A federal judge ruled Friday that a Virginia school district's policy barring a male transgender student from using the boys bathrooms violates the U.S. Constitution, an important victory for transgender rights advocates in a closely watched case.

In a 28-page ruling, Judge Arenda Wright Allen of the U.S. District Court in Norfolk, Va., said that the school district's policy violated the rights of Gavin Grimm, a former student.

"There is no question that the board's policy discriminates against transgender students on the basis of their gender nonconformity," Wright Allen wrote. "Transgender students are singled out, subjected to discriminatory treatment, and excluded from spaces where similarly situated students are permitted to go."

School bathroom policies vary, sometimes district by district, across the country. Many in recent years have faced contentious legal challenges over which bathrooms transgender students should be allowed to use. Grimm's lawsuit against Gloucester County Public Schools in Virginia is among the best known.

Wright Allen's ruling echoes those in several other courts that have recently ruled in favor of allowing transgender students to use bathrooms corresponding to the gender they identify with.

Yet nationwide, the question is far from resolved. The Supreme Court this year chose not to take up an appeal in a similar case. And it is not clear that the Supreme Court would take up any such cases until there are conflicting opinions in lower appellate courts, according to Joshua Block, Grimm's lawyer. To date, there have not been any, he said.

Grimm, 20, attended Gloucester High School from 2013 to 2017. The district School Board had maintained that Grimm's "biological gender" was female, prohibiting administrators from allowing him to use the boys restrooms.

Grimm, who wrote an op-ed essay in The New York Times in June about his experiences growing up, said in an interview that Friday's ruling was "wonderful."

"It was certainly a victory for the trans community," he said.

Block said the ruling applied only to Grimm, but it would most likely become "persuasive precedent" in other cases. He said the school district's policy was still in effect.

"If another student is subjected to this discriminatory policy, that student can go to court and has this decision to point to right away," said Block, a senior staff attorney with the American Civil Liberties Union. "Other school districts in Virginia and around the country have been looking to see what happens with this case."

A lawyer for Gloucester County Public Schools declined to comment on the decision Friday.

A federal judge in Oregon said last year that forcing transgender students to use bathrooms and locker rooms inconsistent with their gender identity would harm transgender students. An appellate court in Pennsylvania ruled in July 2018 in favor of a policy that supported transgender students, despite a challenge from other students who said sharing bathrooms with transgender students would infringe on their rights to privacy, among other laws.

"There has been striking uniformity over the past three years where judges who are confronted with real trans students, and real evidence, are finding that there is simply no basis for treating boys and girls who are transgender differently than other boys and girls," Block said.

Wright Allen's ruling Friday culminates a lengthy legal process in Grimm's case.

He sued in July 2015. The School Board argued in essence that its policy, adopted in 2014, was valid because Title IX of the Education Amendments of 1972 allows for claims only on the basis of sex, rather than gender identity, and that its policy did not violate the equal protection clause.

Partway through the proceedings, in March 2017, President Donald Trump's administration rescinded protections for transgender students.

The Supreme Court then vacated a prior appeals court decision in favor of Grimm and sent the case back to the federal appeals court in Virginia for further consideration in light of the new guidance from the Trump administration. The case was later returned to the District Court.

In May 2018, Wright Allen, who was appointed to the bench by President Barack Obama, denied a motion by the School Board to dismiss the lawsuit.

Gillian Branstetter, a spokeswoman for the National Center for Transgender Equality, called Friday's ruling "extremely important."

"For many people, in a cultural sense, the Gavin Grimm case is the case, and not merely the case governing the right of transgender students, but the case centering on transgender rights, period," she said.

A teenager was arrested Monday in connection with the fatal shooting of a transgender woman in Miami-Dade County's Goulds neighborhood.

According to Miami-Dade police detectives, a witness identified Marcus Watson as Marquis "Kiki" Fantroy's killer in a photo lineup. Records show Watson is in foster care. 

The 21-year-old transgender woman died July 31 after an early morning shooting near her home.

