The first federal appellate court has recognized gender dysphoria as an ADA disability


A transgender woman with gender dysphoria spent six months incarcerated in an adult detention center. Prison deputies initially assigned her to women’s housing. But, after they learned that she was transgender, they quickly moved her to men’s housing.

It was a nightmare.

In men’s housing, the transgender woman (who I’ll refer to shortly as “Plaintiff”) experienced delayed medical treatment for her gender dysphoria, harassment by other inmates, and persistent and intentional misgendering and harassment by prison deputies, including a rough body search.

After her release from the detention center, Plaintiff sued the Sheriff for many things, including violating the Americans with Disabilities Act. The district court dismissed her ADA claim, concluding that the ADA’s definition of “disability,” which explicitly excludes “gender identity disorders not resulting from physical impairments,” eliminates gender dysphoria as a liability also.

According to the Mayo Clinic, gender dysphoria is the feeling of discomfort or distress that might occur in people whose gender identity differs from their sex assigned at birth or sex-related physical characteristics.

But, in this 2-1 decision, the United States Court of Appeals for the Fourth Circuit (MD, VA, NC, SC) disagreed with the lower court. Although the facts and circumstances of each case will vary, the Fourth Circuit found three reasons why the ADA could cover gender dysphoria.

First, when Congress passed the ADA, gender dysphoria wasn’t even on the radar. Instead, in 1990, “gender identity disorders not resulting from physical impairments” focused on being transgender. So, how could Congress have meant to exclude gender dysphoria from the ADA definition of disability, especially when it specifically instructed that courts construe the ADA broadly? Indeed, transgender and gender dysphoria are different. The latter involves distress and other disabling symptoms primarily. In other words, many (but not all) transgender individuals suffer from gender dysphoria.

Second, gender dysphoria may result from physical impairments, which are disabilities under the ADA.

Third, the court had “little trouble” concluding that “a law excluding from ADA protection both ‘gender identity disorders’ and gender dysphoria would discriminate against transgender people as a class, implicating the Equal Protection Clause of the Fourteenth Amendment.” The Fourth Circuit concluded that the “only reason” Congress did so was “a bare desire to harm a politically unpopular group, which cannot constitute a legitimate governmental interest.”

For these reasons, the Fourth Circuit concluded that the ADA covers gender dysphoria.

Although this is not an “employment decision,” it will apply with equal force in the workplace, especially if you operate within the Fourth Circuit. For the rest of you, your mileage may vary. However, the Fourth Circuit’s decision aligns with a growing jurisprudential trend recognizing ADA coverage for gender dysphoria.

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