EXHIBIT F 

Expert Report of Dr. Ryan Gorton

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UNITED STATES DISTRICT COURT 

SOUTHERN DISTRICT OF OHIO

STACIE RAY,

et al.,

Plaintiffs,

v.

LANCY HIMES,

et al.,

Defendants.

Case No. 2:18-cv-00272

Judge: Michael Watson

Magistrate Judge: Chelsey Vascura

EXPERT REPORT OF DR. RYAN NICHOLAS GORTON, M.D.

I. INTRODUCTION

1. My name is Ryan Nicholas Gorton. I have been retained by counsel for Plaintiffs 

as an expert in connection with the above-captioned litigation.

2. I have been asked by Plaintiffs’ counsel to provide my expert opinion to respond 

to and rebut the opinions offered by Dr. Quentin L. Van Meter, M.D (“Dr. Van Meter”) in his 

expert report in order to show how Ohio’s policy refusing to provide accurate birth certificate 

gender markers for transgender people born in Ohio harms transgender individuals.

3. I prepared this report to set forth the opinions I may express at trial and the basis 

for my opinions. I have not examined the Plaintiffs in this case. The opinions expressed in this 

report are based on the information that I have reviewed to date, which includes the Complaint, 

the report of Randi Ettner, PhD, and the report of Quentin Van Meter, M.D. I reserve the right to 

revise and supplement the report if any new information becomes available in the future. My 

opinion is based on my clinical experience, professional knowledge, and review of relevant 

research. A bibliography is attached as Exhibit B.

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4. In the last four years, I have testified as an expert at trial or by deposition in the 

following cases: Corbitt v. Taylor, 2:18-CV-91-MHT-GMB (M.D. Ala. filed Feb. 6, 2018); 

Edmo v. Idaho Department of Correction, 358 F. Supp. 3d 1103 (D. Idaho 2018); Keohane v. 

Jones, 328 F. Supp. 3d 1288 (N.D. Fl. 2018); and Cruz v. Zucker, 218 F. Supp. 3d 246 (S.D.N.Y. 

2016).

5. I am not being compensated for preparation of this report and will also prepare for 

deposition or trial testimony and provide deposition or trial testimony on a pro bono basis. I do 

not charge fees for travel time, but, if I do incur out-of-pocket costs to attend a deposition or a 

trial in the Litigation, Plaintiffs will reimburse me. 

II. SUMMARY OF QUALIFICATIONS

6. I am a physician licensed in California. I received my medical degree from the 

University of North Carolina School of Medicine in 1998 and completed my residency and chief 

residency in emergency medicine at Kings County Hospital in Brooklyn, New York.

7. Since 2005, I have worked as an Emergency Medicine physician at Sutter Davis 

Hospital and served as a primary care physician at Lyon-Martin Health Services (“LyonMartin”) in San Francisco. At Lyon-Martin, I have provided primary care and transition-related 

care to more than 400 transgender patients. I provide medical assessments including the 

diagnosis of Gender Dysphoria, initiate and monitor hormonal treatment, and refer for mental 

health treatments. I also determine whether and when patients are appropriate for referral for sex 

reassignment surgeries, provide pre-operative preparation and clearance, and provide postoperative care in consultation with the appropriate surgeon. I also provide supervision to Nurse 

Practitioners and Physician Assistants treating transgender patients at Lyon-Martin. Lyon-Martin 

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is an historically LGBT clinic that has been serving transgender patients for over 30 years. LyonMartin is also one of just a handful of sites in the United States that trains medical students, 

residents, and fellows to provide transgender primary care, and I have been a primary clinical 

instructor for these trainees. I have provided extensive clinical instruction to over 100 trainees 

during this time.

8. I also serve as a lead clinician consultant for TransLine,

1

a national transgender 

medical consultation service for clinicians needing expert advice about the care of their 

individual patients. I am a member of the World Professional Association for Transgender 

Health (WPATH).

9. I have presented lectures and grand rounds on transgender health issues at 

numerous medical school and residency programs throughout the United States as well as 

national and international conferences. I have also co-authored numerous publications addressing 

transgender health, including professional journal articles and chapters and sections in 

professional texts, and publications aimed at the transgender community itself.

10. A copy of my Curriculum Vitae is attached as Exhibit A.

III. TERMINOLOGY

11. In this report, I will use a number of terms that are important to understand my 

rebuttal to the opinions offered by Dr. Van Meter in this case. These include the following:

12. Gender Dysphoria (GD), like Depression, is both a diagnosis and the 

predominant symptoms of that diagnosis. The symptom of gender dysphoria is the psychological 

 

1 TransLine. (n.d.). Retrieved from http://project-health.org/transline/.

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distress one feels when there is a conflict between, on the one hand, one’s internal gender 

identity, and on the other, one’s physical characteristics and perception and treatment by others 

in society. Like depression, this can range from being mild to severe emotional distress.

13. Gender Identity Disorder (GID) is the prior name for what is now called 

Gender Dysphoria. This change was first recognized in the American Psychiatric Association’s 

Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (“DSM-5”) and the DSM4 versions used GID. I may use the terms GD and GID roughly interchangeably, though 

generally GID is used for older medical records and discussion.

14. Gender Identity is the internal sense of oneself as, for example, being a male or

female.

IV. BACKGROUND ON GENDER DYSPHORIA

15. Gender Dysphoria (GD) is a medical condition in the DSM-5. Individuals with 

Gender Dysphoria experience incongruence between their gender identity and birth-assigned sex, 

and experience distress as a result. This diagnosis was previously referred to as Gender Identity 

Disorder (GID).

