Fourth Circuit Extends ADA Protection to Individuals with Gender Dysphoria

By: Kaitlin L. Robidoux, Shelby A. Hicks-Merinar

Published: August 23, 2022

The Fourth Circuit has become the first appellate circuit to extend the protection of the Americans with Disabilities Act (ADA) to individuals with gender dysphoria by way of its recent ruling in Kesha T. Williams v. Stacey A. Kincaid, et al. Specifically, the Fourth Circuit’s ruling has declared that “gender dysphoria” — a disorder which causes distress due to the discrepancy between a person’s gender identity and their sex assigned at birth — may qualify as a “disability” under the ADA.

In the Williams case, the plaintiff, a transgender woman, filed a complaint against prison employees for discriminatory treatment while she was incarcerated. The plaintiff alleged that she was housed on the men’s side of the prison, denied timely medical treatment, harassed, and intentionally misgendered by prison officials in various ways. The complaint alleged violations of the ADA and the Rehabilitation Act, which the defendants moved to dismiss on the grounds that gender dysphoria is not a “disability” under the ADA. The defendants’ argument rested on the ADA’s statutory exclusions from the Act’s broad definition of “disability,” one of which is “gender identity disorders not resulting from physical impairments.”

In a split decision, the Fourth Circuit rejected the defendants’ argument. Instead, the Court acknowledged that, when the ADA’s exclusions were drafted in 1990, gender dysphoria was not recognized as a “gender identity disorder.” An examination of that history showed that a “gender identity disorder,” as it was understood at that time, simply meant that an individual identified as a gender that was incongruent with the sex assigned at birth. The Court’s historical plunge also revealed that the American Psychiatric Association (APA) removed “gender identity disorder” from its diagnostic manual of mental disorders in 2013 — and added the diagnosis of “gender dysphoria.” According to the APA, gender dysphoria is defined as clinically significant distress experienced by some, but not all, transgender persons.

The Court found that the two diagnoses are not the same, as they have different symptoms and affect different populations, and that the move away from recognizing “gender identity disorder” and toward recognizing gender dysphoria reflects “a significant shift in medical understanding.” Therefore, considering Congress’ direction to broadly construe the definition of “disability” under the ADA and to “construe the ADA in favor of maximum protection for those with disabilities,” the Court determined that the plaintiff’s gender dysphoria was protected under the ADA.

The Court also found that the plaintiff, Williams, had sufficiently alleged that her gender dysphoria resulted from a physical impairment, as her need for hormone therapy may indicate a physical basis for her diagnosis. Furthermore, the Court noted that the Department of Justice has agreed that medical and scientific research has identified possible physical causes of gender dysphoria.

One judge (Judge Quattlebaum) dissented and found that the ADA claim should have been dismissed based on the text of the ADA.

The Fourth Circuit’s ruling heralds greater protection for individuals who seek accommodations for gender dysphoria in employment and public accommodations. Employers should take note of this ruling and ensure that they are complying with the ADA’s requirements for employees with gender dysphoria.

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