Case: 24-30399 Document: 247-1 Page: 1 Date Filed: 10/16/2024
`
`No. 24-30399
`
`════════════════════════════════════════
`In the United States Court of Appeals for the Fifth Circuit
`─────────────────────────────
`
`STATE OF LOUISIANA, by and through its Attorney General,
`ELIZABETH B. MURRILL; LOUISIANA DEPARTMENT OF
`EDUCATION; STATE OF MISSISSIPPI, by and through its Attorney
`General, LYNN FITCH; STATE OF MONTANA, by and through its
`Attorney General, AUSTIN KNUDSEN; STATE OF IDAHO, by and
`through its Attorney General, RAUL LABRADOR; SCHOOL BOARD
`OF WEBSTER PARISH; SCHOOL BOARD OF RED RIVER PARISH;
`SCHOOL BOARD OF BOSSIER PARISH; SCHOOL BOARD SABINE
`PARISH; SCHOOL BOARD OF GRANT PARISH; SCHOOL BOARD
`OF WEST CARROLL PARISH; SCHOOL BOARD OF CADDO
`PARISH; SCHOOL BOARD OF NATCHITOCHES PARISH; SCHOOL
`BOARD OF CALDWELL PARISH; SCHOOL BOARD OF ALLEN
`PARISH; SCHOOL BOARD LASALLE PARISH; SCHOOL BOARD
`JEFFERSON DAVIS PARISH; SCHOOL BOARD OF OUACHITA
`PARISH; SCHOOL BOARD OF FRANKLIN PARISH; SCHOOL
`BOARD OF ACADIA PARISH; SCHOOL BOARD OF DESOTO
`PARISH; SCHOOL BOARD OF ST. TAMMANY PARISH; ALL
`PLAINTIFFS,
`Plaintiffs-Appellees,
`
`v.
`
`UNITED STATES DEPARTMENT OF EDUCATION; MIGUEL
`CARDONA, in his official capacity as Secretary of Education; OFFICE
`FOR CIVIL RIGHTS, UNITED STATES DEPARTMENT OF
`EDUCATION; CATHERINE LHAMON, in her official capacity as the
`Assistant Secretary for Civil Rights; UNITED STATES DEPARTMENT
`
`
`
`
`
`
`
`No. 24-30399
`
`════════════════════════════════════════
`In the United States Court of Appeals for the Fifth Circuit
`─────────────────────────────
`
`STATE OF LOUISIANA, by and through its Attorney General,
`ELIZABETH B. MURRILL; LOUISIANA DEPARTMENT OF
`EDUCATION; STATE OF MISSISSIPPI, by and through its Attorney
`General, LYNN FITCH; STATE OF MONTANA, by and through its
`Attorney General, AUSTIN KNUDSEN; STATE OF IDAHO, by and
`through its Attorney General, RAUL LABRADOR; SCHOOL BOARD
`OF WEBSTER PARISH; SCHOOL BOARD OF RED RIVER PARISH;
`SCHOOL BOARD OF BOSSIER PARISH; SCHOOL BOARD SABINE
`PARISH; SCHOOL BOARD OF GRANT PARISH; SCHOOL BOARD
`OF WEST CARROLL PARISH; SCHOOL BOARD OF CADDO
`PARISH; SCHOOL BOARD OF NATCHITOCHES PARISH; SCHOOL
`BOARD OF CALDWELL PARISH; SCHOOL BOARD OF ALLEN
`PARISH; SCHOOL BOARD LASALLE PARISH; SCHOOL BOARD
`JEFFERSON DAVIS PARISH; SCHOOL BOARD OF OUACHITA
`PARISH; SCHOOL BOARD OF FRANKLIN PARISH; SCHOOL
`BOARD OF ACADIA PARISH; SCHOOL BOARD OF DESOTO
`PARISH; SCHOOL BOARD OF ST. TAMMANY PARISH; ALL
`PLAINTIFFS,
`Plaintiffs-Appellees,
`
`v.
`
`UNITED STATES DEPARTMENT OF EDUCATION; MIGUEL
`CARDONA, in his official capacity as Secretary of Education; OFFICE
`FOR CIVIL RIGHTS, UNITED STATES DEPARTMENT OF
`EDUCATION; CATHERINE LHAMON, in her official capacity as the
`Assistant Secretary for Civil Rights; UNITED STATES DEPARTMENT
`
`
`
`
`
`
`
`Case: 24-30399 Document: 247-1 Page: 2 Date Filed: 10/16/2024
`
`OF JUSTICE; MERRICK B. GARLAND, in his official capacity as the
`Attorney General of the United States; KRISTEN CLARKE, in her
`official capacity as Assistant Attorney General for the Civil Rights
`Division of United States Department of Justice,
`Defendants-Appellants.