16. The diagnostic criteria for Gender Dysphoria in the DSM-5 for adults and 

adolescents are twofold:

a. A marked incongruence between one’s experiences/expressed gender and 

assigned gender, of at least six months’ duration, as manifested by at least two of 

the following:

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i. A marked incongruence between one’s experienced/expressed gender and 

primary and/or secondary sex characteristics (or in younger adolescents, 

the anticipated secondary sex characteristics).

ii. A strong desire to be rid of one’s primary and/or secondary sex 

characteristics because of a marked incongruence with one’s 

experienced/expressed gender (or in younger adolescents, a desire to 

prevent the development of the anticipated secondary sex characteristics).

iii. A strong desire for the primary and/or secondary sex characteristics of the 

other gender.

iv. A strong desire to be of the other gender (or some alternative gender 

different from one’s assigned gender).

v. A strong desire to be treated as the other gender (or some alternative 

gender different from one’s assigned gender).

vi. A strong conviction that one has the typical feelings and reactions of the 

other gender (or some alternative gender different from one’s assigned 

gender).

b. The condition is associated with clinically significant distress or impairment in 

social, occupational, or other important areas of functioning.

17. Individuals with Gender Dysphoria, if not treated, often suffer clinically 

significant emotional distress, including depression or suicidal thoughts, and/or impairment of 

functioning in their daily lives. Without appropriate treatment, a significant proportion (30-40%) 

become suicidal, with many attempting and completing suicide. 

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18. The accepted medical protocols for treatment of people with Gender Dysphoria 

involve both social and medical interventions to assist patients to live in accordance with their 

gender identity. The widely accepted standards of care in the U.S. and internationally are 

published by the World Professional Association for Transgender Health (“WPATH”). WPATH 

is an international not-for-profit organization that held its first international symposium in 1969 

and published its initial standards of health care for transgender individuals in 1979. As the 

American Medical Association has stated, the medical community recognizes the WPATH 

Standards of Care as the standards of care for treating gender dysphoria. Social transition is the 

process by which the patient begins living their life authentically in the gender role that 

corresponds with their gender identity. This typically involves adopting a new name, changing 

name and gender markers on identity documents, dressing and grooming appropriate to the 

patient's gender identity, using pronouns and other markers of their gender, and using restrooms 

and other sex-segregated spaces congruent with their gender identity.

19. In contradistinction to the mainstream social and medical interventions to assist 

patients with Gender Dysphoria to live in accordance with their gender identity, attempts to 

change an individual’s gender identity are ineffective, dangerous, and medically both unorthodox

and unsound.

V. OPINIONS

a. Sex and Gender Identity

20. Gender identity is the internal sense of oneself as, for example, male or female, 

and arises from the central nervous system. Sex is the biological characteristics of an individual 

or organism that place it along a spectrum or in discreet categories including male and female. 

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While there is a great variation in sex in other organisms (for example, the well-known 

haplodiploidy in bees), in humans, the majority of people fall into one of two categories: male 

and female.

21. From a clinical and basic scientific perspective, sex is determined by numerous 

biological characteristics which include sex chromosomal type, in humans presence of the 

SRY-gene, hormonal milieu and sexual characteristics produced by this hormonal milieu (e.g.,

external genitalia or secondary sex characteristics), size of gametes produced (generally large 

for female, small for male), gender identity (which is biologically based and determined by 

many factors including genetics and in utero environment including the hormonal milieu as 

above), and gonad type (testes, ovaries, or other variants). While we can describe these 

biological characteristics as different categories, these often have strong but not absolute 

influence on the others. For example, the SRY gene is generally found on the Y chromosome, 

but rarely this can be translocated to the X chromosome leading to an XX fetus that develops in 

every other way along the typical male fashion.

22. In the majority (at least 95%) of people, sex is correctly assigned at birth based 

on a cursory examination of the genitals by a pediatrician, family practitioner, or delivering 

obstetrician or midwife. This determination, which is recorded on the birth certificate as sex, is 

in most cases correct and reflects a congruence of most or all of the characteristics that make up 

sex. However, in a minority of cases these determinations are either incorrect or may not be 

initially recorded at all due to notably atypical genitalia (medically referred to as “ambiguous 

genitalia”).

23. Cases where sex is not initially recorded are because of sufficiently visibly 

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obvious atypical genitalia and are generally referred to specialists for a more thorough 

diagnostic evaluation. These infants are a subset of those who have Disorders of Sexual 

Development (“DSD”). Some children with DSDs have atypical genitalia and are generally 

identified at birth, while others may have genitalia that appear sufficiently male or female 

typical that they are not identified by genital examination at birth.

24. Cases where the initially recorded sex is incorrect may include both transgender 

individuals (most of whom, before treatment, meet the DSM-5 diagnostic criteria for gender 

dysphoria) and people with DSDs who do not have sufficiently abnormal genitalia as to be 

identified at birth.

25. As noted above, sex is a characteristic determined by numerous biological 

characteristics of an individual. In cases where they are incongruent, of these many biological 

characteristics the single most important characteristic for identifying sex in an individual 

human being is their gender identity, which is determined by both genetics and early 

environment (including prenatal hormonal milieu).

26. Gender identity is the most important biologic determinant of overall sex (in 

transgender people and those with DSDs). This concept is accepted broadly in the medical 

community. This is reflected by the fact that people whose gender identity is incongruent with

other sex characteristics (including external genitals which generally determine sex assigned at 

birth) are diagnosed with gender dysphoria and are prescribed treatment by the medical 

community for hormonal, surgical, and social transition. This is supported by major medical 

organizations including the American Medical Association, the American College of 

Obstetricians and Gynecologists, the Endocrine Society, the American Academy of Family 

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Physicians, the American Psychological Association, the American Psychiatric Association, the 

World Health Association, and the World Professional Association for Transgender Health.

