Parents Versus Public Schools: Supreme Court to Consider Transgender Instruction

I launched my family medical practice in Montgomery County, Maryland, in March 1990. The practice grew to over 7,000 patients before I sold it to my associate in 2008, when my family and I moved to Pennsylvania. I knew my 7,000 plus patients well. They confided in me and shared their secrets. Many were gay or lesbian. How many were transgender? Not one. 

Today, transgender individuals are common. But as recently as 17 years ago, they were rare. In 1994, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) noted that, “There are no recent epidemiological studies on prevalence of Gender Identity Disorder [in the United States]. Data from smaller countries in Europe with access to total population statistics and referrals suggest that roughly 1 per 30,000 adult males and 1 per 100,000 adult females seek sex-reassignment surgery” (in 1994, the official term was “Gender Identity Disorder”).

In 2023, the national Youth Risk Behavior Survey assessed transgender identity in a large and demographically representative survey of American high school students. In the survey, 3.3% of high school students identified as transgender. So we have gone from roughly 1 in 30,000 in 1994, to more than 3 in 100 in 2023—a change of more than two orders of magnitude in about 30 years. A study published in the Journal of the American Medical Association found that between 2016 and 2019, the number of Americans undergoing gender affirmation surgery nearly tripled.

Twenty years ago, I wrote a book titled Why Gender Matters. That book had one paragraph about transgender identity. More recently, the publisher asked me to write a second edition: 4 out of 12 chapters address gender-conforming, lesbian, gay, bisexual, transgender, and intersex issues, with the last two chapters taking a deep dive into the rise in transgender identity. We have learned that gender identity is much more susceptible to cultural influences than was previously suspected—cultural influences, such as what kids are taught in school and what they see and hear on social media. 

In 2022, Montgomery County Public Schools launched a new county-wide initiative to encourage inclusivity. Children in pre-K through grade 3 were read books such as Trinity’s Rainbow, about a prepubescent boy who transitions to being a girl, and Born Ready, about a prepubescent girl who transitions to being a boy. The children were told that when you are born, the doctors make a “guess” about whether you are a boy or a girl, but sometimes the doctors guess wrong, and then, when you are four or five years old, you have to tell your parents that the doctors guessed wrong. 

A group of parents—consisting of Muslim, Christian, and Jewish individuals—requested permission for their children to opt out of the inclusivity program, but the permission was denied. The parents sued the district but lost. They appealed to the federal district court, where they also lost, so they appealed to the United States Supreme Court, which agreed to hear the case. Oral argument in Mahmoud v. Taylor will take place on April 22. 

The lawyers representing the parents will argue that the Montgomery County program is an unconstitutional infringement on the parents’ First Amendment right of free exercise of their religion. Orthodox Judaism, Christianity, and Islam all teach that if God created you female, it is not in your authority to remake yourself as male, and vice versa. By reading books to 5-year-olds in which young boys reinvent themselves as girls and young girls reinvent themselves as boys, the plaitiffs argue, Montgomery County Public Schools is engaging in religious instruction, and violating their First Amendment rights by not allowing the parents to opt out.¹

What are the long-term effects of transgender identity? We now have good research on this topic. All Danish citizens have universal healthcare, which means that researchers have access to a comprehensive database of everything that’s going on in Denmark. A recent review published in the Journal of the American Medical Association found that transgender Danes are more than seven times as likely to attempt suicide, and more than three times as likely to commit suicide, compared to non-transgender Danes. Transgender Danes are also about twice as likely to die prematurely from all causes compared to other Danes. If a biological male takes female hormones throughout adulthood, that increases the risk of blood clots, stroke, and other adverse outcomes. Denmark is about as friendly to transgender individuals as any country on the planet, but that friendliness doesn’t diminish the risk of adverse medical or psychiatric outcomes. A study in the United States published by the American Academy of Pediatrics found that the prevalence of psychiatric disorders is several times higher in transgender children and teens than in kids who are not transgender. 

