September 20, 2022

Court Issues Landmark Decision Pertaining to Gender and Protections Under the ADA

On August 16, 2022, the United States Court of Appeals for the Fourth Circuit, in the matter of Williams v. Kincaid, issued a landmark decision, providing that individuals with gender dysphoria may be protected under the Americans with Disabilities Act and the Rehabilitation Act.

In Williams, a transgender woman sued a Virginia correctional facility after she was housed in a men’s facility and faced severe discrimination while incarcerated.  Specifically, the Plaintiff asserted that she was denied access to medical treatment, including her hormone therapy which she had been taking for 15 years prior to incarceration.  Further, the Plaintiff stated that she was misgendered by prison staff, forced to wear men’s clothing, and harassed by fellow inmates.

The Plaintiff ultimately sued several prison employees, including the Sheriff, alleging violations of the Americans with Disabilities Act (“ADA”), the Rehabilitation Act, the United States Constitution, and state common law.  However, the District Court dismissed the case on the basis that gender dysphoria was specifically excluded as a recognized disability under the ADA as a “gender identity disorder not resulting from physical impairments.” 42 U.S.C. §12211(b)(1).

On appeal, the Plaintiff argued that (1) gender dysphoria was not a gender identity disorder and, (2) even if it were a gender identity disorder, it results from a physical basis and cannot be excluded from ADA protection.

The Court initially noted that while “gender identity disorders not resulting from physical impairments” were categorically excluded as ADA disabilities, that term is not defined in the ADA.  Further, gender dysphoria itself was not specifically excluded because it did not exist as a diagnosis in 1990.  As such, the ADA definition of “gender identity disorders not resulting from physical impairments” should be interpreted as it was understood upon enactment.

With those premises in mind, a gender identity disorder diagnosis in 1990 marked being transgender as a mental illness.  However, with advances in medical understanding, the American Psychiatric Association (APA) removed “gender identity disorders” from the DSM-5 in 2013.  Gender dysphoria replaced “gender identity disorders,” in the DSM-5, which now defines gender dysphoria as “clinically significant distress” someone may experience based on “an incongruence between their gender identity and assigned sex.”

Guided by Congress’ mandate that the courts must construe the definition of “disability” as broadly as the text of the ADA permits, the Court held that the categorical exclusion of “gender identity disorders” from the ADA is obsolete considering the DSM-5 changes, and therefore the exclusion does not apply to gender dysphoria.

To the Plaintiff’s second argument, the Court noted that hormone treatment enables “feminization or masculinization of the body,” and that Plaintiff claims that she experienced “emotional, psychological, and physical distress” without the treatment.  Plaintiff further identified medical and scientific research noting possible physical bases of gender dysphoria.  As such, the Court held that Plaintiff’s allegations raise “the reasonable inference” that her gender dysphoria results from a physical impairment.

The Fourth Circuit Court of Appeals is one of twelve regional appellate courts.  The Court presides over appeals from nine federal district courts in Maryland, Virginia, West Virginia, North Carolina, and South Carolina.  Post Williams, employees experiencing gender dysphoria in these jurisdictions are entitled to the protections of the ADA, including reasonable accommodation.  However, Williams marks a change in the legal landscape, at the federal level, pertaining to transgender rights.  All employers should expect requests from employees seeking to use gendered facilities and those that seek a leave of absence to pursue gender-affirming treatment.  Diversity and inclusion programs, as well as revised policies and proactive planning, can help employers proactively navigate gender dysphoria-related requests for accommodation and unnecessary legal challenge and associated liability.

If you have any questions regarding Williams and its effects on your business or any related policies, please contact one of the attorneys in our Employment Law Group at 1-888-488-2638 or


The information in this article is provided for general informational purposes only and may not reflect the current law in your jurisdiction.  By reading this article, you understand that there is no attorney-client relationship between you and Cipriani & Werner, P.C. or any of our attorneys.  No information contained in this article should be construed as legal advice from Cipriani & Werner, P.C. or the individual authors.