psychosocial outcomes, 72 Clinical
`Endocrinology 214, 214–231 (2010) ...................... 9
`
`
`
`

`

`v
`Nat. Ctr. for Transgender Equality, The Report
`of the 2015 U.S. Transgender Survey (2016),
`http://www.transequality.org/sites/default/
`files/docs/usts/USTS%20Full%20Report%20-
`%20FINAL%201.6.17.pdf .................................... 15
`Ira B. Pauly, The Current Status of the
`Change of Sex Operation, 147 J. Nervous
`& Mental Disease 460 (1968) ................................ 4
`Kristie L. Seelman, Transgender Adults’ Access
`to College Bathrooms and Housing and the
`Relationship to Suicidality, 63 J. Homosexu-
`ality 1378 (2016), available at
`http://www.tandfonline.com/doi/pdf/10.1080/0
`0918369.2016.1157998?needAccess=true ........... 12
`Substance Abuse & Mental Health Servs.
`Admin., Ending Conversion Therapy:
`Supporting and Affirming LGBTQ Youth
`(2015) available at http://store.samhsa.
`gov/ shin/content//SMA15-4928/SMA15-
`4928.pdf ................................................ 4, 5, 8, 9, 10
`World Professional Association for Trans-
`gender Health, Standards of Care for the
`Health of Transsexual, Transgender, and
`Gender-Nonconforming People (2012),
`available at http://www.wpath.org/ upload-
`ed_files/140/files/Standards%20of%20Care,
`%20V7% 20Full%20Book.pdf. ............. 1, 11, 12, 14
`
`
`
`
`

`

`
`
`INTEREST OF THE AMICI CURIAE1
`The World Professional Association
`for
`Transgender Health (WPATH), formerly known as
`the Harry Benjamin International Gender Dysphoria
`Association, is an international professional associa-
`tion with membership consisting of more than 900
`physicians, psychologists, social scientists, and legal
`professionals. To further WPATH’s mission to pro-
`vide
`evidence-based
`research and
`care
`for
`transgender health, WPATH develops and publishes
`the medical consensus for best practices to promote
`health, research, education, respect, dignity, and
`equality for transgender people. WPATH’s Standards
`of Care for the Health of Transsexual, Transgender,
`and Gender-Nonconforming People (Standards of
`Care)2 is widely recognized in the medical communi-
`ty as the authoritative standard for the provision of
`transgender health care.
`(Whitman-
`The Whitman-Walker Clinic
`Walker) is a non-profit, community-based Federally
`Qualified Health Center serving the Washington
`D.C. metropolitan area, suburban Maryland, and
`northern Virginia. Established in 1973, Whitman-
`Walker is nationally renowned for its commitment to
`LGBT health and to HIV and sexual health care.
`Whitman-Walker is also home to one of the nation’s
`
`1 All parties consented to the filing of this brief. No counsel for
`a party authored any portion of this brief. No party and no oth-
`er entity, except amici and their counsel, made any monetary
`contribution toward the preparation or submission of this brief.
`2 WPATH, Standards of Care for the Health of Transsexual,
`Transgender, and Gender-Nonconforming People (2012) (Stand-
`ards of Care), available at http://www.wpath.org/ upload-
`ed_files/140/files/Standards%20of%20Care,%20V7%20Full%20
`Book.pdf.
`
`
`
`

`

`2
`oldest medical-legal partnerships and is active in le-
`gal matters of concern to the LGBT community, in-
`cluding access to healthcare, protections against dis-
`crimination, and transgender legal issues. Whitman-
`Walker’s Youth Services team provides free care nav-
`igation, school-based and site-based health promo-
`tion and mental health services for LGBT youth and
`young adults.
`The Mazzoni Center, founded in 1979, is the on-
`ly health care provider in the Philadelphia region
`specifically targeting the unique health care needs of
`the LGBT community by providing comprehensive
`health and wellness services in an LGBT-focused en-
`vironment while preserving the dignity and improv-
`ing the quality of life of the individuals it serves.
`Mazzoni’s Pediatric & Adolescent Comprehensive
`Transgender Services program, also known as
`PACTS, provides a comprehensive approach to ad-
`dressing the specific needs of transgender youth and
`their families. PACTS’ collaborative approach to care
`draws on the input and expertise of multiple de-
`partments within the Mazzoni Center—medical pro-
`viders, social workers, therapists, and legal staff—to
`provide the best possible care for clients. PACTS cur-
`rently serves 354 youth, ranging in age from 4 to 20,
`along with their families.
`The Child and Adolescent Gender Center
`(CAGC) at UCSF Benioff Children’s Hospital is a col-
`laboration between UCSF and community organiza-
`tions. CAGC offers comprehensive medical and psy-
`chological care, as well as advocacy and legal sup-
`port, to gender nonconforming and transgender
`youth and adolescents. CAGC opened in May 2012
`and currently serves over 250 patients, ranging in
`age from three to twenty-two. The healthcare team
`
`
`
`
`
`

