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Fourth Circuit Court of Appeals Finds Gender Dysphoria Protected

Gender dysphoria is a "discomfort or distress that is caused by a discrepancy between a person's gender identity and that person's sex assigned at birth." Kesha Williams is a transgender woman with gender dysphoria. She was incarcerated for six months in a Virginia detention center. She says the detention center moved her to the men's housing area where she experienced delays in receiving medical treatment, harassment by other inmates, and the prison deputies misgendered her. After her release, Williams sued, alleging a violation of the Americans with Disabilities Act (ADA) and other claims.

Williams alleged she notified the detention center staff immediately that she is transgender and had been taking hormone medical treatment for fifteen years to treat her gender dysphoria. When the nurse learned William still had her birth genitalia, the nurse labeled her as male and transferred her. The prison's policy required gender assignment based on genitalia. The prison staff also took away her female clothing and required her to wear male clothing. The center repeatedly denied her requests for any body searches to be conducted by female deputies. They referred to her as a man and failed to authorize her hormone medication.

In a question of first impression for the federal appellate courts, the Fourth Circuit followed "Congress' direction" to construe the ADA "in favor of broad coverage of individuals." The ADA expressly excluded "gender identity disorders" when Congress passed it. The appellate court assessed whether gender dysphoria is a gender identity disorder. The court noted that "gender dysphoria" was added to the American Psychiatric Association's (APA) diagnoses in 2013, reflecting a change in medical understanding. The APA's definition of gender dysphoria differs from the previous "gender identity disorder," which no longer exists as a diagnosis. A gender dysphoria diagnosis focuses on the individual's distress and other disability symptoms. The diagnosis does not center on the individual's status as transgender. The court noted that not all transgender individuals suffer from gender dysphoria, and simply being transgender is not a disability. When gender dysphoria results in physical distress or requires physical treatment, the appellate court held it may constitute a protected disability.