Historically, a person's gender was determined at birth. But in recent years, some have argued that their "gender identity" is different from their gender at birth. For example, while born a biological male, a person comes to identify with the female gender. Such persons are commonly referred to as "transgender” individuals. Some of them have surgery or hormonal therapy to change some of their physical characteristics, but many do not.

On May 13, 2016, the Civil Rights Division of the US Department of Justice (DOJ) issued a letter advising schools receiving federal financial assistance of their obligations under a federal law (Title IX of the Education Amendments of 1972) regarding transgender students. The letter warns schools that "they have a responsibility to provide a safe and nondiscriminatory environment for all students, including transgender students," and that a failure to do so may lead to loss of federal financial assistance under federal programs.