According to the arrest report, Watson got upset during a conversation, shot at a person officers identified as "Victim Bell" and then started chasing and shooting at Fantroy. 

Detectives said Watson ran after her and shot at her several times. 

Fantroy was near a corner where Southwest 115th Court and Southwest 116th Avenue meet, north of Southwest 224th Street, when she collapsed, police said. 

Miami-Dade Fire Rescue personnel took her to Jackson South Medical Center, where she was pronounced dead. 

Fantroy was the 13th transgender woman killed this year in the U.S. and all of them have been African-American, TransGriot reported. Advocates reported 26 transgender women were killed in the U.S. in 2018 and 29 were killed in 2017.

Watson faces a charge of second-degree murder and an attempted murder charge.

 Laverne Cox sees this as a best of times, worst of times moment for transgender people.

“We’ve never ever been more visible than we are right now and yet we are under attack by this administration,” she told The Associated Press in a recent interview.

The Trump administration has moved to revoke newly won health care protections for transgender people, restrict their presence in the military, and withdraw federal guidance that trans students should be able to use bathrooms of their choice.

The “Orange is the New Black” co-star said she has no plans to slow down as an activist for her transgender community now that the Netflix series has reached its end.

“There’s so many things to celebrate right now, and then there’s so many things to mourn and to grieve over and to be in pain over and to fight for at the same time,” she said.

In 2018, advocates tracked at least 26 violent deaths of transgender people in the U.S., according to the Human Rights Campaign. Most were black transgender women. So far this year, at least 13 transgender people have been killed by violence in the U.S., the advocacy group reports.

Cox said she’s been motivated since childhood to do work “that makes it better for people who follow me.” She recalled a black history picture book filled with African American leaders and artists that her mother gave her when she was 5 or 6.

She was obsessed with the soprano Leontyne Price.

“I thought how amazing would it be to have my work as an artist change the world in some way for people who may follow me,” Cox said.

She cited a growing list of working trans actors: Indya Moore, MJ Rodriguez, Angelica Ross, Hailie Sahar, Dominique Jackson, Asia Kate Dillon, Amiyah Scott and Hari Neff among them.

“We are everywhere,” Cox said. “We’ve always been there.”

By 

In the interest of examining this important news topic through a research lens, Journalist’s Resource collaborated on this story with The Burlington Free Press, where it first appeared.  This piece is part of the newspaper’s series of stories about transgender youth in the state.

As Vermont regulators consider changes to Medicaid that would expand access to gender confirmation surgery for transgender youth, researchers and physicians point to a growing body of peer-reviewed academic scholarship in support of the new proposal.

Among other changes, the proposed rules would eliminate the requirement that transgender individuals on Medicaid must wait until the age of 21 to receive surgery. Individuals over the age of 18 and minors — with informed parental consent — would be eligible.

Such changes are in line with current thinking among academics and physicians in the field. It’s still a fledgling field, as Marci Bowers, a California-based gynecologist and surgeon who specializes in gender confirmation and serves as a professorial lecturer at the Icahn School of Medicine at Mount Sinai points out.

“Kids are coming out very young. A generation ago, they were driven into the closet,” Bowers said. “It’s only these last 20 years or so where instead of that happening, people are getting professional help.”

How common are gender confirmation surgeries in the U.S.?

Estimates suggest that in the U.S., between 2000 and 2014, 10.9% of inpatient visits for transgender people involved gender confirmation surgery. This figure comes from an analysis of inpatient visits for a nationally representative sample that includes, but is not limited to, transgender patients, which was published in 2018in the medical journal JAMA Surgery. Over the study period, the number of patients who sought gender confirmation surgery increased annually.

Further, the percentage of gender confirmation surgeries that are “genital surgeries” — commonly referred to as bottom surgeries — has increased over time. Between 2000 and 2005, 72% of gender confirmation surgeries were bottom surgeries; from 2006 to 2011, that number increased to 84%. And the number of patients insured by Medicare or Medicaid seeking these procedures increased threefold between 2012-2013 and 2014.

