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4th Circuit rules gender identity is a protected characteristic

Ruling a response to N.C., W.Va. legal challenges

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Lewis F. Powell Jr. Courthouse in Richmond, Va. (Photo courtesy of the U.S. Courts/GSA)

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 state’s 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 ā€œapply 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 ā€œapplying 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:

4th Circuit rules against legal argument that trans treatment bans do not discriminate against trans people because ‘they apply to everyone.’

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, ā€œgender 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 ā€œXX chromosomesā€ and ā€œXY chromosomesā€ to get around sex discrimination policies:

The 4th Circuit majority rebuts the state’s proxy discrimination argument.

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 Act’s 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 Circuit’s 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 Carolina’s 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, ā€œThe court’s 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.

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Federal Government

Inside the LGBTQ records of Todd Blanche and Markwayne Mullin

Two men are acting attorney general, DHS secretary

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From left, Acting U.S. Attorney General Todd Blanche and Homeland Security Secretary Markwayne Mullen (Photos public domain)

President Donald Trump became famous for his use of the phrase ā€œYou’re fired!ā€ while hosting the reality TV show “The Apprentice” in the early 2000s. However, during his time in the Oval Office, he has attempted to distance himself from that image.

Despite those efforts, the phrase once again comes to mind as Trump has fired two high-level female Cabinet members within the past month: Pam Bondi and Kristi Noem.

Their replacements — Todd Blanche at the Justice Department and Markwayne Mullin at the Department of Homeland Security — bring records that, while different in depth, both reflect limited support for LGBTQ protections and, in some cases, direct opposition.

Todd Blanche

Acting attorney general

Little has been found regarding Todd Blanche’s LGBTQ history prior to his role as acting head of the Department of Justice. Unlike those who have worked within the Justice Department’s Civil Rights Division or served as state attorneys general, he has not developed a public-facing legal ideology on LGBTQ issues.

Blanche attended American University for his undergraduate studies — like fellow Trump attorney Michael Cohen — where he met his future wife, Kristin, who was studying at nearby Catholic University in D.C.

He began his legal career as an intern at the U.S. Attorney’s Office in Washington, which eventually became a full-time position. He later worked as a paralegal in the U.S. Attorney’s Office for the Southern District of New York while attending Brooklyn Law School at night. Blanche graduated cum laude in 2003. He and his wife later married and had two children.

Blanche left the U.S. attorney’s office in 2014, taking a job in the Manhattan office of the law firm WilmerHale. In September 2017, he moved to Cadwalader, Wickersham & Taft LLP, where he was a partner in the White Collar Defense and Investigations practice.

In his personal capacity, he represented several figures associated with Donald Trump and former New York City Mayor Rudy Giuliani, including Trump’s former campaign manager Paul Manafort, businessman Igor Fruman, and attorney Boris Epshteyn.

In 2024, Blanche switched from Democrat to Republican, aligning himself with Trump’s political orbit. He later served as Trump’s personal defense attorney in the New York State case that led to Trump’s 2024 conviction on 34 felony counts of falsifying business records to cover up hush-money payments to bisexual adult film star Stormy Daniels.

Now the highest-ranking official at the Justice Department, Blanche has played a central role in overseeing the department and has been involved in leadership decisions tied to several controversial actions affecting LGBTQ people.

In a letter to New York Attorney General Letitia James, Blanche declared that the Justice Department ā€œwill not sit idly by while you attempt to use your office to force harmful procedures on our most vulnerable population,ā€ if legal action were taken against NYU Langone. The hospital had ā€œpermanentlyā€ ended a program earlier that month after the Trump-Vance administration threatened to pull all federal funding if it continued prescribing puberty blockers and hormones to minors.

Blanche wrote that ā€œthe Justice Department believes the law is clear, and anti-discrimination laws cannot be used to force NYU Langone to perform sex-rejecting procedures on children.ā€

ā€œAs just one example, your office’s position would require a hospital to prescribe certain medications for certain diagnoses, regardless of the hospital’s or its doctors’ independent medical determination about the propriety of such treatment,ā€ he said.