`
`─────────────────────────────
`
`SCHOOL BOARD RAPIDES PARISH,
`Plaintiff-Appellee,
`
`v.
`
`UNITED STATES DEPARTMENT OF EDUCATION; MIGUEL
`CARDONA, in his official capacity as Secretary of Education; OFFICE
`FOR CIVIL RIGHTS, UNITED STATES DEPARTMENT OF
`EDUCATION; CATHERINE LHAMON, in her official capacity as the
`Assistant Secretary for Civil Rights; UNITED STATES DEPARTMENT
`OF JUSTICE; MERRICK B. GARLAND, in his official capacity as the
`Attorney General of the United States; KRISTEN CLARKE, in her
`official capacity as Assistant Attorney General for the Civil Rights
`Division of United States Department of Justice,
`Defendants-Appellants.
`
`─────────────────────────────
`
`On Appeal from the United States District Court
`for the Western District of Louisiana
`Nos. 3:24-CV-563, 1:24-CV-567
`
`════════════════════════════════════════
`
`BRIEF OF BILLY BURLEIGH, KATHYGRACE DUNCAN,
`LAURA PERRY SMALTS, AND THE MANHATTAN INSTITUTE
`AS AMICI CURIAE SUPPORTING APPELLEES AND
`AFFIRMANCE
`
`════════════════════════════════════════
`
`
`
`
`
`
`
`Case: 24-30399 Document: 247-1 Page: 3 Date Filed: 10/16/2024
`
`ILYA SHAPIRO
`MANHATTAN INSTITUTE
`52 Vanderbilt Ave.
`New York, NY 10017
`(212) 599-7000
`ishapiro@manhattan.institute
`
`
`RONALD MILLER
`JOSHUA K. PAYNE
`JORDAN CAMPBELL
`DANIEL SEPULVEDA
`CAMPBELL MILLER PAYNE,
`PLLC
`5955 Alpha Rd. #1491
`Dallas, TX 75240
`(214) 316-7156
`ron@cmppllc.com
`
`
`
`Counsel for Amici Curiae
`
`
`
`
`
`
`
`Case: 24-30399 Document: 247-1 Page: 4 Date Filed: 10/16/2024
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`CERTIFICATE OF INTERESTED PERSONS
`
`
`
`Counsel of record certifies that the following listed persons and
`
`entities as described in the fourth sentence of Rule 28.2.1 have an
`
`interest in the outcome of this case. These representations are made in
`
`order that the
`
`judges of this court may evaluate possible
`
`disqualification or recusal.
`
`Plaintiffs-Appellees:
`
`State of Louisiana
`
`Louisiana Department of Education
`
`State of Mississippi
`
`State of Montana
`
`State of Idaho
`
`School Board of Webster Parish
`
`School Board of Red River Parish
`
`School Board of Bossier Parish
`
`School Board of Sabine Parish
`
`School Board of Grant Parish
`
`School Board of West Carroll Parish
`
`School Board of Caddo Parish
`
`
`
`i
`
`
`
`Case: 24-30399 Document: 247-1 Page: 5 Date Filed: 10/16/2024
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`School Board of Natchitoches Parish
`
`School Board of Caldwell Parish
`
`School Board of Allen Parish
`
`School Board of LaSalle Parish
`
`School Board of Jefferson Davis Parish
`
`School Board of Ouachita Parish
`
`School Board of Franklin Parish
`
`School Board of Acadia Parish
`
`School Board of Desoto Parish
`
`School Board of St. Tammany Parish
`
`School Board of Rapids Parish
`
`Defendants-Appellants:
`
`U.S. Department of Education
`
`U.S. Department of Education, Office for Civil Rights
`
`Miguel Cardona, in his official capacity as Secretary of
`Education
`
`Catherine Lhamon, in her official capacity as Assistant
`Secretary of Education for Civil Rights
`
`U.S. Department of Justice
`
`Merrick B. Garland, in his official capacity as Attorney General
`of the United States
`
`
`
`ii
`
`
`