As societal acceptance of gender diversity has grown, medical thinking has changed, too, Bowers notes.

“At least in the academic circles, in the medical circles, we realize that yes, it’s valid, that yes, kids do better after treatment, yes, surgery is appropriate, and why wait till 21?” Bowers said. “That’s really completely arbitrary. In fact, it’s probably cruel.”

“Most of the research is on older patients,” Elizabeth Boskey, a social worker at the Center for Gender Surgery at Boston Children’s Hospital and co-author of several research papers on gender confirmation gender-affirming surgery in youth, notes. “But there is evidence in the literature about just overall improved health, reduced anxiety, increased ability to function, for individuals after they have these gender-affirming surgeries.”

What does research say about treatment of transgender youth?

review of the latest research on gender-affirming hormones and surgery in transgender youth, published in a June 2019 edition of The Lancet Diabetes & Endocrinology, supports Bowers’ assertions that gender confirmation surgery benefits adolescents, though it does not go as far as to recommend specific age guidelines.

“Several preliminary studies have shown benefits of gender-affirming surgery in adolescents, particularly regarding bilateral mastectomy in transgender adolescent males, but there is a scarcity of literature to guide clinical practice for surgical vaginoplasty in transgender adolescent females,” the authors write. “The optimal age and developmental stage for initiating [cross sex hormones] and performing gender-affirming surgeries remains to be clarified.”

The World Professional Association for Transgender Health (WPATH), a leading organization for transgender health worldwide whose membership consists of physicians and educators, publishes Standards of Care and Ethical Guidelines for the treatment of transgender patients.

Though WPATH’s Standards of Care was last updated in 2011 and is under revision, even the current standards suggest that individuals at the age of majority in a given country (for the United States, that’s 18) who have lived for at least 12 months in accordance with their gender identity should be eligible for genital surgery, and that chest surgeries can be done earlier.

“I think it’s important to recognize for all of these standards of care, these are flexible guidelines,” says Loren Schechter, director of the Center for Gender Confirmation Surgery at Weiss Memorial Hospital, clinical professor of surgery at the University of Illinois at Chicago, and co-lead for the revision of the WPATH standards of care surgery chapter for adolescents and adults. “It is not necessarily uncommon that we will currently perform bottom surgeries under the legal age of majority now.”

Schechter also indicated that the revision of the standards will likely include lowered age guidelines.

One reason to give transgender youth access to surgery

Schechter maintains that there are many reasons why minors should be eligible to receive gender confirmation surgery.

“One of them is that post-operative care in a supportive environment is very important,” Schechter said. “So, for example, for those individuals going off to college, the ability to recuperate while at home in a supportive environment and parents during that post-operative period is quite important. Trying to have your post-operative care in a dorm room after surgery is it is not necessarily an ideal scenario.”

This reasoning was echoed in a paper published in the Journal of Sexual Medicine in April 2017. For the study, researchers asked 20 WPATH-affiliated surgeons practicing in the U.S. about whether and why they performed genital surgery on transgender female minors.

Respondents noted the beneficial recovery environment some minor patients may have.

“Some surgeons viewed timing the procedure before college attendance as a harm reduction measure: Younger patients who have the support of their families, support of their parents, and can have the operation while they are still at home, as opposed to being alone at school or at work, anecdotally tend to do much better than someone who is alone and doesn’t have appropriate support.”

Others suggest that receiving surgery as a minor might allow the patient to “fully socially transition” in their next phase, such as in college.

Who is ready for surgery? Considerations beyond age

Physicians involved in the study also noted that while the number of minors requesting information about genital surgery had increased, psychological maturity is their main criteria for approval.

As one interviewed surgeon put it, “Age is arbitrary. The true measures of how well a patient will do are based on maturity, discipline and support.”

Eleven of the 20 surgeons interviewed had performed such surgeries. Minors ranged in age from 15 to “a day before 18.” About two-thirds of surgeons interviewed believe that such decisions should be made on a case-by-case basis rather than in strict adherence with current WPATH guidelines, which advises to wait until 18 in the U.S.

