In a case of first impression for federal appellate courts, the United States Court of Appeals for the Fourth Circuit recently held that gender dysphoria qualifies as a “disability” under the Americans with Disabilities Act (“ADA”). In Williams v. Kincaid, the plaintiff, a transgender woman whose gender identity (female) differs from the gender (male) she was assigned at birth, was housed in the male side of a prison because she retained the genitalia with which she was born. She alleged experiencing delays in medical treatment for her gender dysphoria, harassment by other inmates, and persistent and intentional misgendering and harassment by prison deputies. After her release, she filed a lawsuit seeking relief under the ADA, but the district court dismissed her claims because the ADA excludes from the definition of “disability” “gender identity disorders not resulting from physical impairments.”
On appeal, the Fourth Circuit reversed, explaining that when the ADA first became law in 1990, gender dysphoria was not recognized by the medical community as an independent diagnosis or subset of any other condition. However, in 2013, the Diagnostic and Statistical Manual of Mental Disorders, “the basic text used by psychiatrists and other experts,” removed “gender identity disorder” but added “gender dysphoria.” According to the Fourth Circuit, this revision suggests a meaningful difference between the two terms. Gender dysphoria requires a “clinically significant distress” in someone who experiences “an incongruence between their identity and their assigned sex,” whereas a transgender person who does not experience such distress cannot be diagnosed with gender dysphoria. The Court noted “gender dysphoria is a disability suffered by many (but certainly not all) transgender people,” and that while being transgender is not a disability, the clinically significant distress that results in many who are transgender can qualify for protections under the ADA.
The Court further held that the plaintiff’s gender dysphoria resulted from physical impairments because she took hormone therapy for fifteen years to manage and alleviate the condition, and she experienced physical distress without the therapy. Because gender dysphoria “result[ed] from physical impairments,” the condition was not excluded from the definition of disability under the ADA. Finally, the Court reasoned that because many transgender people experience gender dysphoria and both gender identity disorder and gender dysphoria “are very closely connected to transgender identity,” any law excluding both from ADA protections could discriminate against transgender people as a class in violation of the Equal Protection Clause of the Fourteenth Amendment.
Although the facts in this case involved an inmate housed in the male side of a prison, the statutory exclusion of “gender identity disorders” from the definition of “disability” under the ADA applies in the employment setting, as well. The Fourth Circuit’s holding could therefore have far-reaching impacts for how employers must handle requests for accommodations from transgender employees. The Court’s recognition that gender dysphoria is “closely connected” to transgender identity could mean employers may be liable under the ADA if they fail to consider appropriate accommodations or engage in the interactive process when a transgender employee presents a request to perform workplace activities or functions in accordance with the gender in which they identify. These requests can take many forms, some of which could include using a restroom or changing room, or wearing a work uniform that matches their gender identity, or refusing a work task because the task is commonly associated with being performed by the gender that does not match the gender in which they identify. Employers should watch for updates and stay abreast of this evolving area of the law to ensure compliance with their legal obligations under the ADA.