USCA11 Case: 18-13592 Document: 304-1 Date Filed: 12/30/2022 Page: 90 of 150
Inconsistent with Adams’s consistently “masculine” behavior was the fact that the doctor who attended Adams’s birth “assigned” him the “[f]emale” sex at birth. Id. at 83. The doctor made the assignment by briefly examining Adams’s external genitalia in the moments after birth. Still, for the first several years of his life, Adams was unperturbed by any disconnect between how he lived—as a boy—and how his first birth certificate and early medical records identified him—as a girl.
When Adams reached puberty, though, his life took a painful turn. His body began to exhibit female traits, and he “started to hate … every aspect of [his] body.” Id. at 89. At the time, Adams did not consciously associate the hatred he felt for his body with feminine characteristics specifically. But upon reflection, he “only really hated strongly the things that made [him] look more feminine; my hips, my thighs, my breasts.” Id.
Aided by his concerned and supportive parents, Adams got help. He assumed he “had a mental illness,” but he “didn’t really [know of] any particular cause” for his negative feelings. Id. at 90. He saw multiple therapists for what he assumed was only “anxiety” or “depression.” Id. After he entered therapy, Adams, his parents, and his medical providers all concluded that something else was at the root of Adams’s discontent—he was transgender. Being “transgender” meant that Adams “consistently, persistently, and insistently[] identifie[d] as a gender different [from] the sex [he was] assigned at birth.” Doc. 192 at 7 (internal quotation marks
