The Fourth Circuit recently issued a significant decision, Williams v. Kincaid, which held that the Americans with Disabilities Act (ADA) protects individuals with gender dysphoria, becoming the first federal circuit in the country to do so.

Williams v. Kincaid arose from a transgender woman incarcerated in Virginia. Williams has gender dysphoria, a condition involving psychological distress resulting from an incongruence between one’s sex assigned at birth and one’s gender identity.  Prior to her incarceration, Williams had been receiving hormone therapy treatments for 15 years.

Upon incarceration, Williams experienced delays in the medical treatment required to treat her gender dysphoria. Additionally, Williams was housed in a unit with male prisoners despite prison officials knowing her transgender status.

After her release, Williams brought suit alleging violations of the ADA. The district court dismissed the ADA claims on the basis that gender dysphoria did not constitute a disability under the ADA.

The central question on appeal was whether gender dysphoria is a “gender identity disorder,” which is specifically excluded from protection under the ADA. The Fourth Circuit panel held that “nothing in the ADA, then or now, compels the conclusion that gender dysphoria constitutes a ‘gender identity disorder’ excluded from ADA protection.” In reaching this conclusion, the majority took note of the fact that the medical community has treated “gender identity disorder” and “gender dysphoria” as two distinct concepts. The majority additionally held that, because Williams receives medical treatments and provided research identifying possible physical causes for gender dysphoria, it “nevertheless falls within the ADA’s safe harbor for ‘gender identity disorders . . . resulting from physical impairments.’”

This decision directly affects covered employers in Maryland, Virginia, West Virginia, North Carolina, and South Carolina. Employees diagnosed with gender dysphoria are now protected against discrimination, harassment, and retaliation. Moreover, they may be entitled to reasonable accommodations related to their condition, including restroom usage, employer-provided housing, task and shift assignments, and leave for medical treatment.

Employers in states and territories covered by other federal appellate courts should be mindful about the decision and the growing list of federal district courts who have reached a similar conclusion.