USCA11 Case: 18-13592 Date Filed: 07/14/2021 Page: 4 of 80
acknowledged that, when she heard this, she “knew that things were going to get difficult for him. It’s not a great world to live in if you’re different, if you’re transgender.” But she described noticing an “absolutely remarkable” change in Adams after he told his parents that he was transgender. She observed that he “went from this quiet, withdrawn, depressed kid to this very outgoing, positive, bright, confident kid. It was a complete 180.” At the time of trial, Mr. Adams was excelling academically, was a member of the National Honor Society, and spent his summers volunteering.
Together, Mr. Adams and his family met with mental health professionals, who confirmed Adams was transgender. In time, Mr. Adams’s psychiatrist diagnosed him with gender dysphoria, a condition of “debilitating distress and anxiety resulting from the incongruence between an individual’s gender identity and birth-assigned sex.” The sex assigned to Mr. Adams at the time of birth was female, but his consistent, internal sense of gender is male.
To treat and alleviate Mr. Adams’s gender dysphoria, the psychiatrist recommended Adams socially transition to living as a boy. This included cutting his long hair short, dressing in more masculine clothing, wearing a chest binder to flatten breast tissue, adopting the personal pronouns “he” and “him,” and using the men’s restroom in public. Mr. Adams embraced these changes. Socially transitioning to using the men’s restroom, Mr. Adams explained at trial, is “a
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