The Fourth Circuit Court of Appeals (covering Virginia, West Virginia, North Carolina, South Carolina, and Maryland) held that gender dysphoria, a condition experienced by some transgender individuals, is a protected disability under the Americans with Disabilities Act. See Williams v. Kincaid, No. 21-2030 (4th Cir. Aug. 16, 2022). This ruling extends the protections of the Americans with Disabilities Act (“ADA”), such as the right to a reasonable accommodation, to individuals with gender dysphoria.
What is Gender Dysphoria?
Gender dysphoria is significant distress felt by some individuals who experience a mismatch between their gender identity and their sex assigned at birth, often resulting in intense anxiety, depression, and suicidal ideation. People with gender dysphoria may benefit from medical treatment, including hormone therapy. Federal courts have recognized that failure to follow an appropriate treatment plan for gender dysphoria can result in serious psychological and physical harm.
The Fourth Circuit’s Holding
Kesha Williams, a transgender woman with gender dysphoria, was incarcerated in a correctional facility in Virginia. Williams was almost immediately transferred to a men’s housing unit, despite her protests. During her incarceration, she experienced delays in medical treatment for her condition. For at least two weeks, the facility failed to provide hormone therapy injections and medication, which she had taken for 15 years, and she began experiencing significant mental and emotional distress as a result. Williams requested accommodations, including to shower privately and for body searches to be conducted by a female deputy, but they were denied. Williams filed a lawsuit against the county sheriff, deputy, and nurse alleging violations of the ADA and the Rehabilitation Act, among other claims. The district court dismissed the ADA and Rehabilitation Act claims finding that gender dysphoria was not a disability.
On appeal, the Fourth Circuit reversed. In finding gender dysphoria to be a protected disability under the ADA, the court recognized that the medical community’s understanding of these diagnoses has shifted significantly since the law’s enactment. As proof of this shift, the Fourth Circuit noted that the diagnosis of “gender dysphoria” did not even exist as a diagnosis when the ADA was originally adopted in 1990. In light of the basic promise of equality contained within the ADA, the court saw no legitimate reason why Congress would exclude transgender people who experience gender dysphoria from the ADA’s protections.
What This Means for Employers
Although this case is not an employment case, it nonetheless has consequences for employers, at least those located within the Fourth Circuit’s jurisdiction. Employers covered by the ADA are now obligated to extend the ADA protections extended to any other employee with a disability to employees experiencing gender dysphoria. Among other things, this means that employers need to engage in the interactive process and to provide reasonable accommodations to employees with gender dysphoria, which may include leave for medical treatment or access to restrooms that are consistent with an individual’s gender identity.