`Case: 24-30399 Document: 247-1 Page: 6 Date Filed: 10/16/2024
`
`
`Kristen Clarke, in her official capacity as Assistant Attorney
`General for the Civil Rights Division, U.S. Department of
`Justice
`
`Counsel for Plaintiffs-Appellees States:
`
`Elizabeth B. Murrill, Attorney General of Louisiana
`
`J. Benjamin Aguinaga, Solicitor General of Louisiana
`
`Tracy Short, Assistant Chief Deputy Attorney General of
`Louisiana
`
`Autumn Hamit Patterson, Special Assistance Solicitor General
`of Louisiana
`
`Donal A. Daugherty, Jr., Defense of Freedom Institute for Policy
`Studies
`
`Paul Zimmerman, Defense of Freedom Institute for Policy
`Studies
`
`Martha A. Astor, Defense of Freedom Institute for Policy Studies
`
`Lynn Fitch, Attorney General of Mississippi
`
`Scott G. Stewart, Solicitor General of Mississippi
`
`Justin L. Matheny, Deputy Solicitor General of Mississippi
`
`Austin Knudsen, Attorney General of Montana
`
`Christian B. Corrigan, Solicitor General of Montana
`
`Peter Torstensen, Deputy Solicitor General of Montana
`
`Raúl Labrador, Attorney General of Idaho
`
`
`
`iii
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`
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`Case: 24-30399 Document: 247-1 Page: 7 Date Filed: 10/16/2024
`
`
`Alan Hurst, Solicitor General of Idaho
`
`Josh Turner, Chief Constitutional Litigation and Policy for
`Idaho
`
`Counsel for Plaintiff-Appellee Rapides Parish School Board:
`
`John J. Bursch, Alliance Defending Freedom
`
`Jonathan Scruggs, Alliance Defending Freedom
`
`Julie Marie Blake, Alliance Defending Freedom
`
`Matthew S. Bowman, Alliance Defending Freedom
`
`Natalie D. Thompson, Alliance Defending Freedom
`
`Michael T. Johnson, Alliance Defending Freedom
`
`Counsel for Defendants-Appellants:
`
`Brian M. Boynton, Principal Deputy Assistant Attorney General,
`U.S. Department of Justice
`
`Emily B. Nestler, Assistant Branch Director, U.S. Department of
`Justice
`
`Elizabeth Tulis, Trial Attorney, U.S. Department of Justice
`
`Rebecca Kopplin, Trial Attorney, U.S. Department of Justice
`
`Benjamin Takemoto, Trial Attorney, U.S. Department of Justice
`
`Hannah Solomon-Strauss, Trial Attorney, U.S. Department of
`Justice
`
`Pardis Gheibi, Trial Attorney, U.S. Department of Justice
`
`
`
`iv
`
`
`
`Case: 24-30399 Document: 247-1 Page: 8 Date Filed: 10/16/2024
`
`
`Melissa N. Patterson, Attorney, U.S. Department of Justice
`
`Stephanie R. Marcus, Attorney, U.S. Department of Justice
`
`Jack Starcher, Attorney, U.S. Department of Justice
`
`Steven A. Myers, Attorney, U.S. Department of Justice
`
`David L. Peters, Attorney, U.S. Department of Justice
`
`Lisa Brown, General Counsel, U.S. Department of Education
`
`Amici Curiae-Supporting Appellees and Affirmance:
`
`The Manhattan Institute, Amicus Curiae1
`
`
`
`Billy Burleigh, Amicus Curiae
`
`KathyGrace Duncan, Amicus Curiae
`
`Laura Perry Smalts, Amicus Curiae
`
`
`
`Ronald Miller, Attorney, Campbell Miller Payne, PLLC
`
`Joshua K. Payne, Attorney, Campbell Miller Payne, PLLC
`
`Jordan Campbell, Attorney, Campbell Miller Payne, PLLC
`
`Daniel Sepulveda, Attorney, Campbell Miller Payne, PLLC
`
`
`
`
`
`
`
`1 The Manhattan Institute has no parent companies, subsidiaries, or
`affiliates, and does not issue shares to the public.