27. In the case of people with DSDs (whether correctly identified at birth or not), 

the Consensus Statement Management of Intersex Disorders published in Pediatrics, the journal 

of the American Academy of Pediatrics2(which Dr. Van Meter incorrectly attributes to the 

Intersex Society of North America in his paragraph 17) specifically notes the frequency with 

which certain DSDs have male or female gender identity in adulthood. This varies from near

100% certainty in some conditions, such as girls with XY chromosomes and Complete 

Androgen Insensitivity Syndrome who are almost universally reared as girls, and in whom 

virtually all identify as women in adulthood, to barely better than a coin-flip certainty in XY 

children with 5 alpha reductase deficiency. Individuals with this condition are often 

misidentified at birth as female because they have underdeveloped penises that may be 

misidentified as clitorises in infancy but that virilize at puberty. Sixty percent of these 

individuals live as males in adulthood. 

28. The above examples illustrate that even in humans who are commonly thought 

to be either male or female, there are many people, both transgender and those with DSDs, who 

do not fit into these binary classifications. From a biological perspective, sex is better 

understood as a spectrum in which there are a number of biological characteristics that range 

from male typical to female typical. Most individuals will have alignment of these 

characteristics in a largely male or female typical development.

29. The single most important determinant of sex is the patient’s gender identity. 

 

2 Lee, P. A., et al. (2006). Consensus statement on management of intersex disorders. Pediatrics, 118(2), e488-e500.

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For individuals who meet the diagnostic criteria for gender dysphoria (whether or not they have 

a DSD), it is the well accepted standard of care to provide these patients with individualized 

care that, depending on the needs of the individual, may include medical, surgical, and social 

treatment that diminish both their gender dysphoria and the well-known associated psychiatric 

morbidity such as depression, anxiety, suicide attempts, and suicide completions. Social 

treatments include supporting patients with social transition by providing medical information 

to agencies issuing identity documents such as drivers’ license, passport, and birth certificates

where required to change the gender marker to reflect the patient’s gender identity.

30. Identity documents that are congruent with a patient’s gender identity have

significant clinical benefits. A 2015 study demonstrated that having one or more identity 

documents concordant with gender identity was statistically significantly associated with 

reduced suicidal ideations and attempts. Based on this study’s results, changing 1000 identity 

documents would prevent 90 episodes of suicidal ideation and 20 suicide attempts over the 

course of one year.3

31. This study correlates with my clinical experience treating hundreds of patients 

with gender dysphoria over the course of nearly one and a half decades. Congruent identity 

documents diminish dysphoria, anxiety, and depression. They improve social function and 

ability of patients to have normal functional lives. For example, without identity documents,

my patients have reported that they have been unable to or limited in their ability to apply for 

 

3 Bauer, G. R.,et al. (2015). Intervenable factors associated with suicide risk in transgender persons: a 

respondent driven sampling study in Ontario, Canada. BMC public health, 15(1), 525, available at 

https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1867-2.

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work, use a credit or bank card, apply to college, fill prescriptions, travel by plane domestically 

or internationally, rent a car, vote, serve on a jury, and obtain public services and benefits 

including homeless shelter placement. My patients have reported that attempts to undertake 

these mundane tasks have resulted in harassment or physical violence. They have also reported 

that they have withdrawn from these and other activities that may require use of identity 

documents due to fear of harassment and violence.

32. Thus, in addition to the purely scientific mandate that gender identity is the 

appropriate, determinative factor for selecting male or female gender markers on identity 

documents, there is a clinical imperative that gender identity be used to make that 

determination.

33. Transgender men with or without DSDs should be identified as men for the

purposes of all identity documents including birth certificate. Transgender women with or

without DSDs should be identified as women for the purposes of their identity documents

including their birth certificate.

b. Medical Community Norms for Recognizing and Discussing Gender 

i. Dr. Van Meter

34. Dr. Van Meter’s report contains a number of errors and offers conclusions that 

are not only wrong but in opposition to generally recognized understanding of sex, gender, 

gender dysphoria, and DSDs by the broader medical community.

35. In paragraph 16, Dr. Van Meter states “These aberrations of normal 

development are responsible for what we classify as Disorders of Sexual Differentiation 

(DSDs) and they represent a very small fraction of the human population. The incidence of 

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such circumstances occurs in 1:4500 to 1:5500 births.” He cites a paper4 which states clearly 

that this number (1:4500 to 1:5500) represents the portion of DSDs that have sufficiently 

atypical genitalia at birth such that a physician, midwife, or nurse facilitating delivery are 

unable to assign sex based on a visual inspection of the newborn’s genitalia, and notes that this 

is an estimate. “There are no clear estimates of the incidence of subjects presenting with 

atypical genitalia at birth, and only a proportion of them present a major challenge regarding 

male or female assignment. However, it has been estimated to be approximately 1 in 4,500-

5,500.” The paper goes on to cite the incidence of other DSDs such as Kleinfelters syndrome

(infants born with 3 sex chromosomes: XXY) as 1:500-1:1000.

36. In paragraph 19, Dr. Van Meter states, “DSD patients are not ‘transgender’; they 

have an objective, physical, medically verifiable, physiologic condition. Transgender people 

generally do not have intersex conditions or any other verifiable physical anomaly. People who 

identify as ‘feeling like the opposite sex’ or ‘somewhere in between’ do not comprise a third 

sex. They remain biological men or biological women as determined by their chromosomes and 

sex at birth.” Dr. Van Meter is wrong that these are mutually exclusive categories. While there

are many people with DSDs who are not transgender and do not have gender dysphoria and 

many transgender people who do not have a diagnosable DSD (based on the current limitations 

of the diagnostic ability of medicine), Dr. Van Meter oversimplifies and exaggerates this 

distinction. Counting those I have diagnosed primarily and those presenting with a prior 

diagnosis of a DSD, I have personally treated more than 20 patients who both had gender 

 

4 Lee, P. A., et al. (2016). Global disorders of sex development update since 2006: perceptions, approach and care. 

Hormone research in paediatrics, 85(3), 158-180, available at: 

https://www.karger.com/Article/FullText/442975/27603905.

