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On August 16, 2022, in Williams v. Kincaid, the Fourth Circuit became the first federal appellate court to rule that gender dysphoria, a discomfort that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth, could qualify as a disability under the Americans with Disabilities Act (“ADA”).

The case was filed by Kesha Williams (“Williams”), a transgender woman with gender dysphoria who spent six months incarcerated in the Fairfax County Adult Detention Center. Prior to her incarceration, Williams had received medical treatment in the form of a daily pill and biweekly hormone injections for fifteen years to manage and alleviate the gender dysphoria she experienced. During her incarceration, she was housed in a man’s prison and alleged that she was subjected to delays in medical treatment for her gender dysphoria and harassment by other inmates and prison deputies. After her release, Williams filed a lawsuit under Section 1983 alleging violations of the ADA, the Rehabilitation Act, and Virginia common law. The district court granted the defendants’ motion to dismiss, finding that the ADA and Rehabilitation Act afforded Williams no basis for relief because the ADA excludes from its definition of disability, gender identity disorders not resulting from physical impairments. Williams appealed and the Fourth Circuit reversed the district court’s ruling.

In its opinion, the Court of Appeals explained that the text of the ADA does not define the term “gender identity disorders”, nor does it even mention gender dysphoria. Further, when the ADA was enacted in 1990, the term “gender identity” focused on transgender status only. However, advances in medical understanding supports the notion that “a diagnosis of gender dysphoria, unlike that of ‘gender identity disorder,’ concerns itself primarily with distress and other disabling symptoms, rather than simply being transgender.” The Court also held that Williams sufficiently pled in her complaint that her gender dysphoria resulted from physical impairments, which are recognized disabilities under the ADA. Specifically, the need for hormone therapy well-indicated that her gender dysphoria has some physical basis.

Although this case wasn’t brought under Title I of the ADA, it still poses significant implications for employers, especially those in the Fourth Circuit (which covers Maryland, North Carolina, South Carolina, Virginia and West Virginia). Going forward, employers should expect to see more ADA accommodation requests, such as restroom usage or leaves of absences from employees claiming to be experiencing gender dysphoria. Employers should ensure that engagement in the interactive process and responses to accommodation requests are consistent with any other ADA accommodation request.