Executive Commitee: President Mchole Crete, MD, FCP Frode ltang Vice President ‘Quentin var Meter MO,FCP Georgie Rancph Mathews, MO, FCP Secretary Pate Lee June, MD, FCP Georgia Past President Den Trumbull MO, FCP ‘Beard of rector: Jane Anderson, MO, FCP Caos Michael Arsques, MO, FCP Misesspp Tom Berton MO, MPH, FCP Jef Brewster, MD, MBA, FCP ‘eos Soot Fils, MO, FOP Aisbome Repacea Huzen, D0, FCP Mongar fn Staw, MO FCP vagina Ferseand Yates, MO, FCP fe York Emeritus, Director Eogone Damone, HD, FCP os Christopher Ferra, eq Vigne American College of Pediatricians. ‘The Best for Children PO Box 357190, Gainesville, FL 32635-7190 ‘www Best4Children.org Date: January 21, 2016 Dear Mr. Cates: I write on behalf of Parents for Privacy who are deeply concerned about policy changes recently enacted regarding gender identity. As President of the American College of Pediatricians, I applaud you for seeking to encourage a school environment of respectful self- expression for all students; this is indispensable. However, I also urge you to devise a way to promote respectful tolerance while simultaneously ensuring bodily privacy for all students, Prior to 2014, biologically normal children who expressed the belief that they were or desired to be the opposite sex were diagnosed with Gender Identity Disorder (GID). The recently revised 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) published by the American Psychiatric Association (APA), still recognizes this disorder though it was renamed Gender Dysphoria (GD) in an effort to reduce the stigma often experienced by those afflicted with it. The DSM-V is used as the recognized standard by mental health professions in the U.S. and some other countries for identifying and describing mental disorders. Although GD may cause great distress for children, when treated early with long-term therapy, the vast majority of cases resolve. According to the DSM-V, up to 98% of boy’ and up to 88% of girls with this condition will develop a gender identity in accordance with their biological sex by the time they pass through puberty. This is wonderful news for the children with GD who would otherwise be faced with the decision of using puberty blocking medications as young as age 9, followed by a life-time of toxic and carcinogenic cross-sex hormones and potentially numerous surgeries in order to appear as the opposite sex. However, reinforcing a child's gender confusion, which gender identity policies do, can result in making GD intractable. Clearly, itis of vital importance to avoid gender identity-based policies and curricula for the sake of the student with GD. It is also imperative for the sake of his or her peers. First and foremost, adopting gender identity curricula and policies that eliminate sex- segregated private areas will challenge all students’ gender idemtity development and sense of security. As psychiatrist Keith Ablow succinctly explains, "[These policies] shak[e] the certain knowledge in boys and girls of whether they can count on not being seen naked by the opposite gender, not to mention whether they are themselves actually the gender they thought they were." He goes on to characterize the promotion of gender ideology as "a powerful, devious and pathological way to weaken [children] by making them question their sense of safety, security and certainty about anything and everything.” Phone: 352-376-1877 « Fax: 362-415-0022 - admin@acpeds.org "American College of Pediatricians isa not-for profit corporetion organized for scientific and educational purposes, exempt from income tax under Section 801(c) (3) ofthe U.S. Intemal Revenue Code.Second, and more significantly, schools must maintain sex-segregated restrooms and changing areas due to the extreme anxiety that results among all students, most especially girls (some of whom may be survivors of sexual assault), when privacy protection is not guaranteed. I have had anumber of middle school and high school girls raise this concem to me in recent years saying they would withdraw from school sports rather than risk "someone with male parts coming into my locker room." It seems to me this would constitute a serious violation of Title IX from the point of view of the biological female students. Ironically, the opposite has been alleged: that refusing to incorporate gender ideology violates Title IX, but this is not so. Title IX exists to maintain equality between the sexes. For human beings sex is a binary genetic trait: male for individuals who possess a Y chromosome and female for those who do not. Human sexuality is binary by design with the obvious purpose being the reproduction and flourishing of our species. This is self-evident. Gender, in contrast, is not an objective biological trait. Gender is a sociological and psychological concept; the awareness of oneself as male or female. No one is bom transgender because no human being is born with an awareness of themselves as male or female, This awareness develops over time, and like all thoughts and enduring beliefs, may be in accordance with reality or not, as explained by principles of psychodynamic and social learning theories. The bottom line is this, children who believe they are the opposite sex do not ever become the opposite sex, nor do they comprise a third sex. All of these children in fact remain either biological boys with a Y chromosome and male genitalia, or biological girls without a Y chromosome or male genitalia, regardless of how they identify. Hence, Title IX is not violated when restrooms and private spaces are segregated by biological sex. To reiterate, no child should be harassed for his or her unique characteristics. Schools should encourage an environment of respectful self-expression for all students, Parental involvement should be a school’s primary method of resolution for particular cases with programs ‘emphasizing general respectfulness serving to set the tone in the classrooms. It is both in keeping with this spirit of respectfulness and imperative for the optimal health of all students, to avoid all curricula, books and other media, and policies, that promote gender fluid ideology. This includes ‘maintaining restrooms and other private spaces that are segregated according to one's biological sex. Sincerely, Michelle A. Cretella, MD President, American College of Pediatricians ‘cc: Board of Education Parents for Privacy