`v
`
`
`
`
`
`Case: 24-30399 Document: 247-1 Page: 9 Date Filed: 10/16/2024
`
`/s/ Ronald Miller
`Ronald Miller
`
`Counsel for Amici Curiae Billy Burleigh,
`KathyGrace Duncan, Laura Perry Smalts, and
`the Manhattan Institute
`
`
`
`
`
`
`
`
`vi
`
`
`
`Case: 24-30399 Document: 247-1 Page: 10 Date Filed: 10/16/2024
`
`TABLE OF CONTENTS
`
`
`CERTIFICATE OF INTERESTED PERSONS ......................................... i
`TABLE OF CONTENTS ......................................................................... vii
`TABLE OF AUTHORITIES ...................................................................viii
`INTEREST OF AMICI CURIAE ............................................................... 1
`SUMMARY OF ARGUMENT ................................................................... 3
`ARGUMENT ............................................................................................. 4
`I. The Individual Amici Know from Personal Experience That
`Youthful Gender Transition Is Harmful ........................................... 4
`
`II. Scientific Evidence Demonstrates That Youthful Gender
`Transition Is Harmful ..................................................................... 11
`
`A. Encouraging Children to Transition Changes Outcomes by
`Preventing Natural Desistance. ................................................... 11
`
`B. Detransitioning Is on the Rise, and Also Shows That Young
`People Become Comfortable with Their Sex over Time. .............. 14
`
`
`
`
`
`C. Evidence Is Lacking for Benefits That Would Outweigh the
`Clear Harms of Transitioning to Minors. ..................................... 16
`CONCLUSION ........................................................................................ 19
`CERTIFICATE OF COMPLIANCE ........................................................ 21
`CERTIFICATE OF SERVICE ................................................................. 22
`
`
`
`
`vii
`
`
`
`Case: 24-30399 Document: 247-1 Page: 11 Date Filed: 10/16/2024
`
`TABLE OF AUTHORITIES
`
`
`Other Authorities
`
`Carly Guss, et al., Transgender and Gender Nonconforming Adolescent
`Care: Psychosocial and Medical Considerations, 27(4) Curr. Opin.
`Pediatr. 421-426 (2015) ........................................................................ 13
`
`Elie Vandenbussche, Detransition-Related Needs and Support: A Cross-
`Sectional Online Survey, 69(9) J. Homosex. 1602-1620 (2022), Epub
`Apr. 30, 2021………………………………………………………………….14
`
`Independent Review of Gender Identity Services for Children and Young
`People: Final Report, The Cass Review (April 2024).…………………..18
`
`Isabel Boyd, et al., Care of Transgender Patients: A General Practice
`Quality Improvement Approach, 10(1) Healthcare 121 (2022) ............ 16
`
`J. Straub, et al., Risk of Suicide and Self-Harm Following Gender-
`Affirmation Surgery, 16(4):e57472 Cureus 1-9 (2024)…………...…….19
`
`Laura Edwards-Leeper & Erica Anderson, The Mental Health
`Establishment Is Failing Trans Kids, Wash. Post, Nov. 24, 2021 ...... 15
`
`Lisa Littman, Individuals Treated for Gender Dysphoria with Medical
`and/or Surgical Transition Who Subsequently Detransitioned: A
`Survey of 100 Detransitioners, 50(8) Arch. Sex. Behav. 3353-3369
`(2021) ........................................................................................ 14, 15, 16
`
`Lisa Marchiano, Gender Detransition: A Case Study, 66(4) J. of Anal.
`Psychol. 813-832 (2021) ................................................................... 15-16
`
`Pamela Paul, As Kids, They Thought They Were Trans. They No Longer
`Do., N.Y. Times, Feb. 2, 2024 .......................................................... 16-17
`
`Pamela Paul, Why Is the U.S. Still Pretending We Know Gender-
`Affirming Care Works?, N.Y. Times, July 12, 2024 ....................... 17, 18
`
`Pien Rawee, et al., Development of Gender Non-Contentedness During
`Adolescence and Early Adulthood, 53 Arch. Sex. Behav. 1813-1825
`(2024)……...…………………………………………………………………..12
`
`
`
`viii
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`
`
`Case: 24-30399 Document: 247-1 Page: 12 Date Filed: 10/16/2024
`
`R. Hall, et al., Access to Care and Frequency of Detransition Among a
`Cohort Discharged by a UK National Adult Gender Identity Clinic:
`Retrospective Case-Note Review, 7(6):e184 BJPsych Open. 1-8 (2021) 16
`
`Ruth Hall, et al., Impact of Social Transition in Relation to Gender for
`Children and Adolescents: A Systematic Review, Archives of Disease in
`Childhood 1 (2024)……..……………………………………………………17
`
`Thomas D. Steensma, et al., Factors Associated With Desistence and
`Persistence of Childhood Gender Dysphoria: A Quantitative Follow-Up
`Study, 52(6) J. Am. Aca. Child Adolesc. Psychiatry 582-590 (2013) ... 13
`
`Wylie C. Hembree, et al., Endocrine Treatment of Gender-
`Dysphoric/Gender-Incongruent Persons: An Endocrine Society
`Clinical Practice Guideline, 102(11) J. of Clinic. Endocrin. & Metab.