Boskey, who works for the Center for Gender Surgery at Boston Children’s Hospital, notes: “Just setting the age guidelines in place doesn’t remove the need to appropriately assess whether the surgery is something that should be happening,” she said.

“They’re going to need to make certain that the patient is appropriate for that surgery, that they are being diagnosed with gender dysphoria, that they are taking hormones as appropriate, that they are living in their affirmed gender, that they are aware of all of the life-changing nature of these surgeries,” she said. “These are surgeries that require pretty intense assessment to make certain that they’re appropriate. But that needs to come from the clinical side, rather than the insurance side.”

Will trans youth regret surgery? What the research says

Research supports the benefits of early interventions.

A 2018 study published in JAMA Pediatrics of 136 transmasculine youth and young adults between the ages of 13 and 25 receiving care at Children’s Hospital of Los Angeles finds that, on average, chest dysphoria, or distress caused by one’s chest, was significantly higher among participants who had not received chest reconstruction surgery as compared with those who did.

Serious complications among the surgery group were rare, and only one of the 68 patients who received surgery reported experiencing regret sometimes, with the other 67 reporting no regret over the procedure. The time that had elapsed between surgery and the survey ranged from less than 1 year to 5 years.

“Given these findings,” the authors conclude, “professional guidelines and clinical practice should consider patients for chest surgery based on individual need rather than chronologic age.”

Those who study the impact of early access to gender confirming surgeries often point to research from the Netherlands, home to one of the earliest comprehensive gender clinics.

“[T]hey’ve probably got the most data on transgender, gender non-conforming adolescents, who have been followed longitudinally, prospectively in the most rigorous way — that data indicates that people do well with early access and early interventions,” Schechter says. “By early, I mean late adolescence — we’re not, of course, talking about operating on children.”

Adolescents who were the first 22 people to receive gender confirming surgery at the clinic in the Netherlands showed after surgery that they no longer experienced distress over their gender, according to a 1997 publication in the Journal of the American Academy of Child & Adolescent Psychiatry.

The study also showed that the 22 adolescents scored within the normal range for a number of psychological measures.

Further, the authors note, “Not a single subject expressed feelings of regret concerning the decision to undergo sex reassignment.”

A follow-up study, published four years later, of another group of 20 adolescents receiving surgery after the first group of 22 confirmed the initial findings.

Another, later study in the Netherlands focused on the outcomes of 55 transgender young adults who received gender confirmation surgery between 2004 and 2011. The participants all “were generally satisfied with their physical appearance and none regretted treatment.”

Moreover, gender dysphoria was alleviated, mental health improved, and well-being among those studied was similar to or better than their peers in the general population.

Trans people and their allies gathered at the Peace Park and marched through downtown Montreal waving trans flags.

Organised by the trans rights collective Euphorie dans le genre, the political march demanded “universal access to trans-affirmative care” in Canada.

Bruna Hill, one of the people at the march, said, “Even though some institutions and big corporations support us when we take a job, many people don’t respect our rights.”

“We should have access to more information, more support from the government, from the police and also from society. Trans rights are human rights and if all lives matter, our lives also matter,” Hill said.

Montreal marchers: end the medicalisation of being transgender

The trans community in Quebec wants to “put an end to the psychiatrisation and the tendency to pathologise transness,” said Harley Vescio, a spokesperson for the collective organisers.

“We’re asking for, first and foremost, a system of informed consent because we just have to jump through all kinds of weird hoops, just in order to get access to hormones, to get access to surgeries,” Vescio said.

“I think we know what we are, we know what we need and with just a regular healthcare professional who knows what they’re doing.”

Those marching had a list of demands including coverage by Quebec’s health insurance board for all treatments related to transition, such as hormones, facial surgery, breast augmentation or removal, vocal training and laser hair removal.

“It’s not to be more attractive. It’s to affirm who we are. It’s for our safety,” said Vescio.

“There are people whose access to their bank account is cut off because, when they call to replace a card, they are told that they don’t have a woman’s voice,” Vescio added.

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