`

`3
`at CAGC provides consultation to other providers
`around the United States regarding affirming medi-
`cal treatment and hormone therapy for transgender
`patients. Most recently (in 2015) Dr. Rosenthal,
`CAGC’s Medical Director, and three principal inves-
`tigators were awarded a $6 million grant from the
`National Institutes of Health (NIH) for a longitudi-
`nal consortium study of transgender adolescents and
`young adults. Dr. Rosenthal is the principal investi-
`gator for the CAGC site.
`The Center for Transyouth Health and De-
`velopment at Children’s Hospital Los Angeles pro-
`motes healthy futures for transgender youth by
`providing services, research, training, and capacity
`building that is developmentally informed, affirma-
`tive, compassionate, and holistic for gender noncon-
`forming children and transgender youth. The Center
`is the largest clinic of its kind in the United States
`and is currently serving approximately 500 patients.
`The healthcare team at the Center provides consul-
`tation to other providers around the United States
`regarding affirming medical treatment and hormone
`therapy for transgender patients. Most recently (in
`2015) Dr. Johanna Olson, the Center’s Medical Di-
`rector, and three principal investigators were award-
`ed a $6 million grant from the NIH for a longitudinal
`consortium study of transgender adolescents and
`young adults.
`Amici have a substantial interest in this case as
`organizations dedicated to promoting and improving
`the health and well-being of transgender individuals
`(in particular, transgender adolescents), and as
`community-based health centers providing medical
`and mental health services to transgender individu-
`als, including adolescents and young adults. To that
`
`
`
`
`
`

`

`4
`end, several amici have regularly filed amicus briefs
`in cases, like this one, that raise issues of significant
`concern to amici and the individuals they serve. See,
`e.g., Kosilek v. O’Brien, No. 14-1120 (U.S.); Carcano
`v. McCrory, No. 16-1989 (4th Cir.); Tovar v. Essentia
`Health, No. 16-3186 (8th Cir. 2016).
`Amici submit this brief to explain the medical
`consensus and scientific evidence concerning the
`treatment of transgender adolescents and the man-
`ner in which the Gloucester County School Board’s
`policy undermines the health of transgender citizens
`like Gavin Grimm.
`SUMMARY OF ARGUMENT
`Transgender people have been part of every hu-
`man culture. In the United States, however, the
`medical community did not recognize the existence of
`transgender persons until the late nineteenth centu-
`ry. Medical professionals in this country historically
`viewed being transgender as a pathology to be cor-
`rected or “cured.”3 Today, medical science recognizes
`that being transgender is a natural part of human
`diversity and that, with proper support, transgender
`people are healthy, contributing members of society.4
`
`3 See Ira B. Pauly, The Current Status of the Change of Sex Op-
`eration, 147 J. Nervous & Mental Disease 460, 465-66 (1968)
`(discussing how “well-meaning therapists” attempted “to ‘cure’”
`transgender patients by attempting to realign their gender
`identities with the sex assigned at birth, and in doing so caused
`harm).
`4 See, e.g., Substance Abuse & Mental Health Servs. Admin.,
`Ending Conversion Therapy: Supporting and Affirming LGBTQ
`Youth 11 (2015) (SAMHSA, Ending Conversion Therapy),
`available at http://store.samhsa.gov/shin/content//SMA15-4928/
`SMA15-4928.pdf (“[V]ariations in gender identity and gender
`
`
`
`
`
`

