USCA11 Case: 18-13592 Document: 304-1 Date Filed: 12/30/2022 Page: 93 of 150
Adams underwent changes to ensure his body and behaviors were aligned with his gender identity.
Adams began with social changes. Often, these social changes involve “changing your appearance, your activities, and your actions … to the gender that matches your gender identity so that everything you do from the time you get up in the morning and you go to bed at night is in that particular gender.” Doc. 166-2 at 27. For Adams, these changes included cutting his hair, wearing masculine clothing, using male pronouns to refer to himself, and wearing a chest binder—a device that gives the wearer the appearance of a flat chest.
Adams also began using the men’s restroom in public as part of his social transition. For Adams, using the men’s restroom was important because it was a “simple action” that expressed he was “just like every other boy” who could “use the men’s bathroom without thinking about it.” Doc. 160-1 at 107. Transgender individuals “typically seek privacy and discreteness in restroom use and try to avoid exposing any parts of their genitalia that would reveal sex characteristics inconsistent with their gender identity.” Doc. 192 at 8. When Adams uses the men’s restroom, he walks in, goes into a stall, locks the door to the stall, uses the restroom, leaves the stall, washes his hands, and exits the restroom.
In addition to his social transition, Adams underwent medical changes. He took birth control medication to halt menstruation. With the help of his endocrinologist, he also began to take testosterone to produce secondary sex characteristics: “increased