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dysphoria and a DSD. In the DSM-5, having a DSD does not exclude a patient from being 

diagnosed with gender dysphoria. 

37. Gender identity is an immutable characteristic in adolescents and adults, and not 

merely “feeling like the opposite sex” as Dr. Van Meter suggests. As discussed above, attempts 

to alter a patient’s gender identity are harmful and ineffective, and the clinical benefits of 

recognizing a patient’s gender identity are profoundly beneficial. A biological origin of 

transgender identity is supported by scientific evidence including a significant heritability 

demonstrated by a higher concordance of gender dysphoria among identical rather than 

fraternal twins5and gene mutations associated with gender dysphoria in transgender men and 

women.6 However, scientific recognition of the complex biological nature of gender identity 

does not imply that we currently have a simple blood test or imaging study that will diagnose 

patients with gender dysphoria. The current best clinical diagnostic indicator of gender 

dysphoria is evaluation by a licensed health care professional who assesses the patient’s gender 

identity.7

38. In paragraph 24 Dr. Van Meter states, “Gender incongruity occurs in 0.001% of 

biological females and 0.033% of biological males.” To support this, he cites an article by Eric 

 

5 Coolidge, F. L., et al. (2002). The heritability of gender identity disorder in a child and adolescent twin sample. 

Behavior genetics, 32(4), 251-257; Diamond, M. (2013). Transsexuality among twins: identity concordance, 

transition, rearing, and orientation. International Journal of Transgenderism,14(1), 24-38.

6 Henningsson, S., et al. (2005). Sex steroid-related genes and male-to-female transsexualism. 

Psychoneuroendocrinology, 30(7), 657-664; Bentz, E. K., et al. (2008). A polymorphism of the CYP17 gene related 

to sex steroid metabolism is associated with female-to-male but not male-to-female transsexualism. Fertility and 

sterility, 90(1), 56-59; Hare, L., et al. (2009). Androgen receptor repeat length polymorphism associated with maleto-female transsexualism. Biological psychiatry, 65(1), 93-96.

7 However, there is no demonstrated clinical benefit to requiring medical documentation to update the sex 

designation on an identity document. An opportunity for the individual to attest to their own gender identity is, in 

my opinion, the most clinically appropriate policy for sex designations on identity documents because it minimizes 

unnecessary delay to a potentially life-saving intervention.

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Seaborg in Endocrine News.8 The citation does not mention incidence at all. Numerous studies 

demonstrate a higher incidence than Dr. Van Meter suggests.9 Prevalence of transgender people 

is an evolving number. For example, a 2016 systematic review and meta-analysis of worldwide 

studies ranging including Iran, Taiwan, Japan, multiple European countries, Australia, Iceland, 

and the United States showed that overall the rate of receiving a transgender specific diagnosis 

(such as gender dysphoria or GID in older studies), was 6.8/100,000 or 0.068%. However, this 

meta-analysis spanned studies from 1968-2014 and the authors note that the prevalence has 

significantly increased in later studies. Moreover, in this same meta-analysis, in population 

studies (from 2010 to 2015), assessing for transgender identity, demonstrated a prevalence of 

355/100,000 or 0.35% of the total population.

39. In paragraphs 31-34, Dr. Van Meter makes clinical pronouncements and 

assumptions about the plaintiffs that I do not believe are supported by the clinical information 

that he states he has reviewed. While it is reasonable to assume that since Ms. Rey’s, Ms.

Breda’s, and Ms. Doe’s birth certificates list them as male, that their genitals at birth most 

likely appeared to be male, and that Mr. Argento’s similarly likely appeared to be female, it is 

inappropriate to assume their karyotype (the 23 pairs of chromosomes in a typical human cell, 

with one pair isolated as “sex chromosomes”—typically either an XX pairing or an XY pairing)

based on only knowing the sex recorded on their birth certificate. A 2011 study of karyotypes 

in transgender patients found that the rate of abnormal karyotypes was 3.2% among transgender 

 

8 Seaborg, E. About-Face, Endocrine News (May 2014), https://endocrinenews.endocrine.org/may-2014-about-face/.

9 Collin, L., et al. (2016). Prevalence of transgender depends on the “case” definition: A systematic review. J. Sex. 

Med., 13(4), 613-626.

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women.10 This is compared to about 0.5% in the normal population. The authors of this study 

concluded that karyotyping transgender patients is not clinically supported and I concur, as it 

rarely provides clinically useful information. However, knowing that transgender people have a 

higher percentage of chromosomal abnormalities, I would never state, as Dr. Van Meter did,

that “I can conclude that Ray’s chromosomes are, and have always been, XY.”