`

`5
`Particularly since the 1960s, significant advances in
`research about transgender people and their medical
`needs have affirmed that transgender Americans are
`entitled to the same dignity and respect afforded to
`all people. Based on the contemporary scientific un-
`derstanding
`of
`sex, gender dysphoria, and
`transgender persons, the medical community recog-
`nizes that the purpose of medical care is to support
`the health and well-being of transgender individuals,
`thereby enabling them to live consistently with their
`gender identity, just as other men and women do.
`How society treats our transgender members, includ-
`ing students, can either undermine or support that
`goal, with lifelong consequences for both the individ-
`uals affected and the larger society.
`ARGUMENT
`MEDICAL SCIENCE RECOGNIZES THE
`REALITY OF TRANSGENDER IDENTITY
`AND THE IMPORTANCE OF SUPPORT-
`ING TRANSGENDER PERSONS IN LIV-
`ING HEALTHY LIVES CONSISTENT
`WITH THEIR GENDER IDENTITY.
`
`I.
`
`Gender identity is a person’s inner sense of be-
`longing to a particular gender.5 It is an innate, deep-
`ly felt, and core component of human identity that is
`
`expression are a part of the normal spectrum of human diversi-
`ty and do not constitute a mental disorder.”)
`5 See Am. Psychological Ass’n, Guidelines for Psychological
`Practice with Transgender and Gender Nonconforming People,
`70 The Am. Psychologist 832, 834 (2015) (APA Guidelines)
`available at https://www.apa.org/practice/guidelines/trans
`gender.pdf (“Gender identity is defined as a person’s deeply felt,
`inherent sense of being a girl, woman, or female; a boy, a man,
`or male; a blend of male or female; or an alternative gender.”).
`
`
`
`
`
`

`

`6
`fixed at an early age.6 At birth, infants are as as-
`signed an identity of male or female based on a cur-
`sory observation of their external genitalia.7 That
`identification is then recorded on the person’s birth
`certificate. Everyone has a gender identity, and for
`most people, their gender identity is consistent with
`their sex assigned at birth. Transgender people,
`however, have a gender identity that is different
`from the sex they were identified as, or assumed to
`be, at birth.8
`
`
`6 See Am. Psychological Ass’n & Nat’l Ass’n of Sch. Psycholo-
`gists, Resolution on Gender and Sexual Orientation Diversity in
`Children and Adolescents in Schools (2015), http://www.apa.org/
`about/policy/orientation-diversity.aspx (“a person’s gender iden-
`tity develops in early childhood”). A growing body of scientific
`research has concluded that gender identity likely has a strong
`biological basis. Am. Psychological Ass’n, Report of the APA
`Task Force Report on Gender Identity and Gender Variance 52-
`53
`(2009)
`(APA Task Force Report), available at
`https://www.apa.org/pi/lgbt/resources/policy/gender- identity-rep
`ort.pdf (“Research has begun to identify some unrelated, possi-
`bly biologically based characteristics of children and adults with
`GID, suggesting that GID may have a biological basis as well.”
`(citation omitted)); Peggy T. Cohen-Kettenis et al., The Treat-
`ment of Adolescent Transsexuals: Changing Insights, 5 J. of
`Sexual Med. 1892, 1895 (2008) (“Biological factors do seem to
`play a role and may contribute to persistent GID.” (citations
`omitted)).
`7 APA Guidelines 862 (“Sex (sex assigned at birth): sex is typi-
`cally assigned at birth (or before during ultrasound) based on
`the appearance of external genitalia.”)
`8 See id. at 863 (“Transgender: an adjective that is an umbrella
`term used to describe the full range of people whose gender
`identity and/or gender role do not conform to what is typically
`associated with their sex assigned at birth.”); see also David A.
`Levine & Committee on Adolescence, Am. Acad. of Pediatrics,
`Technical Report, Office-Based Care for Lesbian, Gay, Bisexual,
`Transgender, and Questioning Youth, 132 Pediatrics e297, e298
`
`
`
`
`
`

`

`7
`The medical diagnosis of gender dysphoria refers
`to the often severe emotional distress resulting from
`this difference, or incongruity. People diagnosed with
`gender dysphoria have an intense and persistent dis-
`comfort with the primary and secondary sex charac-
`teristics of their birth sex. Gender dysphoria is a se-
`rious medical condition codified in the DSM-5.9
`Gender dysphoria was previously referred to as
`“gender identity disorder,” or “GID.” The American
`Psychiatric Association changed the name and diag-
`nostic criteria for this condition to reflect that gender
`dysphoria “is more descriptive than the previous
`[DSM] term gender identity disorder and focuses on
`dysphoria as the clinical problem, not identity per
`se.”10 Like the American Psychiatric Association, all
`major professional associations of medical and men-
`tal health providers share this view.11 They recog-
`nize that having a gender identity that differs from a
`person’s sex assigned at birth is not in itself a disor-
`der, but that the associated distress is a medical
`condition requiring appropriate treatment that af-
`firms the person’s gender identity.12
`
`
`(2013) (AAP Technical Report), available at http://pediatrics.
`aappublications.org/content/ pediatrics/132 / 1/e297.full.pdf (“For
`transgender individuals, their gender or identity does not
`match their natal sex.”).
`9 See Am. Psychiatric Ass’n, Diagnostic and Statistical Manual
`of Mental Disorders 451-59 (5th ed. 2013) (DSM-5).
`10 DSM-5, at 451.
`11 See sources cited infra note 16.
`12 DSM-5, at 451-453; see also Cohen-Kettenis 1893 (many of
`the problems transgender youth struggle with are “the conse-
`quence rather than the cause” of their gender dysphoria).
`
`
`
`
`
`

