On August 16 in Williams v. Kincaid, a divided three-judge panel of the Fourth Circuit Court of Appeals (which includes North Carolina, South Carolina, and Virginia) became the first federal appellate court to hold that gender dysphoria is a disability under the Americans with Disabilities Act (ADA). The appeal arose from the dismissal of a lawsuit filed by a transgender female inmate. During her incarceration, the plaintiff alleged that she had been assigned to male housing and required to wear male clothing. The plaintiff also alleged that she had been subjected to harassment and purposeful misgendering.

The court started by noting that the ADA expressly excludes from the definition of a “disability” a number of conditions, including “gender identity disorders not resulting from physical impairments.” Assessing the plain language of the statute, the Court determined that when the ADA was passed “in 1990, the gender identity disorder diagnosis marked being transgender as a mental illness.” In contrast, based on advances in medical understanding, “gender dysphoria” goes beyond the original understanding of “gender identity disorders” and only includes situations involving “clinically significant distress.” Moreover, the plaintiff had adequately alleged that her condition had a “physical” basis due to her need for fifteen years of hormone treatment. Finally, in dicta hinting at the possibility of future rulings on this issue, the court reflected that if the ADA were defined to exclude individuals experiencing gender dysphoria, this view may not survive constitutional challenge.

Following the heels of the Supreme Court’s Bostock v. Clayton County decision, which held that gender identity is a protected classification under Title VII, employers within the Fourth Circuit should consider gender dysphoria a disability under the ADA. As a result, individuals experiencing gender dysphoria are entitled to reasonable accommodation and may not be subject to discrimination based on their impairment.