40. In summary, Dr. Van Meter’s views expressed in his declaration oversimplify 

the current scientific and medical understanding of sex and gender. His views about the sex of 

transgender people are highly unorthodox within the community of clinicians that treat 

transgender patients and scientists who perform research in this area. Moreover, his conclusions 

about identity document changes—in this case Ohio birth certificates—place patients’ health 

and welfare at risk and run contrary to the day-to-day treatments provided to patients by their 

treating clinicians, which includes assistance with social transition and the change of identity 

documents to accurately reflect the patient’s sex. He makes assumptions and diagnostic 

pronouncements about the plaintiffs that are not supported by the data he reports to have 

reviewed. He makes unsupported claims of much lower prevalence of both DSDs and gender 

dysphoria than the currently accepted prevalence rates.

ii. American College of Pediatricians

41. The American Academy of Pediatrics (“AAP”) is the largest professional 

organization of pediatricians in the United States with 67,000 members, 45,000 of which are 

board certified by the American Board of Pediatrics.11 AAP has issued 179 policy statements 

 

10 Inoubli, A., et al. (2011). Karyotyping, is it worthwhile in transsexualism? J. Sex. Med., 8(2), 475-478.

11 About the American Academy of Pediatrics, https://www.healthychildren.org/English/Pages/About-AAP.aspx, 

(last visited July 30, 2019).

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covering topics including: car seats, asthma treatment, school start times, vaccination, 

intravenous fluids, summer camps, water safety, children with special needs, radiation 

emergencies, health insurance, cleft lip, palliative care, sepsis in neonates, teen drivers, 

hypertension, pain assessment, breastfeeding, impacted earwax, and one entitled “Ensuring 

Comprehensive Care and Support for Transgender and Gender-Diverse Children and 

Adolescents.”

42. Contrary to the AAP, the American College of Pediatricians (“ACPeds”) is a

designated anti-LGBT hate group by the Southern Poverty Law Center which describes ACPedse

as “a fringe anti-LGBT hate group that masquerades as the premier U.S. association of 

pediatricians to push anti-LGBT junk science, primarily via far-right conservative media and

filing amicus briefs in cases related to gay adoption and marriage equality.”

12

43. In contrast to the AAP’s 67,000 members, ACPeds has, by its own claim, 500 

members.

44. The ACPeds has 41 policy statements, a disproportionate number having to do 

with LGBT issues, which, in all cases, run contrary to currently accepted mainstream clinical

practice and the policy statements of legitimate medical organizations. For example, the 

ACPeds’s policy “Psychotherapy for Unwanted Homosexual Attraction Among Youth” supports 

reparative therapy in gay and lesbian children, a practice that has been discredited by research as 

junk science that can cause irreparable damage to children, been condemned by the AAP, the 

AMA, both APAs, and has also been outlawed in a number of states and municipalities due to 

 

12 Southern Poverty Law Center. American College of Pediatricians. https://www.splcenter.org/fightinghate/extremist-files/group/american-college-pediatricians (last visited July 30, 2019).

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Exhibit A

Dr. Ryan Nicholas Gorton, M.D. CV

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Ryan Nicholas Gorton, MD, DABEM

901 Douglass Ave, Davis CA 95616

(504) 261-8379 (mobile)

(530) 297-7880 (home)

nickgorton@gmail.com

Professional Practice

February 2005 – Current Emergency Medicine Physician

Sutter Davis Hospital

Davis, CA

July 2002 – February 2005 Emergency Medicine Physician

St Tammany Parish Hospital

Covington, LA

Professional Practice: Volunteer Activities

March 2005 – Current Primary Care Provider and Clinical Instructor

Lyon-Martin Health Services

San Francisco, CA.

August 2005 – February 2006 Acting Medical Director

Lyon-Martin Health Services

San Francisco, CA.

September 2008 – Current Executive Committee Member and Lecturer

Project HEALTH http://www.project-health.org/

San Francisco, CA.

January 2011 – Current Lead Clinician TransLine National Clinical Consultation Line

Medical-Legal Consultant: Sylvia Rivera Law Project, New York, NY

Lambda Legal Defense and Education Fund, Inc., New York, NY

Transgender Law Center, San Francisco, CA

National Center for Lesbian Rights. San Francisco, CA

Northwest Justice Project, Seattle, WA

The Legal Aid Society, New York, NY

National Center for Transgender Equality, Washington, DC

TGI Justice Project, Oakland, CA.

ACLU Florida

Post Graduate Training

June 2001 – June 2002 Chief Resident, Department of Emergency Medicine

Kings County Hospital Center/SUNY Downstate

Brooklyn, NY

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July 1998 – June 2002 Emergency Medicine Residency

Kings County Hospital Center/SUNY Downstate

Brooklyn, NY

Education

August 1994 – May 1998 Doctor of Medicine

University of North Carolina School of Medicine

Chapel Hill, NC

August 1988 – August 1991 Bachelor of Science in Biochemistry, Summa Cum Laude

North Carolina State University

Raleigh, NC

Professional Affiliations

World Professional Association for Transgender Health (formerly HBIGDA)

◆ Transgender Medicine and Research Committee

◆ Institutionalized Persons Committee

University of California at San Francisco Center of Excellence for Transgender Health

◆ Medical Advisory Board 2010-2013 (during development of original Primary Care

Protocols)

American Medical Association

◆ GLBT Advisory Committee 2009-2011

Gay and Lesbian Medical Association

◆ LGBT Medical Experts Panel

Licensure/Certification

Nov 2003 – Present Diplomate American Board of Emergency Medicine

Nov 2004 – Present CA State Medical License A89440

Feb 2002 – 2009 LA State Medical License 14466R

June 2001 – 2010 NY State Medical License 221808

Publications and Papers

Gorton, R, and Berdahl, C. Improving the Quality of Emergency Care for

Transgender Patients. Annals of emergency medicine. 71(2):

189-192. 2018.

Gorton, R, and Erickson-Schroth, L. Hormonal and Surgical Treatment Options for

FTMs. Psychiatric Clinics of North America. Psychiatric Clinics of

North America. 40(1): 79-97. 2017.

Gorton, R, and Jaffe, J.M., Transline Medical Consultation Service: Four Years of

Clinician Support. USPATH Poster Presentation: February, 2017.