`

`8
`II. GENDER TRANSITION IS THE ONLY
`RECOGNIZED SAFE AND EFFECTIVE
`TREATMENT FOR GENDER DYS-
`PHORIA.
`
`According to the established medical consensus,
`the only effective treatment for the disabling experi-
`ence of gender dysphoria is to provide medical and
`social support to enable the transgender person to
`live authentically, based on his or her core identity.13
`A person’s gender identity is an innate, deeply-rooted
`aspect of who that person is, and cannot be changed.
`Appropriate treatment does not attempt to realign
`an individual’s gender identity to be consistent with
`physical sex characteristics, and past efforts to do so
`have caused individuals extraordinary harm and an-
`guish. “[C]onversion therapy—efforts to change an
`individual’s sexual orientation, gender identity or
`gender expression—is a practice that is not support-
`ed by credible evidence and has been disavowed by
`behavioral health experts and associations.”14 Today,
`
`13See APA Guidelines 846 (“Research has primarily shown posi-
`tive treatment outcomes when [transgender] adults and adoles-
`
`cents receive [transgender]‐affirmative medical and psychologi-
`
`cal services (i.e. psychotherapy, hormones, surgery…)”); SAM-
`HSA, Ending Conversion Therapy 25 (“There is also scientific
`consensus that for many people, medical intervention in the
`form of hormone therapy or gender affirming surgeries may be
`medically necessary to alleviate gender dysphoria.”).
`14 SAMHSA, Ending Conversion Therapy 1. Therapy seeking to
`realign an individual’s gender identity has been expressly re-
`jected by the American Medical Association, the American
`Academy of Pediatrics and all other leading medical profession-
`al organizations. See, e.g., Am. Med. Ass’n, Policy No. H-
`160.991, Health Care Needs of the Homosexual Population
`(2012), https://searchpf.ama-assn.org/SearchML/ searchDetails.
`action?uri=%2FAMADoc%2FHOD.xml-0-805.xml (“Our AMA . .
`
`
`
`
`
`

`

`9
`medical professionals recognize that treatment must
`respect the person’s gender identity and support the
`person’s ability to live consistently with that identi-
`ty.
`is well-
`for gender transition
`The protocol
`established and highly effective.15 That protocol is
`
`. opposes[] the use of ‘reparative’ or ‘conversion’ therapy for
`sexual orientation or gender identity.”); Hilary Daniel & Renee
`Butkus, Am. College of Physicians, Lesbian, Gay, Bisexual, and
`Transgender Health Disparities: Executive Summary of a Policy
`Position Paper from the American College of Physicians, 163
`Annals Internal Med. 135, Appendix (2015), available at
`http://annals.org/article.aspx?articleid=2292051 (“Available re-
`search does not support the use of reparative therapy as an ef-
`fective method in the treatment of LGBT persons. Evidence
`shows that the practice may actually cause emotional or physi-
`cal harm.”); Am. Sch. Counselor Ass’n, The School Counselor
`and LGBTQ Youth
`37-38
`(2016), https://www.school
`counselor.org/asca/media/asca/PositionStatements/PS_LGBTQ.
`pdf; Daniel & Butkus 37 (“The College opposes the use of ‘con-
`version,’ ‘reorientation,’ or ‘reparative’ therapy for the treat-
`ment of LGBT persons”); Am. Psychoanalytic Ass’n, Position
`Statement on Attempts to Change Sexual Orientation, Gender
`Identity, or Gender Expression (2012), http://www.apsa.org/
`content/2012-position-statement-attempts-change-sexual-orien
`tation-gender-identity-or-gender
`(“Psychoanalytic
`technique
`does not encompass purposeful attempts to ‘convert,’ ‘repair,’
`change or shift an individual’s sexual orientation, gender iden-
`tity or gender expression. Such directed efforts are against fun-
`damental principles of psychoanalytic treatment and often re-
`sult in substantial psychological pain by reinforcing damaging
`internalized attitudes.”).
`15 See Mohammad Hassan Murad et al., Hormonal therapy and
`sex reassignment: a systemic review and meta-analysis of quali-
`ty of life and psychosocial outcomes, 72 Clinical Endocrinology
`214, 214–231 (2010) (meta-analysis reporting that 80% of par-
`ticipants receiving trans-affirmative care experienced an im-
`proved quality of life, decreased gender dysphoria, and a reduc-
`tion in negative psychological symptoms); SAMHSA, Ending
`
`
`
`
`
`

