Page:Adams ex rel. Kasper v. School Board of St. Johns County, Florida (2022).pdf/91

 omitted). Put differently, his “gender identity”—his “internal sense of being male, female, or another gender,” id. (internal quotation marks omitted—was, and remains, that of a male. As one of Adams’s physicians and expert witnesses—Deanna Adkins, M.D., a pediatric endocrinologist at Duke University—testified at trial, a person’s gender identity cannot be changed; it is not a choice. Diane Ehrensaft, Ph.D., a clinical psychologist and expert witness for Adams echoed Dr. Adkins’s opinion, testifying that the “prevailing perspective on gender identity” is that gender identity is “an innate … effectively immutable characteristic.” Doc. 166-5 at 38 (internal quotation marks omitted). It is a “deep-seated, deeply felt component of human identity”; it “is not a personal decision, preference, or belief.” Doc. 166-3 at ¶ 22. It “appears to be related to one’s brain messages and mind functioning” and so, crucially, “has a biological basis.” Id. ¶¶ 21, 25.

Putting these concepts together, Adams is a transgender boy because his gender identity—male—is different from his birth-assigned sex—female. When a person is not transgender, meaning his or her birth-assigned sex and gender identity align, that person is “cisgender.” Doc. 192 at 7.