Ingram, N., Pratt V., and Gorton, R. Counting trans* patients: A Community

Health Center Case Study. TSQ: Transgender Studies Quarterly.

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2(1): 136-147. 2015.

Gorton, R and Grubb, M. (2014), General, Sexual, and Reproductive Health In

Erickson-Schroth, L (Ed) Trans Bodies, Trans Selves: A Resource

for the Transgender Community. New York, NY: Oxford

University Press.

Gorton R. Transgender as Mental Illness: Nosology, Social Justice, and the

Tarnished Golden Mean. In Stryker S and Aizura A (Eds.), The

Transgender Studies Reader, Vol 2. New York, NY Taylor and

Francis. 2013.

Ehrbar R, Gorton R, and Winters K. Sugerencias para la revisión de los

diagnósticos relacionados con el genero en el DSM y el CIE. In

Miquel Missé and Gerard Coll-Planas (Eds.), El Género

Desordenado - Críticas en torno a la patologización de la

transexualidad. Madrid: EGALES. 2010.

Ehrbar R, and Gorton R. Exploring Provider Treatment Models in Interpreting the

Standards of Care. International Journal of Transgenderism,

12(4):198-210. 2010.

Pittsburgh Transgender Health Research Summer Institute: A Review and Guidance

for Future Research—Proceedings from the Summer Institute at

the Center for Research on Health and Sexual Orientation,

University of Pittsburgh t. International Journal of Transgenderism,

12(4):211-229. 2010.

Haraldsen I, Ehrbar R, Gorton R, and Menvielle E. Recommendations for Revision

of the DSM Diagnosis of Gender Identity Disorder in Adolescents.

International Journal of Transgenderism, 12(2):75-79. 2010.

Gorton R. Transgender Health Benefits: Collateral Damage in the Resolution of

the National Health Care Financing Dilemma. Sexuality Research

and Social Policy: Journal of NSRC. 4(4):81-91. Dec 2007.

Gorton R. Health Care and Insurance Issues for Transgender Persons.

American Family Practitioner. 74(12):2022. December 2006.

http://www.aafp.org/afp/20061215/letters.html

Gorton R. Current Summary of the Medical Knowledge Base and Current

Clinical Standards Surrounding the Treatment of Patients with

Gender Identity Disorder. Report prepared for the Lambda Legal

Defense Fund. May 2005.

Gorton R, Buth J, and Spade D. Medical Therapy and Health Maintenance for

Transgender Men: A Guide For Health Care Providers.

Lyon-Martin Women's Health Services. San Francisco, CA. 2005.

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ISBN 0-9773250-0-8 (www.nickgorton.org)

Gorton R. A Critical Analysis of the Hayes Report: "Sex Reassignment Surgery and

Associated Therapies for Treatment of GID." Report prepared for

the Lambda Legal Defense Fund. May 2005.

Greenberg's Text Atlas of Emergency Medicine, Michael Greenberg Ed. Lippincott

Williams & Wilkins. ISBN 0-7817-4586-1 2004. Contributing

Author: Chapter 4 – Eyes/Ophthalmic.

Gorton R. “Toward a Resolution of GID, the Model of Disease, and the

Transgender Community.” MAKE. March 2005.

http://www.makezine.org/giddisease.htm

Sinnert R, et al, Gorton R. “The ratio of ionized calcium to magnesium modifies

the bronchodilatory effects of magnesium therapy in acute

asthma.” Aced Emerg Med 2002 9(5) 436-437.

Morris D, Rosamond W, Hinn A, Gorton R. “Time delays in accessing stroke care

in the emergency department.” Acad Emerg Med 1999 Mar; 6(3)

218-23.

Rosamond W, Gorton R, Hinn A, Hohenhaus S, Morris D. “Rapid response to

stroke symptoms: the Delay in Accessing Stroke Healthcare

(DASH) study.” Acad Emerg Med 1998 Jan; 5(1) 45-51.

Selected Conference Presentations and Invited Talks

Gorton, R. Genital Gender Affirming Surgery for the Transgender Patient: A

Didactic and Hands-on Fresh Cadaver-Based Course: “Hormone

Replacement for Transgender Patients”. American Urological Association

2018. San Francisco, CA. May, 2018.

Gorton, R, Jaffe, JM, Tescher, J, and Baker, K. “Mini-Symposium: As California

Goes, So Goes the Nation (Hopefully)”. USPATH. February, 2017.

Gorton, R. Sessuion Moderator. USPATH Symposium. San Francisco CA.

February, 2017.

Gorton, R. “Acute and Long Term Complications of Silicone Pumping: Primary,

Secondary, and Tertiary Prevention”. WPATH Symposium. Amsterdam,

The Netherlands. June, 2016.

Gorton, R, Ettner, R, Brown, G, Bermudez, F, Orthwein, J and Mazur, T. “Orange

isn’t the New Black (Yet)”. WPATH Symposium. Amsterdam, The

Netherlands. June, 2016.

Gorton R. “Transgender Patient Care in the Emergency Department”. American

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Academy of Emergency Medicine Scientific Assembly. Las Vegas,

Nevada. February 2016.

Gorton R. “Transgender Patients in the Emergency Department”. Stanford

University Department of Emergency Medicine SimWars. Stanford, CA.

February 2016.

Gorton R. “History of Transgender Medicine”. UCSF School of Medicine

Transgender Health elective. San Francisco, CA. February 2016.

Gorton R. “Free Silicone Complications and Management”. National Transgender

Health Summit. Oakland, CA. April 2015.

Gorton R. “History of Transgender Medicine”. UCSF School of Medicine

Transgender Health elective. San Francisco, CA. March 2015.