`

`10
`codified in the Standards of Care developed by
`WPATH, and is broadly recognized as the acceptable
`and appropriate treatment for gender dysphoria.16
`
`Conversion Therapy 48-49 (“[T]he research showing positive
`effects for these interventions are based on protocols that re-
`quire supportive, gender-clarifying therapy and a psychologi-
`cal/readiness evaluation”) (emphasis in original).
`16 See, e.g., Am. Med. Ass’n House of Delegates, Resolution 122
`(A-08) Removing Financial Barriers to Care for Transgender
`Patients 1 (2008), available at http://www.tgender.net/taw/ama_
`resolutions.pdf (“[WPATH]” is the leading international, inter-
`disciplinary professional organization devoted to the under-
`standing and treatment of gender identity disorders, and has
`established internationally accepted Standards of Care for
`providing medical treatment for people with GID [that] are rec-
`ognized within the medical community to be the standard of
`care for treating people with GID.” (footnotes omitted)); APA
`Task Force Report 32 (“The Standards of Care reflects the con-
`sensus in expert opinion among professionals in this field on
`the basis of their collective clinical experience as well as a large
`body of outcome research . . . .”); AAP Technical Report e301
`(the Standards of Care “integrate the best available evidence
`with clinical experience from experts in the field of assisting
`transgender patients with transition.”);Wylie C. Hembree et al.,
`Endocrine Treatment of Transsexual Persons: An Endocrine So-
`ciety Clinical Practice Guideline, 94(9) J. Clinical Endocrinology
`& Metabolism
`3132,
`3136
`(2009),
`available
`
`at
`http://bit.ly/2lmCmfO (identifying the Standards of Care as
`“carefully prepared documents [that] have provided mental
`health and medical professionals with general guidelines for the
`evaluation and treatment of transsexual persons”); Cohen-
`Kettenis 1893 (“[P]rofessionals largely follow the Standards of
`Care of the [WPATH]. . . .”); see also De’Lonta v. Johnson, 708
`F.3d 520, 522-23 (4th Cir. 2013) (“The Standards of Care, pub-
`lished by the World Professional Association for Transgender
`Health, are the generally accepted protocols for the treatment
`of [gender dysphoria]”); Soneeya v. Spencer, 851 F. Supp. 2d
`228, 231 (D. Mass. 2012) (“The course of treatment for Gender
`Identity Disorder generally followed in the community is gov-
`erned by the ‘Standards of Care’ promulgated by the World Pro-
`
`
`
`
`
`