`3869-3903 (2017) ............................................................................. 12-13
`
`
`
`ix
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`
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`Case: 24-30399 Document: 247-1 Page: 13 Date Filed: 10/16/2024
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`
`
`INTEREST OF AMICI CURIAE
`
`Amici Billy Burleigh, KathyGrace Duncan, Laura Perry Smalts,
`
`and the Manhattan Institute respectfully submit this brief in support of
`
`Appellees and affirmance.2
`
`Billy Burleigh, KathyGrace Duncan, and Laura Perry Smalts
`
`experienced gender dysphoria when they were adolescents and young
`
`adults. They were led to believe that “affirming” perceptions of
`
`themselves as members of the opposite sex for the purpose of “gender
`
`transition” would resolve their gender dysphoria and permit them to live
`
`healthy, well-adjusted lives. Sadly, these amici learned through their
`
`experiences that such affirmation did not resolve their mental health
`
`issues or gender dysphoria. Instead, the pathway they were led down,
`
`which included social transitioning and medical interventions such as
`
`cross-sex hormones and surgeries, only caused physical harm and
`
`increased their distress as they realized their bodies had been
`
`irreversibly altered based upon a false promise.
`
`
`2 No counsel for a party authored this brief in whole or in part, and no
`person other than amici or their counsel made a monetary contribution
`intended to fund the preparation or submission of the brief. All parties
`have consented to the filing of this brief.
`
`
`
`1
`
`
`
`Case: 24-30399 Document: 247-1 Page: 14 Date Filed: 10/16/2024
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`The Manhattan Institute is a nonprofit policy research foundation
`
`whose mission is to develop and disseminate ideas that foster individual
`
`responsibility and agency across multiple dimensions. It has sponsored
`
`scholarship and filed briefs opposing regulations that interfere with
`
`constitutional liberties, including in several cases pending in circuit
`
`courts regarding pediatric gender care and parental rights.
`
`Amici support the ability of states, organizations, and individuals
`
`like Appellees to protect young people from the harms of transitioning by
`
`not “affirming” a student’s perception as a member of the opposite sex
`
`and instead maintaining traditionally separate spaces for women and
`
`girls and upholding free speech rights.
`
`Amici respectfully submit this brief to provide this Court with an
`
`understanding of the experiences of detransitioners, the evidence
`
`showing that youthful gender transition is harmful, and the evidence
`
`showing that gender dysphoria often resolves when children are allowed
`
`to grow up naturally without being steered into a path of medical or social
`
`transition.
`
`
`
`
`
`
`
`2
`
`
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`Case: 24-30399 Document: 247-1 Page: 15 Date Filed: 10/16/2024
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`
`
`SUMMARY OF ARGUMENT
`
`Billy Burleigh, KathyGrace Duncan, and Laura Perry Smalts are
`
`living proof that “affirming” a young person to identify as the opposite
`
`sex is deeply harmful. These individuals experienced gender dysphoria
`
`when they were adolescents and young adults. They were led to believe
`
`that social and medical gender transition, including cross-sex hormones
`
`and surgical procedures, would resolve their gender dysphoria and
`
`permit them to live healthy, well-adjusted lives. Sadly, these amici
`
`learned through their experiences that transitioning did not resolve their
`
`mental health issues or gender dysphoria, but only caused physical harm
`
`and increased their distress as they realized their bodies had been
`
`irreversibly altered based upon a false promise.
`
`Consistent with the experiences of the individual amici, available
`
`evidence shows that gender dysphoria usually resolves on its own or
`
`through counseling a young person to cope with the reality of their
`
`natural sex. Social and medical transition is thus unnecessary and often
`
`harmful. Furthermore, evidence is lacking for benefits that would
`
`outweigh the clear harms of transitioning to minors.
`
`
`
`
`
`3
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`
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`Case: 24-30399 Document: 247-1 Page: 16 Date Filed: 10/16/2024
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`I.
`
`ARGUMENT
`
`The Individual Amici Know from Personal Experience That
`Youthful Gender Transition Is Harmful
`
`Billy Burleigh
`
`Billy Burleigh grew up in a good family with supportive parents.
`
`But in the first grade he began experiencing intrusive thoughts that “God
`
`made a mistake. I’m a girl.” Through elementary school he had learning
`
`and emotional difficulties. He was in emotional pain, and he withdrew
`
`from others, trying to cope. He was sexually abused in sixth grade by a
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`male diving coach.
`
`Looking for answers to his distress, the prevailing information he
`
`received was that the only way to overcome the disconnect was to change
`
`his body to conform to what his mind was telling him. Driven by
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`depression and thoughts of suicide, Billy was willing to try anything to
`
`relieve his suffering. He told his therapist he wanted to transition, and
`
`she provided him a letter to begin cross-sex hormones. Billy was
`
`prescribed spironolactone, to block testosterone, and estrogen. He
`
`underwent multiple surgeries. Starting at age 34, he underwent
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`vaginoplasty, labioplasty, an Adam’s apple shave, facial plastic surgery,
`
`and voice feminization surgery.
