Supreme Court lets stand gender dysphoria case in liberal win

The Supreme Court on Friday let a lower court ruling stand that sided with a transgender woman who contested that her rights were violated in jail when she was deprived of her hormone treatment.

Kesha Williams, who was incarcerated for six months in 2018, was initially placed on the women’s side of the Fairfax County Adult Detention Center in northern Virginia, but was moved to the men’s facility after the center’s deputies learned she was transgender.

Williams, at that point, had transitioned more than a decade earlier and had also been receiving hormone replacement therapy to treat her gender dysphoria for more than a decade. At the men’s facility, Williams’s treatment was routinely withheld by jail officials, often for weeks at a time, according to court documents, causing severe emotional and mental distress.

Williams in 2020 sued Fairfax County Sheriff Stacey Kincaid, along with a nurse at the jail and a deputy, alleging the jail had violated both the Americans with Disabilities Act (ADA) and the Rehabilitation Act in failing to appropriately treat her gender dysphoria.

After a lower court sided with Williams, Kincaid’s office appealed to the justices. The court declined to take up the case in a brief, unsigned order Friday, letting Williams’s victory stand.

In a public dissent authored by Justice Samuel Alito and joined by Clarence Thomas, the two conservatives said they would have taken up the case rather than waiting to see how other lower courts to grappled with the issue.

“This decision will raise a host of important and sensitive questions regarding such matters as participation in women’s and girls’ sports, access to single-sex restrooms and housing, the use of traditional pronouns, and the administration of sex reassignment therapy (both the performance of surgery and the administration of hormones) by physicians and at hospitals that object to such treatment on religious or moral grounds,” Alito wrote.

Kincaid’s office argued that gender dysphoria — severe distress stemming from a mismatch between a person’s gender identity and sex assigned at birth — is not a disability as defined by the ADA, because it is not caused by a physical impairment.

The ADA’s definition of disability specifies does not include “gender identity disorders not resulting from physical impairments,” including “transvestism” and “transsexualism.”

But the 4th Circuit U.S. Court of Appeals found that Williams’s gender dysphoria diagnosis was a distinct condition from “gender identity disorder,” which is no longer recognized by the American Psychiatric Association (APA), and therefore the ADA applied.

The APA eliminated that diagnosis in its 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, replacing it with gender dysphoria — a diagnosis that did not exist when the ADA was adopted in 1990.

Unlike a “gender identity disorder” diagnosis, which is characterized by a “gender incongruence” — a disparity between a person’s “experienced gender” and their sex assigned at birth — gender dysphoria relates specifically to the “clinically significant distress” that arises from the feeling that a person’s gender identity does not match their assigned sex.

“Reflecting this shift in medical understanding, we and other courts have thus explained 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,” 4th Circuit Judge Diana Gribbon Motz wrote in last year’s decision.

Alito’s dissent called “several aspects” of the court’s reasoning “troubling.”

“In short, the Fourth Circuit’s ruling leaves a great many people and institutions under the looming threat of liability, forcing them to change their behavior—behavior that may be deeply rooted in moral or religious principles—or face an unending stream of lawsuits. If it is at least possible that the ADA does not require these results, we should be willing to resolve the question now rather than later,” Alito wrote.

Kincaid’s attorney in the request to the justices wrote the court’s review is necessary to “avoid the judicial rewriting of a federal law.”

“This case raises important questions of statutory interpretation in an area of tremendous social and political importance,” they wrote.

Williams responded by urging the court to not take up the appeal. She asserted that Kincaid had not challenged a second rationale that supported the lower court’s decision: Even if gender dysphoria was a “gender identity disorder,” the ADA still applied, because Williams had adequately pleaded that it resulted from physical impairments.

“The Fourth Circuit’s decision reflects the straightforward application of well-settled principles of statutory construction. No further review is warranted,” Williams’s attorney wrote.

Updated at 1:30 p.m. ET.