Gorton R. “Transgender Healthcare”. UC Davis School of Medicine. Sacramento,

CA.

December 2015.

Gorton R. “Engaging and Retaining Transgender Patients in Ongoing Primary

Care”. National Association of Community Health Centers Health Institute

and Expo. San Diego, CA. August 2014.

Gorton R. “Sexual and Reproductive Health: A Focus on Transgender Patients”.

California Family Health Council. Webinar. March 2014.

Gorton, R, Green, J and Tescher, J. “California Dreaming: Two Decades of Change

in Health Insurance Law and Policy”. WPATH Symposium. Bangkok,

Thailand. February, 2014.

Gorton, R and Chung, C. “From Grassroots Health Advocacy to Expanding

Clinician Competency: Project HEALTH (Harnessing Education,

Advocacy & Leadership for Transgender Health)”. WPATH Symposium.

Bangkok, Thailand. February, 2014.

Gorton, R and Tescher, J. “Minding the Gap: Development and Implementation of

a Clinical Rotation in Transgender Health”. WPATH Symposium.

Bangkok, Thailand. February, 2014.

Gorton R and Keenan C. “LGBT Sexual and Reproductive Health Issues”.

California Family Health Council Women's Health Update. San Francisco,

CA. April, 2013.

Gorton R. “Transgender Medicine”. California AHEC Webinar. San Francisco,

CA. April, 2013.

Gorton R. “Transgender Aging Issues”. Institute on Aging Conference on LGBT

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Aging. San Francisco, CA. November, 2012.

Gorton R and Branning N. “Transgender Primary Care”. California Academy of

Physician Assistants Annual Conference. Palm Springs, CA.

October, 2012.

Gorton R. “Primary care and Hormonal Treatment for Transgender Clients”.

Samuel Merritt University. Oakland, CA. June 2012.

Gorton R. “Primary care and Hormonal Treatment for Transgender Clients” Grand

Rounds for the VA Medical Center. San Francisco, CA. June 2012.

Gorton R and Wertz K. “Transgender Health Care” Webinar for the California

Family Health Council. San Francisco, CA. June, 2012.

Eichenbaum J, Gorton R and May A. “Transgender Health, the VA, and Barriers to

Care.” San Francisco Veterans Administration Mental Health

Services Grand Rounds. San Francisco, CA. May, 2012.

Gorton R and Wertz K. “Working With GLBT Clients” California Family Health

Council Webinar. Los Angeles, CA. May, 2011.

Gorton R. “Improving Access to Transgender Health Care: Outcomes from Project

HEALTH” World Professional Association for Transgender

Health. Atlanta, GA. September, 2011.

Gorton R and Wertz K. “Trailblazing for Transgender Health” Southern Comfort

Conference. Atlanta, GA. September, 2011.

Gorton R. “Nuts and Bolts of Transgender Primary Care” Gay and Lesbian

Medical Association Annual Conference. Atlanta, GA. September,

2011.

Gorton R. “Transgender Medicine and Cultural Competency” Kaiser Department

of OB/Gyn Grand Rounds. San Francisco, CA. April, 2011.

Gorton R. “Evidence Based Transgender Medicine” Opening Plenary UCSF

National Transgender Health Summit. San Francisco, CA. January,

2011.

Green J and Members of the Center of Excellence for Transgender Health Medical

Advisory Board. “Primary Care Protocols” Morning Plenary UCSF

National Transgender Health Summit. San Francisco, CA. January,

2011.

Freshel K, Gorton R, Hansom C and Barnes A. “Communities Working Together

to Become Culturally Competent” California State Rural Health

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Association Conference. Sacramento, CA. November, 2010.

Gorton R, Spade D and Wilkinson W. “Transposium: Healthcare Access and

Quality For Transgender Individuals” Shaking the Foundations:

The West Coast Conference on Progressive Lawyering, Primary

Care Associate Program, Stanford School of Law. Stanford CA.

October, 2010.

Gorton R. "Improving Access to Transgender Healthcare: Outcomes from Project

HEALTH (Harnessing Education, Advocacy, and Leadership for

Transgender Health)" Gay and Lesbian Medical Association Annual

Conference. San Diego, CA. September 2010.

Gorton R, Gould D and Wertz K. “Trailblazing for Transgender Health” National

Gay and Lesbian Task Force Creating Change Conference. March 2010.

Gorton R. “Grand Rounds: Transgender Medicine” Highland General Hospital

Department of Internal Medicine. Oakland, CA. January, 2010.

Gorton R. “Grand Rounds: Transgender Medicine” Kaiser Permanente Department

of Internal Medicine. San Francisco, CA. December, 2009.

Keatley J and Gorton R. “Transgender Health Care Issues in California Today”

Equality California and the California LGBT Legislative Caucus

Briefing on LGBTI Health Care Issues. Sacramento, CA.

December 2009.

Ehrbar R, Winters K, and Gorton R. “Revision Suggestions for Gender Related

Diagnoses in the DSM and ICD” WPATH XXI Biennial

Symposium. Oslo, Norway. June, 2009.

Gorton R. “A Place at the Table” American College Health Association Annual

Meeting. San Francisco, CA. May, 2009.

Famula M, Hall A, Pardo S, Gorton R. “Providing Trans-Specific Health Care to

Transgender Students in the College Setting.” American College

Health Association Annual Meeting. San Francisco, CA. May,

2009.

Gorton R. “Transgender Health” American Medical Student Association: Regional

Conference. Lubbock, TX. March, 2009.

Gorton R. “Medical Ethics and Evidence Based Transgender Medicine” Equality

and Parity II: A Statewide Action for Transgender HIV Prevention and

Care.

Los Angeles, CA, January 2009.