`
`
`
`4
`
`
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`Case: 24-30399 Document: 247-1 Page: 17 Date Filed: 10/16/2024
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`However, no matter how many surgeries he had, every time Billy
`
`looked in the mirror he saw a man staring back at him. Despite a
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`successful professional career and passing well as a woman he still had
`
`all the same problems and mental distress he had before transitioning.
`
`After seven years, he began to detransition. What helped Billy come to
`
`terms with his male body was finding peace with God and a wonderful
`
`faith community. With the help of healthy relationships with other men
`
`and a community that loved and supported him, he was able to make the
`
`journey back to embracing his male self. Billy got married in 2011 and is
`
`currently living happily as a male, a husband, and father, although he
`
`still must live with the consequences of a scarred body and the inability
`
`to engage sexually with his wife.
`
`Based on his experience, Billy believes strongly that, even with
`
`parental consent, interventions aimed at “affirming” a discordant gender
`
`identity are harmful to children. They are putting a band-aid on the
`
`underlying issues that the child is having. Children are looking for
`
`acceptance, significance, and security. “Gender-affirming” treatments
`
`are offered to satisfy those needs, but from his own painful experience
`
`Billy warns they cannot do that long term. Billy has spoken with many
`
`
`
`5
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`
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`Case: 24-30399 Document: 247-1 Page: 18 Date Filed: 10/16/2024
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`detransitioned young people. Many of them have experienced trauma
`
`and/or sexual abuse. Billy has realized that these kids need therapy and
`
`a safe environment to work through and address the severe mental
`
`health issues they are experiencing. Children facing the struggles Billy
`
`faced need help with their thoughts, not a body “fix” with hormones and
`
`surgery.
`
`KathyGrace Duncan
`
`From a very young age, KathyGrace was gender nonconforming;
`
`she preferred male attire, thought she was a “boy,” and wanted to live as
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`one. However, it was not until after she had medically transitioned and
`
`lived for many years as a man that she was able to reflect on the complex
`
`true origins and causes of her self-perception and gender dysphoria.
`
`Growing up in a dysfunctional family in which her mother was often the
`
`victim of her father’s emotional and verbal abuse, KathyGrace intuited
`
`the message that “my dad would love me if I were a boy.” Sexual abuse
`
`by a family member between the ages of 10 and 12 further convinced her
`
`that being a girl meant being unsafe and unlovable.
`
`In sixth grade, she learned about female to male transsexuals,
`
`leading her to conclude that her distress was caused by not having the
`
`
`
`6
`
`
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`Case: 24-30399 Document: 247-1 Page: 19 Date Filed: 10/16/2024
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`“right” body and the only way to live a normal life was to medically
`
`transition and become a heterosexual male. At age 19, she began living
`
`as a man named Keith and went to a therapist who formally diagnosed
`
`her with gender dysphoria. She began testosterone and a year later had
`
`a mastectomy. At the time, she believed changing her body was necessary
`
`so that what she saw in the mirror matched what she felt on the inside.
`
`She never viewed her condition as touching on mental health issues, and
`
`neither did the therapist who diagnosed her. Whether her self-perception
`
`and desire to transition was related to her mental health issues was
`
`never explored.
`
`After 11 years passing as a man and living a relatively “happy” and
`
`stable life (which included having a number of girlfriends), KathyGrace
`
`realized that she was living a lie built upon years of repressed pain and
`
`abuse. Hormones and surgery had not helped her resolve underlying
`
`issues of rejection, abuse, and sexual assault. Her desire to live as a man
`
`was a symptom of deeper, unmet needs.
`
`With the help of life coaches and a supportive community,
`
`KathyGrace returned to her female identity and began addressing the
`
`underlying issues that had been hidden in her attempt to live as a man.
`
`
`
`7
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`
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`Case: 24-30399 Document: 247-1 Page: 20 Date Filed: 10/16/2024
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`She experienced depression that she had repressed for years and grieved
`
`over the irreversible changes to her body. KathyGrace believes that if
`
`someone had walked with her through her feelings instead of affirming
`
`her desire to transition, she would have been able to address her mental
`
`health issues more effectively and not spent so many years making and
`
`recovering from a grave mistake.