Blanche also echoed his predecessor’s public stance on limiting LGBTQ-related protections at the federal level, aligning with Bondi’s sentiments in June 2025 regarding the U.S. Supreme Court’s 6–3 decision that restricted LGBTQ history lessions in schools and limits lower federal courts from issuing nationwide injunctions — rulings that have often blocked Trump administration policies.

Calling it ā€œanother great decision that came down today,ā€ Blanche argued that the ruling ā€œrestores parents’ rights to decide their child’s education,ā€ adding: ā€œIt seems like a basic idea, but it took the Supreme Court to set the record straight, and we thank them for that. And now that ruling allows parents to opt out of dangerous trans ideology and make the decisions for their children that they believe is correct.ā€

In December 2025, a Justice Department memo stated that, ā€œeffective immediately,ā€ prisons and jails would no longer be held responsible for violations of standards meant to protect LGBTQ people from harassment, abuse, and rape under the Prison Rape Elimination Act. The law, passed unanimously by Congress in 2003, requires that incarcerated people be screened for their risk of sexual assault, including consideration of LGBTQ status, and applies to all correctional facilities.

Additionally, when the Justice Department, under Blanche’s deputy leadership and at Trump’s behest, attempted to force Children’s National Hospital in D.C. to turn over medical records related to gender-affirming care, U.S. District Judge Julie R. Rubin ruled that the effort ā€œappears to have no purpose other than to intimidate and harass.ā€

Blanche is also described as having a ā€œstrong belief in executive authority.ā€

Markwayne Mullin

Secretary of Homeland Security

While Blanche’s record is defined more by recent actions than a long paper trail, Markwayne Mullin brings a more established history on LGBTQ issues from his time in Congress.

The head of the Department of Homeland Security has served in Congress since 2013, in both the U.S. House of Representatives and U.S. Senate. He has been actively engaged in shaping restrictions and aligns with broader cultural rhetoric that frames anti-LGBTQ speech as protected expression.

In May 2016, Mullin criticized the Department of Education and the Justice Department’s ā€œDear Colleagueā€ letter on transgender students, arguing that trans girls should not use girls’ restrooms in public schools.

By January 2021, Mullin and then-Hawaii Congresswoman Tulsi Gabbard had introduced a bill to prevent trans women from participating in women’s sports.

Mullin was not recorded as voting on the final passage of the Respect for Marriage Act, which codified federal recognition of same-sex and interracial marriage.

In 2023, Mullin received a rating of just 6 percent from the Human Rights Campaign.

While serving in the Senate and as a member of the Health, Education, Labor, and Pensions (HELP) Committee, Mullin has been a vocal critic of policies aimed at expanding LGBTQ inclusion in federal programs. He has participated in broader Republican efforts questioning equity-based implementation of the Older Americans Act, including guidance related to sexual orientation and gender identity in aging services, arguing such policies could have unintended consequences.

Mullin also makes history as the first Native American — and a citizen of the Cherokee Nation — to lead the Department of Homeland Security.

He was among the 147 Republicans who voted to overturn the 2020 presidential election results despite no evidence of widespread fraud, and was present in the House on Jan. 6.

The Washington Blade reached out to DHS and the DOJ for comment on the two cabinet choices’ records on LGBTQ rights. DHS responded, telling the Blade, ā€œSecretary Mullin’s record at the Department of Homeland Security will be one of protecting ALL Americans,ā€ while the DOJ has yet to respond.

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Federal Government

Trump budget targets ‘gender extremism’

Proposed spending package would target ‘leftist’ political ideologies

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The FBI seal on granite. (Photo courtesy of Bigstock)

The White House submitted its 2027 budget request to Congress last month, outlining a push for the Federal Bureau of Investigation to ā€œproactivelyā€ target what it describes as ā€œextremismā€ related to gender — raising concerns about the potential for law enforcement to target LGBTQ people.

