Federal Government
4th Circuit rules gender identity is a protected characteristic
Ruling a response to N.C., W.Va. legal challenges

BY ERIN REED | The 4th U.S. Circuit Court of Appeals ruled Monday that transgender people are a protected class and that Medicaid bans on trans care are unconstitutional.
Furthermore, the court ruled that discriminating based on a diagnosis of gender dysphoria is discrimination based on gender identity and sex. The ruling is in response to lower court challenges against state laws and policies in North Carolina and West Virginia that prevent trans people on state plans or Medicaid from obtaining coverage for gender-affirming care; those lower courts found such exclusions unconstitutional.
In issuing the final ruling, the 4th Circuit declared that trans exclusions were “obviously discriminatory” and were “in violation of the equal protection clause” of the Constitution, upholding lower court rulings that barred the discriminatory exclusions.
The 4th Circuit ruling focused on two cases in states within its jurisdiction: North Carolina and West Virginia. In North Carolina, trans state employees who rely on the State Health Plan were unable to use it to obtain gender-affirming care for gender dysphoria diagnoses.
In West Virginia, a similar exclusion applied to those on the stateās Medicaid plan for surgeries related to a diagnosis of gender dysphoria. Both exclusions were overturned by lower courts, and both states appealed to the 4th Circuit.
Attorneys for the states had argued that the policies were not discriminatory because the exclusions for gender affirming care āapply to everyone, not just transgender people.ā The majority of the court, however, struck down such a claim, pointing to several other cases where such arguments break down, such as same-sex marriage bans āapplying to straight, gay, lesbian, and bisexual people equally,ā even though straight people would be entirely unaffected by such bans.
Other cases cited included literacy tests, a tax on wearing kippot for Jewish people, and interracial marriage in Loving v. Virginia.
See this portion of the court analysis here:

Of particular note in the majority opinion was a section on Geduldig v. Aiello that seemed laser-targeted toward an eventual U.S. Supreme Court decision on discriminatory policies targeting trans people. Geduldig v. Aiello, a 1974 ruling, determined that pregnancy discrimination is not inherently sex discrimination because it does not “classify on sex,” but rather, on pregnancy status.
Using similar arguments, the states claimed that gender affirming care exclusions did not classify or discriminate based on trans status or sex, but rather, on a diagnosis of gender dysphoria and treatments to alleviate that dysphoria.
The majority was unconvinced, ruling, āgender dysphoria is so intimately related to transgender status as to be virtually indistinguishable from it. The excluded treatments aim at addressing incongruity between sex assigned at birth and gender identity, the very heart of transgender status.ā In doing so, the majority cited several cases, many from after Geduldig was decided.
Notably, Geduldig was cited in both the 6th and 11th Circuit decisions upholding gender affirming care bans in a handful of states.
The court also pointed to the potentially ridiculous conclusions that strict readings of what counts as proxy discrimination could lead to, such as if legislators attempted to use āXX chromosomesā and āXY chromosomesā to get around sex discrimination policies:
Importantly, the court also rebutted recent arguments that Bostock applies only to “limited Title VII claims involving employers who fired” LGBTQ employees, and not to Title IX, which the Affordable Care Actās anti-discrimination mandate references. The majority stated that this is not the case, and that there is “nothing in Bostock to suggest the holding was that narrow.”
Ultimately, the court ruled that the exclusions on trans care violate the Equal Protection Clause of the Constitution. The court also ruled that the West Virginia Medicaid Program violates the Medicaid Act and the anti-discrimination provisions of the Affordable Care Act.
Additionally, the court upheld the dismissal of anti-trans expert testimony for lacking relevant expertise. West Virginia and North Carolina must end trans care exclusions in line with earlier district court decisions.
The decision will likely have nationwide impacts on court cases in other districts. The case had become a major battleground for trans rights, with dozens of states filing amicus briefs in favor or against the protection of the equal process rights of trans people.Ā Twenty-one Republican statesĀ filed an amicus brief in favor of denying trans people anti-discrimination protections in healthcare, and 17 Democratic statesĀ joined an amicus brief in support of the healthcare rights of trans individuals.
Many Republican states are defending anti-trans laws that discriminate against trans people by banning or limiting gender-affirming care. These laws could come under threat if the legal rationale used in this decision is adopted by other circuits. In the 4th Circuitās jurisdiction, West Virginia and North CarolinaĀ already have gender-affirming care bans for trans youth in place, andĀ South Carolina may consider a similar bill this week.
The decision could potentially be used as precedent to challenge all of those laws in the near future and to deter South Carolinaās bill from passing into law.
The decision is the latest in a web of legal battles concerning trans people. Earlier this month, the 4th Circuit also reversed a sports ban in West Virginia, ruling that Title IX protects trans student athletes. However, theĀ Supreme Court recently narrowedĀ a victory for trans healthcare from the 9th U.S. Circuit Court of Appeals and allowed Idaho to continue enforcing its ban on gender-affirming care for everyone except the two plaintiffs in the case.
Importantly, that decision was not about the constitutionality of gender-affirming care, but the limits of temporary injunctions in the early stages of a constitutional challenge to discriminatory state laws. It is likely that the Supreme Court will ultimately hear cases on this topic in the near future.
Celebrating the victory, Lambda Legal Counsel and Health Care Strategist Omar Gonzalez-Pagan said in a posted statement, āThe courtās decision sends a clear message that gender-affirming care is critical medical care for transgender people and that denying it is harmful and unlawful ⦠We hope this decision makes it clear to policy makers across the country that health care decisions belong to patients, their families, and their doctors, not to politicians.ā
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Erin Reed is a transgender woman (she/her pronouns) and researcher who tracks anti-LGBTQ+ legislation around the world and helps people become better advocates for their queer family, friends, colleagues, and community. Reed also is a social media consultant and public speaker.
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The preceding article was first published at Erin In The Morning and is republished with permission.
Federal Government
So far, virtually no acknowledgement of Pride month by federal gov’t
Trump-Vance administration proclaimed ‘no more drag shows’ at Kennedy Center

Just a few days from the start of June, there has been virtually no acknowledgment of Pride month by federal government agencies this year, a striking departure from recent policy and practice under the Biden-Harris administration and even under President Donald Trump’s first term.
Some limited and more localized observances have been preserved or renewed in 2025, for example by the U.S. courts’ webpage celebrating history-making LGBTQ jurists like Judges Deborah A. Batts and J. Paul Oetken of the U.S. District Court for the Southern District of New York, and by the Metropolitan Washington Airports Authority, which notes on its website plans to actively participate in WorldPride 2025.
The paltriness of Pride this year comes pursuant to several policy changes under Trump 2.0 such as executive orders narrowing the definition of gender to exclude trans and nonbinary people and banning activities related to diversity, equity, and inclusion, which have led to agency-wide changes including the removal of LGBTQ focused website content and dissolution of “affinity groups.”
Many of these actions came to light in the first few months of Trump’s second term. For example, in January the Associated Press reported a memo from the U.S. Defense Intelligence Agency indicating that observances related to Martin Luther King Jr. Day, Pride Month, Holocaust Days of Remembrance, and other cultural or historical annual events would be paused.
While it remains to be seen whether and to what extent the White House, federal government, and Congress will acknowledge Pride month in 2025, in 2024:
- ⢠At the end of May, President Joe Biden issued a proclamation declaring June LGBTQ Pride Month, as he had done for the previous three years of his administration
- ⢠The U.S. Senate, then under Democratic control, introduced a resolution recognizing June 2024 as LGBTQ Pride Month
- ⢠Federal agencies across the whole of government participated in Pride activities, and at a high level ā for instance, then-U.S. Secretary of State Antony Blinken hosted a Pride month convening focused on U.S. foreign policy, national security, inclusive development, and human rights
- ⢠Actions in June, which in many cases were coordinated via LGBTQ employee resource groups or affinity groups, included celebrations of LGBTQ individuals ā for example, the U.S. Department of Commerce’s Economic Development Administration toasted those who made significant contributions to economic growth, while the U.S. Patent and Trademark Office hosted a “Proud Innovation 2024” event, highlighting the accomplishments of LGBTQ innovators, entrepreneurs, and small business owners who utilize intellectual property to grow their businesses and mentor others in their communities.
- Agencies also provided support indirectly ā for example, the U.S. Federal Trade Commission sponsored attorneys who wished to represent the FTC at LGBTQ Pride events organized by various bar associations
The Washington Post pointed to some of the challenges facing organizers of WorldPride as they plan festivities in D.C. throughout early June: “This year, the LGBTQ+ celebration is being held in the backyard of a government that has targeted transgender rights and made major cuts to HIV prevention programs. At the Kennedy Center, President Donald Trump has promised āNO MORE DRAG SHOWS, OR OTHER ANTI-AMERICAN PROPAGANDA.”
On June 14, Trump is set to preside over a military parade in Washington commemorating the 250th anniversary of the U.S. Army, his 79th birthday, and Flag Day, in a celebration that will feature 6,600 soldiers from at least 11 corps and divisions nationwide and 150 military vehicles, including 28 M1 Abrams tanks.
Federal Government
HRC memo details threats to LGBTQ community in Trump budget
‘It’s a direct attack on LGBTQ+ lives’