`
`Laura Perry Smalts
`
`Laura Perry Smalts will never experience giving birth to or
`
`breastfeeding a child because she became convinced that she was “born
`
`in the wrong body” and that her body needed to be altered to conform to
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`her belief that she was really male. She now realizes that there are far
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`better and healthier ways to assist a child who is distressed with her body
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`that bring long-term resolution, and her story is living proof of that truth.
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`Like many detransitioners, Laura did not conform to gender
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`stereotypes and experienced sexual abuse by a neighbor and family
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`dysfunction during childhood, which contributed to her believing that she
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`was really a boy. From an early age she fantasized about being a boy and
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`wrote stories of herself as a male character but was not aware of the
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`concept of being transgender until age 25. The desire to become male had
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`Case: 24-30399 Document: 247-1 Page: 21 Date Filed: 10/16/2024
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`become so strong that she began searching on the internet and was
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`shocked to find numerous stories, websites, and support groups related
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`to being transgender.
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`Laura went to a support group which immediately affirmed her as
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`“transgender.” From that point on, she was absolutely convinced that she
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`was a “man trapped in a woman’s body” and her body needed to be fixed.
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`She started taking testosterone at age 25 after receiving a diagnosis of
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`gender identity disorder and letter from a therapist. Laura’s physician,
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`who was aware of her history of chronic hormone imbalance, nevertheless
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`prescribed the cross-sex hormones on the same day. During nine years
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`on testosterone, Laura experienced her voice getting lower, her jaw
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`becoming more masculinized, her body shape changing, more hair
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`growing on her body, and hair receding on her scalp. Her blood became
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`very thick so that she became in danger of a stroke. Laura had to undergo
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`therapeutic blood withdrawals to thin her blood.
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`With the medical interventions to support “gender transition,”
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`Laura fully passed as male and would have described herself as happy
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`for the first few years. However, she also began to have problems with
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`her memory and cognitive functioning. She became anxious, depressed,
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`Case: 24-30399 Document: 247-1 Page: 22 Date Filed: 10/16/2024
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`and neurotic about talking to people, becoming obsessed with “every
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`detail of life fitting a male narrative.” She couldn’t function at work. Still,
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`Laura was convinced that she wanted these interventions and underwent
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`a double mastectomy at age 27 and complete hysterectomy, sending her
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`into menopause, at age 30.
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`During the time that she lived as a man, Laura was constantly
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`reminded of the truth, but had to constantly override it, which she found
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`to be exhausting. After seven years of medical transition treatments,
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`Laura was depressed and suicidal. She was so restless she had difficulty
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`sleeping and staying focused at work. She credits faith in Jesus Christ
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`and the “positive message of love in God’s Word,” as what brought true
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`healing in her heart. If Laura had not given her life to Christ, she believes
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`that she would have taken her own life because she realized she could
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`neither escape the pain of her past nor become the man she longed to be.
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`She entered a support group that helped her process the pain of her life
`
`and talk openly about the sexual trauma, issues with her mother, and
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`rejection by others. She began working through a healing community,
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`which restored her emotionally and psychologically as a woman. She
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`received counseling that helped her see the broken patterns, process
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`10
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`Case: 24-30399 Document: 247-1 Page: 23 Date Filed: 10/16/2024
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`negative thinking towards herself, and understand healthy womanhood.
`
`She began to realize that she was not a man but had fixated on becoming
`
`a person who would be loved. In 2016 she detransitioned. In May 2022,
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`Laura got married and no longer experiences any gender dysphoria.
`
`Laura believes minors do not have the capacity to appreciate the
`
`gravity of these decisions, which involve the complications of medical
`
`transition and what children would be giving up, including sexual
`
`function and parenting. Nor does she believe a parent should be allowed
`
`to radically alter their child’s body or allow their child to be sterilized
`
`because their child is experiencing a mental ailment. Based on her
`
`experience, Laura believes transition procedures do not solve anything
`
`but only give temporary relief, like taking a pain killer for a broken bone.
`
`From personal experience, Laura knows there are far healthier ways to
`
`help children resolve distress with their bodies.
`
`II. Scientific Evidence Demonstrates That Youthful Gender
`Transition Is Harmful
`
`A. Encouraging Children to Transition Changes Outcomes by
`Preventing Natural Desistance.