And yet, we have schools celebrating transgenderism. A school I know well recently celebrated a girl’s decision to transition to the male role. There was a school-wide party. The child was rewarded with the role of Professor Harold Hill in the school’s production of The Music Man. Over the past 24 years, I have visited more than 500 schools, and this school is not unusual, nor is the program in Montgomery County. It should disturb us that so many schools encourage and celebrate transgenderism, when we now have good evidence that transgender individuals are more likely to suffer from psychiatric disorders, to commit suicide, and to die prematurely. 

What about the familiar warning that many parents hear, “Would you rather have a live son or a dead daughter?” Five years ago, the National Health Service in the United Kingdom appointed Dr. Hilary Cass, former President of the Royal College of Paediatrics, to review all the research on transgender kids and to issue a report with recommendations. Dr. Cass commissioned six comprehensive reviews of every study from every country worldwide, looking at every kind of intervention with regard to kids and gender identity. Dr. Cass and her team published the report last year, and found no evidence that transition decreases the risk of suicide. This very point came up this past December when the Supreme Court heard oral arguments concerning a Tennessee law prohibiting, for example, underage girls from having mastectomies as a “gender-affirming surgery” when they transition from female to male. Justice Samuel Alito challenged ACLU attorney Chase Strangio, noting that the Cass Commission review in the UK had found “no evidence that gender-affirmative treatments reduce suicide.” In response to Justice Alito’s direct challenge, Strangio had to acknowledge “there is no evidence in some—in the studies that this treatment reduces completed suicide.”

What Can Parents Do?

Parents need to be aware that gender identity is fragile—much more so than anybody guessed just 20 years ago. I was recently involved in a case of a teenage girl who was struggling with depression. She had seen a TikTok video that basically said only girls struggle with depression; transition to being a boy, and you won’t be depressed. She believed that video and informed her parents that she wanted to be a boy. When her parents refused, she ran away from home and became a ward of the state. The parents sued the state to regain custody and hired me as an expert witness. I told the judge the girl was mistaken—transitioning to the male role is not the solution to her depression. Twenty years ago, nobody would have guessed that watching a video on social media would lead a girl to doubt that she was a girl. 

I think the simplest example parents can set when it comes to gender is just by having a mother and father in the home. In our household, I shop for groceries and my wife fixes the lawn tractor. We break gender stereotypes. But our daughter has both a father and a mother. That’s a big advantage. Not every family has that. If you don’t, then it’s even more important to find a community of women for your daughter, and a community of men for your son. Your synagogue, your church, or your mosque may offer this.

But it’s also important to limit what your kids are seeing on social media. I endorse Jonathan Haidt’s recommendation to ban all use of social media by kids under 16 years of age, a ban also endorsed by leading researcher Jean Twenge. Social media is where a lot of this false messaging originates. 

We need to raise girls to be women and boys to be men. That doesn’t mean endorsing gender stereotypes. On the contrary, one of the ironies of transgender activism is that the transgender activists themselves are inadvertently reinforcing the stereotypes. Today, I hear stories of girls who want to serve in combat, who are asked “What are your preferred pronouns? Do you want to transition to the male role?” And the boy who wants to dance ballet is asked whether he is transitioning, or if he is gay.

There is more than one way to be a good man. There is more than one way to be a good woman. We need to celebrate the diversity of gender, acknowledging that there are many ways to be a woman and to be a man. But at the same time, we need to encourage girls to become women, not men.

Leonard Sax, MD PhD is a family physician, psychologist, and the author of four books for parents, including Why Gender Matters: What Parents Need to Know About the Emerging Science of Sex Differences. More information is online at www.leonardsax.com. 

Editor's Note: The opinions expressed in this article are those of the author and do not necessarily reflect the official policy or views of the Institute for Family Studies.

1. Along with several other psychologists, I am a co-author of a friend-of-the court brief in this case, advising the Court how this kind of instruction at an early age can normalize and promote transgender identity in the mind of a child.