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On August 16, 2022, the Fourth Circuit Court of Appeals issued its landmark decision, Williams v. Kincaid, holding that gender dysphoria qualifies as a disability under the Americans with Disabilities Act (ADA) and Rehabilitation Act. The Fourth Circuit is the first Federal Court of Appeals to make this ruling. 


Ms. Williams, a transgender woman with gender dysphoria, was incarcerated in a Virginia correctional facility. She alleged that the defendants violated the ADA when they transferred her from women’s housing to men’s housing after discovering she was a transgender woman. Ms. Williams further asserted that defendants delayed her medical treatment for gender dysphoria and that she experienced harassment by inmates and prison officials. After her release, Ms. Williams filed a lawsuit under Section 1983 alleging violations of the ADA, the Rehabilitation Act, and Virginia common law. Upon consideration of a motion to dismiss, the trial court dismissed Ms. Williams’ ADA and Rehabilitation Act claims because it held that gender dysphoria did not constitute a disability.    

On appeal to the Fourth Circuit, the defendants conceded that gender dysphoria met the definition of a “disability.” The ADA broadly defines “disability” as “a physical or mental impairment that substantially limits one or more major life activities of such individual.”  42 U.S.C. § 12102(1)(A). However, the ADA excludes from this definition “gender identity disorders not resulting from physical impairments.”  Id. § 12211(b). Based on this exclusion, defendants argued that Ms. Williams’ claims under the statutes failed. The Fourth Circuit rejected this argument and reversed and remanded the matter to the trial court for further proceedings. 

Is “Gender Dysphoria” Covered Under the ADA?

The Fourth Circuit indicated the ADA and Rehabilitation Act provide identical protection “with respect to the matters at issue in this case.” The Court, therefore, combined the two claims and principally analyzed the ADA claim. 

In reaching its decision, the Fourth Circuit looked towards the medical community to facilitate its interpretation of “gender dysphoria” under the ADA umbrella. The World Professional Association for Transgender Health Standards of Care defines “gender dysphoria” as a “discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth.” The Court further assessed the American Psychiatric Association’s definition of “gender dysphoria”—the “clinically significant distress” felt by some of those who experience “an incongruence between their gender identity and their assigned sex.” 

After analyzing Supreme Court precedent, Circuit Court precedent, congressional intent, and advances in the medical community, the Fourth Circuit determined gender dysphoria is encompassed by the Act, and does not fall within the “gender identity disorders” which Congress intended to exclude from the Act’s protections. Notably, “gender dysphoria” did not exist as a diagnosis in 1990 when Congress enacted the ADA. The Court further emphasized that “a diagnosis of gender dysphoria, unlike that of ‘gender identity disorder,’ concerns itself with distress and other disabling symptoms, rather than simply being transgender.

The Fourth Circuit also agreed with Ms. Williams’ alternative argument—even if “gender dysphoria” and “gender identity disorder” were not categorically distinct, her gender dysphoria, as alleged in the complaint, falls within the ADA’s safe harbor for “gender identity disorders . . . resulting from physical impairments.” In Williams’ case specifically, her long tenure of hormone therapy persuaded the Court to hold that the allegations set forth in the complaint warranted an inference that her gender dysphoria results from physical impairments. As a result, the Fourth Circuit held that the district court erred in dismissing the claims on this alterative basis.

Employers’ Obligations Under the ADA and the Effect of the Williams Decision

Employers are obligated to engage in the interactive process with employees who are qualified individuals with a disability under the ADA. The Act covers individuals who are qualified to perform the essential functions of the job with or without reasonable accommodation. It is important to note that ADA protections also extend to individuals who have a record of a substantially limiting impairment and individuals who are regarded as having a substantially limiting impairment. This ruling also affords employees with gender dysphoria the ADA’s protections against harassment, retaliation, and discrimination.

The Fourth Circuit encompasses Maryland, North Carolina, South Carolina, Virginia, and West Virginia. Employers with employees in these five states should train Human Resources personnel on any types of medical procedures or treatments associated with gender dysphoria as such qualified individuals will be entitled to the interactive process and a reasonable accommodation. By way of example, accommodations could branch from medical treatments, hormone therapy, leaves of absences, shift assignments, housing sponsored by employers, and restroom usage. Employers should begin to understand where accommodations may need to be afforded for employees with gender dysphoria. An expanded definition calls for a careful look at compliance. 

Buchanan’s labor and employment team is closely monitoring the Williams litigation and will keep you informed of any further appeals. Contact our labor and employment team if you have any questions with respect to reasonable accommodation and the interactive process in light of the Fourth Circuit’s decision.