Gorton R. “Transgender Medicine 101” AMSA Regional Conference. Lubbock,

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TX. December, 2008.

Gorton R, Djordjevic M, and Brownstein M. “Female to Male (FTM) Health

Update” (Provider Session) The 7

th Annual Mazzoni Center Trans-Health

Conference. Philadelphia, PA. May 2008.

Gorton R. “FTM Hormones 201.” (Community Session) The 7

th Annual

Mazzoni Center Trans-Health Conference. Philadelphia, PA. May 2008.

Green J, Gorton R, Razza R, and Tamar-Mattis A, “Healthcare and Access Issues

Panel.” University of California Hastings College of the Law

Transposium Conference. April 2008.

Arkles G, Gorton R, Sanchez D, Suarez C. “Trans Issues in Health Care Panel.”

Harvard Law School Lambda Legal Advocacy Conference. February

2008.

Gorton N, Thaler C, and Keisling M. “Drawing the Curtain: An Overview of

Medical

Privacy Protections and Risks for Transgender Patients and Providers ”

WPATH Symposium, 2007, Chicago.

Gorton R. “Transgender Medicine 2007: A Medical Ethics and Evidence Based

Paradigm Shift.” (Provider Session) The 6

th Annual Mazzoni Center

Trans-Health Conference. Philadelphia, PA. April 2007.

Gorton R. “FTM Hormones 201.” (Community Session) The 6

th Annual Mazzoni

Center Trans-Health Conference. Philadelphia, PA. April 2007.

Gorton R. “Medical Ethics and Evidence Based Transgender Medicine.” FORGE

Forward. Milwaukee WI. March 2007.

Gorton R. “FTM Hormonal Treatment: Beyond 101.” FORGE Forward.

Milwaukee

WI. March 2007.

Gorton R. "Transgender Healthcare in 2007: Its Time to Take it Seriously."

Humboldt

State University 13

th Annual Diversity Conference and Education Summit.

Arcata CA. March 2007.

Spade D, Gehi P, Arkles G, and Gorton R. “Barriers to health care access for

transpeople.” UCLA School of Law, Williams Institute Annual Update.

Los

Angeles, CA. February 2007.

Marksamer J and Gorton R. "Legal Support and Advocacy for Transgender

Youth and Their Families." Gay and Lesbian Medical Association Annual

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Conference. San Francisco, CA. October 2006.

Gorton R. “Hormone Therapy 101.” FTM-Gender Odyssey 2006. Seattle, WA.

September 2006.

Gorton R. “Hormone Therapy 201.” FTM-Gender Odyssey 2006. Seattle, WA.

September 2006.

Gorton R. “Transgender Medicine.” California Department of Health Early

Intervention Program Statewide Conference. May 2006.

Gorton R. “Primary Care and Hormonal Therapy for Transgender Males.”

(Provider

Session) The 5

th Annual Mazzoni Center Trans-Health Conference.

Philadelphia, PA. March 2006.

Gorton R. “Health Maintainence for Transgender Men.” (Community Session) The

5

th

Annual Mazzoni Center Trans-Health Conference. Philadelphia, PA.

March

2006.

Gorton R. “Primary Care and Hormonal Therapy for Transgender Males.” The 23

rd

Annual Conference of the Gay and Lesbian Medical Association. Montreal,

Canada. September, 2005.

Spade, D, and Gorton R. “Medical-Legal Policy Update in the Quest for Trans

Health

Care and Justice.” The 23

rd Annual Conference of the Gay and Lesbian

Medical Association. Montreal, Canada. September, 2005.

Arkles Z, and Gorton R. “Medical-legal Collaboration in the Quest for Trans

Health

Care and Justice” The 19

th Biennial Symposium of the Harry Benjamin

International Gender Dysphoria Association. Bologna, Italy. April, 2005.

Professional Advocacy

Supported as physician member of the American Medical Association for adoption

of inclusive language for transgender people within AMA policy.

“Recommendations to Modify AMA Policy to Ensure Inclusion for

Transgender Physicians, Medical Students and Patients.” Accepted

by the AMA Board of Delegates July 2007. See “AMA Meeting:

Anti-discrimination policy extended to transgendered.” AMA

News July 16, 2007.

http://www.ama-assn.org/amednews/2007/07/16/prsk0716.htm.

Policy amendment available at:

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http://www.ama-assn.org/ama1/pub/upload/mm/467/bot11a07.doc

Authored and proposed with Vernon A, and Maxey K. Resolution to amend the

American College of Emergency Physicians 'Code of Ethics for

Emergency Physicians.' Accepted as policy October 2005. Now

reads (amended language underlined): “Provision of emergency

medical treatment should not be based on gender, age, race,

socioeconomic status, sexual orientation, real or perceived gender

identity, or cultural background.”

Awards

Claire Skiffington Vanguard Award. Transgender Law Center. San Francisco, CA.

2012.

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Exhibit B

Dr. Ryan Nicholas Gorton, M.D. Bibliography

Case: 2:18-cv-00272-MHW-CMV Doc #: 69-7 Filed: 01/16/20 Page: 30 of 32 PAGEID #: 2807
1

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American Psychological Association, Task Force on Gender Identity and Gender Variance. 

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Bauer, G. R., et al. (2015). Intervenable factors associated with suicide risk in transgender 

persons: a respondent driven sampling study in Ontario, Canada. BMC public health, 15(1), 

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systematic review. J. Sex. Med., 13(4), 613-626

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adolescent twin sample. Behavior genetics, 32(4), 251-257

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Fraser, L., & Knudson, G.. (2017). Past and Future Challenges Associated with Standards of 

Care for Gender Transitioning Clients. The Psychiatric clinics of North America, 40(1), 15-27.

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475-478.

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