`
`Over the last 50 years, numerous scientific studies have shown that
`
`gender dysphoria in children is not fixed. Instead, the vast majority of
`
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`11
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`Case: 24-30399 Document: 247-1 Page: 24 Date Filed: 10/16/2024
`
`prepubertal children with gender dysphoria who do not socially or
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`medically transition will stop feeling dysphoric by the time they reach
`
`adulthood. Eleven peer-reviewed studies published between 1972 and
`
`2021 investigated the persistence of childhood-onset gender dysphoria,
`
`and all reached the same conclusion: “among prepubescent children who
`
`feel gender dysphoric, the majority cease to want to be the other gender
`
`over the course of puberty—ranging from 61-88% desistance across the
`
`large, prospective studies.” Expert Report of James M. Cantor, PhD, Poe,
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`et al. v. Labrador, et al., No. 1:23-cv-00269 (D. Idaho), ECF 56-4 at 57-58
`
`(listing studies); see also Pien Rawee, et al., Development of Gender Non-
`
`Contentedness During Adolescence and Early Adulthood, 53 Arch. Sex.
`
`Behav. 1813-1825, 1813 (2024) (“Gender non-contentedness, while being
`
`relatively common during early adolescence, in general decreases with
`
`age and appears to be associated with a poorer self-concept and mental
`
`health throughout development.”). No published study has shown
`
`otherwise.
`
`Given this evidence, the Endocrine Society’s Clinical Practice
`
`Guidelines acknowledge “the large majority (about 85%) of prepubertal
`
`children with a childhood diagnosis did not remain GD/gender
`
`
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`12
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`Case: 24-30399 Document: 247-1 Page: 25 Date Filed: 10/16/2024
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`incongruent in adolescence.” Wylie C. Hembree, et al., Endocrine
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`Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An
`
`Endocrine Society Clinical Practice Guideline, 102(11) J. of Clinic.
`
`Endocrin. & Metab. 3869-3903, 3879 (2017).
`
`Yet among children who are affirmed in a transgender identity,
`
`multiple studies have found that few or none grow into comfort with their
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`biological sex: “The gender identity affirmed during puberty appears to
`
`predict the gender identity that will persist into adulthood.” Carly Guss,
`
`et al., Transgender and Gender Nonconforming Adolescent Care:
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`Psychosocial and Medical Considerations, 27(4) Curr. Opin. Pediatr. 421-
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`426, 421 (2015); see also Thomas D. Steensma, et al., Factors Associated
`
`With Desistence and Persistence of Childhood Gender Dysphoria: A
`
`Quantitative Follow-Up Study, 52(6) J. Am. Aca. Child Adolesc.
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`Psychiatry 582-590, 588-89 (2013) (childhood social transitions are
`
`“important predictors of persistence”).
`
`Available evidence, then, suggests that affirming a transgender
`
`identity in children changes outcomes and prevents natural desistance
`
`in many children. Because, as the Endocrine Society recognizes, “we
`
`cannot predict the psychosexual outcome for any specific child,”
`
`
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`Case: 24-30399 Document: 247-1 Page: 26 Date Filed: 10/16/2024
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`Hembree, et al. at 3876, protecting the freedom of States to maintain
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`separate spaces for girls and not “affirm” a student’s transgender identity
`
`would preserve children’s ability to desist naturally, with their natal
`
`bodies and functions intact.
`
`B. Detransitioning Is on the Rise, and Also Shows That Young
`People Become Comfortable with Their Sex over Time.
`
`Consistent with these studies and the experiences of the individual
`
`amici here, research shows that an increasing number of youth and
`
`adults are detransitioning, indicating harm and lack of efficacy of the
`
`interventions. Vandenbussche 2021, for example, is a survey of 237
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`detransitioners with 70% reporting that they detransitioned after
`
`realizing their gender dysphoria was related to other issues. Elie
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`Vandenbussche, Detransition-Related Needs and Support: A Cross-
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`Sectional Online Survey, 69(9) J. Homosex. 1602-1620, 1606 (2022), Epub
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`Apr. 30, 2021. And Littman 2021 is a survey of 100 detransitioners where
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`60% reported their decision to detransition was motivated by the fact that
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`they “became comfortable identifying with their natal sex.” Lisa Littman,
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`Individuals Treated for Gender Dysphoria with Medical and/or Surgical
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`Transition Who Subsequently Detransitioned: A Survey of 100
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`Detransitioners, 50(8) Arch. Sex. Behav. 3353-3369, 3361 (2021).
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`Case: 24-30399 Document: 247-1 Page: 27 Date Filed: 10/16/2024
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`In her study, Dr. Littman found that, as is true of the individual
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`amici, a majority of the study subjects felt that they had been rushed into
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`“gender-affirmative” interventions with irreversible effects without the
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`benefit of adequate psychologic evaluation. Id. at 3364-3366. Dr. Littman
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`also found that several of the participants in her study felt pressured to
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`transition from their doctors or therapists. Id. at 3366. Thirty-eight
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`percent of participants in Dr. Littman’s st
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