`

`11
`for
`support
`the Standards of Care,
`Under
`transgender individuals consists of an individualized
`protocol that can include psychotherapy support and
`counseling, support for social role transition, hor-
`mone therapy (including hormone blockers, as age
`appropriate), and a range of confirming surgeries.17
`The three main components of transition-related
`medical care are social, pharmacological, and surgi-
`cal. Social transition involves bringing a person’s
`gender expression and gender role into alignment
`with their gender identity. It may include wearing
`clothes associated with one’s gender identity, using a
`different name and pronouns, and interacting with
`peers and one’s social environment in a manner that
`matches the person’s gender identity.18
`In addition to social transition, a transgender
`person may also take medications that recalibrate
`the hormone balance in their bodies to achieve levels
`consistent with others who share the same gender
`identity. For example, a transgender man may take
`medications to stop his body from producing estrogen
`and replace those hormones with testosterone, which
`will further masculinize that person’s appearance.19
`Lastly, a transgender person may pursue surgical
`treatment to alleviate the dysphoria associated with
`the person’s primary and secondary sex characteris-
`
`
`fessional Association for Transgender Health (‘WPATH’).”);
`Fields v. Smith, 712 F. Supp. 2d 830, 838 n.2 (E.D. Wis. 2010)
`(accepting WPATH’s Standards of Care as “the worldwide ac-
`ceptable protocol for treating GID [gender dysphoria]”), aff’d
`653 F.3d 550 (7th Cir. 2011).
`17 See Standards of Care 5.
`18 See id. at 18-20.
`19 See id. at 34-36.
`
`
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`12
`tics.20 The precise medical treatments required to al-
`leviate a particular individual’s gender dysphoria
`may vary, based on the person’s individualized medi-
`cal needs.
`An equally-important aspect of gender dysphoria
`treatment, recognized in the Standards of Care, is
`fostering affirmation and support from the communi-
`ty (i.e., family, friends, co-workers, healthcare pro-
`viders, religious leaders).21 That support consists of
`affirming a person’s gender identity and supporting
`their efforts to live, for young people, as the girl or
`boy they know themselves to be, including by refer-
`ring to them with the appropriate pronouns and
`treating them as one would any other boy or girl. By
`embracing a transgender boy as a boy and a
`transgender girl as a girl, the community conveys the
`acceptance of the person’s identity. In contrast, re-
`jecting the person’s identity demeans the individual
`and exacerbates the dysphoric condition leading to
`serious negative health consequences.22 In particu-
`lar, because young people spend so much time at
`school, and because schools play such a major role in
`a young person’s development, the failure of schools
`to support a student who has undergone gender
`transition can have predictably devastating emotion-
`al and developmental consequences.
`
`
`20 See id. at 36.
`21 See id. at 30-32.
`22 Kristie L. Seelman, Transgender Adults’ Access to College
`Bathrooms and Housing and the Relationship to Suicidality, 63
`J. Homosexuality 1378, 1388-89
`(2016), available at
`http://www.tandfonline.com/doi/pdf/10.1080/00918369.2016.115
`7998?needAccess=true (showing an increased risk of suicidality
`for transgender college students denied access to the same facil-
`ities used by other students).
`
`
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`13
`III. THE SCHOOL BOARD’S POLICY CON-
`FLICTS WITH THE STANDARDS OF
`CARE AND HARMS TRANSGENDER
`STUDENTS.
`
`For transgender youth and adolescents, the chal-
`lenges posed by gender dysphoria and the resulting
`need for medically-appropriate treatment are magni-
`fied by their stage of development and their depend-
`ence on schools and the other social institutions that
`govern their lives. Supportive school and family en-
`vironments are essential to helping transgender
`youth cope with these challenges. Conversely, when
`a school undermines a transgender student’s medical
`treatment, that negative treatment can cause seri-
`ous, lasting harms.
`Schools have an obligation to protect the health of
`all of their students. A supportive school eases the
`social challenges of gender transition and sets an ex-
`ample that stigmatizing transgender students is not
`to be tolerated.
`A school that denies support for transgender stu-
`dents undermines their health and well-being. The
`School Board’s policy of denying transgender stu-
`dents access to the same restrooms used by other
`boys and girls marks these students as different and
`unworthy of equal treatment. The stigma caused by
`such discrimination makes it much more difficult
`and, in some cases, impossible for an adolescent deal-
`ing with gender dysphoria to resolve their distress
`and, with the help of their health care providers,
`make progress toward successful treatment.
`The Standards of Care recognize that adolescents
`who are transgender must be given the opportuni-
`ty—and support—to transition so that they can lead
`
`
`
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`

`14
`healthy and authentic lives, rather than suppress or
`hide their identity.23 The School Board’s policy, by
`contrast, impedes a transgender student from fully
`making that transition for as long as the student re-
`mains in the district’s schools, regardless of the stu-
`dent’s medical needs or the severity of the harm
`caused by that interference with the student’s medi-
`cal care. Such a policy exacerbates the psychological
`harms felt by transgender students and contravenes
`the clear scientific and medical consensus on the ap-
`propriate treatment of transgender adolescents to
`promote their long-term health and well-being.
`Because schools play such a major role in stu-
`dents’ lives, the impact of a discriminatory school
`policy is significant. From Monday through Friday,
`for seven hours or more per day, students are in
`schools studying, learning, and interacting with edu-
`cators and peers. Treating a transgender boy differ-
`ently than other boys undermines the student’s med-
`ical treatment, calls into question the student’s core
`sense of who he is, and predictably exacerbates his
`gender dysphoria.
`Young people are particularly reliant on educa-
`tors and school administrators, who both control
`many aspects of students’ daily lives and experiences
`