Recently, the New York Times profiled Tony Bias, a high school sophomore targeted by bullies because he is transgender. Tony was born female but transitioned to male after his freshman year. Fearing even more abuse from classmates if he tried out for the boys’ basketball team, Tony quit playing the sport he loved and excelled at.

Tony lamented the persistent misunderstandings in our society about the lives of transgender people, including transgender children. “They don’t understand I’m not trying to pretend to be someone else,” Tony told the Times. “I’m just trying to be who I have been all along.”





Our sense of who we are as boys or girls, men or women is in our brains as much as it is in our bodies. Gender involves more than hormones and body parts; it is a complex mixture of brain and body. This is well recognized in the medical literature.

Transgender children recognize, often by the time they are toddlers, that their physical bodies do not match their internal experiences of who they are as a boy or a girl. This condition, known as gender identity dysphoria, can cause great distress to a child, often resulting in depression, anxiety, behavioral issues and poor school performance. It is not surprising that if a child cannot live fully in the gender they know themselves to be — including using the appropriate restroom — their gender identity is undermined, with a consequent negative impact on their mental health.

To alleviate the distress, medical and mental health professionals established a standard of care specifying that transgender children live as the gender they know themselves to be, a process called social transition. Social transition includes dressing consistently with the child’s internalized sense of who he or she is as a boy or girl, using names and pronouns that align with the child’s lived gender, and interacting with peers and one’s social environment in that gender role.

Tony’s comment about living as the boy he has always known himself to be surely resonates with many of his transgender peers — including Susan Doe, a student who suffered harassment and discrimination as a fifth-grade student in Orono simply because she is transgender. Susan (a pseudonym) had undergone social transition, and her school treated her like her female classmates in all aspects of school life. That ended when one male student who objected to the state nondiscrimination law followed her into the girls’ bathroom. Rather than focusing on the student’s misconduct, school officials promptly began to deny Susan access to the girls’ bathroom. Susan’s family filed a lawsuit alleging violations of state law prohibiting discrimination against transgender people, including in public education. The Maine Supreme Judicial Court will hear the case later this year.

The Maine Chapter of the American Academy of Pediatrics signed on to a “friend of the court” brief supporting Susan because, as pediatricians, we know that transgender children thrive when they are treated like other girls and boys. They are harmed when they are singled out and made to feel — and to be seen by others — as different. Stigmatizing these young people in the eyes of their peers can lead to social isolation and disrupts their ability to learn. There is also a long term effect: Singling out transgender children and branding them as “different” can do serious and irreparable harm to their long-term emotional and psychological development.

This position is supported by a number of other organizations that also signed the brief: the Maine Psychological Association; the National Association of Social Workers – Maine Chapter; the Maine Women’s Lobby; Parents, Families and Friends of LGBT People in Portland; PFLAG Machias, PFLAG National; Gay, Lesbian and Straight Education Network of Southern Maine; GLSEN Downeast Maine; the Trans Youth Equality Foundation; and the Maine Transgender Network Inc.

We recognize that transgender issues are new to many people and even that a transgender student might make some other students uncomfortable. When that is the case, we need to work with those students, educate them and help them better relate to and respect their classmates who move through the world differently than they do. We need to close that understanding gap so that kids like Tony Bias and Susan Doe can have the same educational opportunities as their classmates.

In the past, transgender children and youth routinely suffered debilitating effects from suppressing or concealing their true gender. But today, with greater understanding, growing numbers of transgender children have an opportunity to grow up with acceptance at home and at school, and to participate equally in the range of activities and social interactions routinely engaged in by other young people. When given this opportunity, transgender children thrive and have the same potential as others to become healthy, productive adults.

Dr. Steven Feder is president of the Maine Chapter of the American Academy of Pediatrics.