A memo issued Monday by the Human Rights Campaign details threats to LGBTQ people from the “skinny” budget proposal issued by President Donald Trump on May 2.
HRC estimates the total cost of “funding cuts, program eliminations, and policy changes” impacting the community will exceed approximately $2.6 billion.
Matthew Rose, the organization’s senior public policy advocate, said in a statement that āThis budget is more than cuts on a pageāitās a direct attack on LGBTQ+ lives.”
“Trump is taking away life-saving healthcare, support for LGBTQ-owned businesses, protections against hate crimes, and even housing help for people living with HIV,” he said. “Stripping away more than $2 billion in support sends one clear message: we donāt matter. But weāve fought back before, and weāll do it againāweāre not going anywhere.ā
Proposed rollbacks or changes at the U.S. Department of Health and Human Services will target the Ryan White HIV/AIDS Program, other programs related to STI prevention, viral hepatitis, and HIV, initiatives housed under the Substance Abuse and Mental Health Services Administration, and research by the National Institutes of Health and Agency for Healthcare Research and Quality.
Other agencies whose work on behalf of LGBTQ populations would be jeopardized or eliminated under Trump’s budget include the U.S. Department of Housing and Urban Development, the U.S. Department of Justice, the U.S. Small Business Administration, and the U.S. Department of Education.
Federal Government
Trump admin cancels more than $800 million in LGBTQ health grants
As of early May, half of scrapped NIH grants were LGBTQ focused

The Trump-Vance administration has cancelled more than $800 million in research into the health of sexual and gender minority groups, according to a report Sunday in The New York Times.
The paper found more than half of the grants through the National Institutes of Health that were scrapped through early May involved the study of cancers and viruses that tend to affect LGBTQ people.
The move goes further than efforts to claw back diversity related programs and gender affirming care for transgender and gender diverse youth, implicating swaths of research by institutions like Johns Hopkins and Columbia along with public universities.
The Times notes that a $41 million cut impacting Florida State University will stall “a major effort to prevent HIV in adolescents and young adults, who experience a fifth of new infections in the United States each year.”
A surge of federal funding for LGBTQ health research began under the Obama-Biden administration and continued since. Under his first term, Trump dedicated substantial resources toward his Ending the HIV Epidemic in the United States initiative.
Cuts administered under the health secretary appointed in his second term, Robert F. Kennedy Jr., have put the future of that program in question.