The Trump-Vance administration’s 2027 budget request, submitted to Congress on April 4, proposes a dramatic increase in national security and law enforcement spending, while reducing foreign aid and restructuring multiple domestic security programs. In total, the administration is requesting $2.16 trillion in discretionary budget authority (including mandatory resources), a 15.3 percent increase over the 2026 proposal.

Central to the proposal is the creation of a new ā€œNSPM-7 Joint Mission Center,ā€ a direct follow-up to the September 2025 National Security Presidential Memorandum 7 (NSPM-7). The directive instructs the Justice Department, the FBI, and other national security agencies to combat what the administration defines as ā€œpolitical violence in America,ā€ effectively reshaping the Joint Terrorism Task Force network to focus on ā€œleftistā€ political ideologies, according to reporting by independent journalist Ken Klippenstein.

The American Civil Liberties Union has characterized NSPM-7 as a way for President Donald Trump to intimidate his political enemies.

In a press release following the memorandum, Hina Shamsi, director of the ACLU’s National Security Project, said, ā€œPresident Trump has launched yet another effort to investigate and intimidate his critics,ā€ and had described the move as an ā€œintimidation tactic against those standing up for human rights and civil liberties.ā€

The proposed mission center would include personnel from 10 federal agencies tasked with targeting ā€œdomestic terroristsā€ associated with a wide range of ideologies. Among them is what the administration labels ā€œextremismā€ related to gender, alongside categories such as ā€œanti-Americanism,ā€ ā€œanti-capitalism,ā€ ā€œanti-Christianity,ā€ and ā€œsupport for the overthrow of the U.S. government.ā€ The document also cites ā€œhostility toward those who hold traditional American viewsā€ on family, religion, and morality — language LGBTQ advocates have increasingly warned could be used to frame queer and transgender rights movements as ideological threats.

The mission center is one component of a proposed $166 million increase in the FBI’s counterterrorism budget.

In total, the FBI would receive $12.5 billion for salaries and expenses under the proposal, a $1.9 billion increase. Planned investments include unmanned aerial systems operations and counter-drone capabilities, counterterrorism efforts, and security preparations for the 2028 Summer Olympics in Los Angeles. The budget also cites 67,000 FBI arrests since Jan. 20, 2026, which it describes as a 197 percent increase from the prior year.

When Congress passed the USA PATRIOT Act in 2001, it also enacted 18 U.S.C. § 2331(5), which defines domestic terrorism as activities involving acts dangerous to human life that violate criminal laws and are intended to intimidate or coerce civilians or influence government policy through violence. That statutory definition has not changed.

However, federal agencies have historically categorized domestic terrorism threats into groups such as racially or ethnically motivated violent extremism, anti-government or anti-authority violent extremism, and other threats, including those tied to bias based on religion, gender, or sexual orientation.

The language in the budget suggests a shift in how those categories are interpreted and applied — particularly by explicitly linking ā€œextremismā€ to gender and to perceived opposition to ā€œtraditionalā€ views — without any corresponding change to federal law. Only Congress has the power to change the definition of domestic terrorism by passing legislation.

The budget document states:

ā€œDT lone offenders will continue to pose significant detection and disruption challenges because of their capacity for independent radicalization to violence, ability to mobilize discretely, and access to firearms. Additionally, in recent years, heinous assassinations and other acts of political violence in the United States have dramatically increased. Commonly, this violent conduct relates to views associated with anti-Americanism, anti-capitalism, and anti-Christianity; support for the overthrow of the U.S. government; extremism on migration, race, and gender; and hostility toward those who hold traditional American views on family, religion, and morality.ā€

This language echoes earlier actions by the Trump-Vance administration targeting trans people.

On the first day of his second term, President Trump signed Executive Order 14168, titled ā€œDefending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.ā€

The order establishes a strict binary definition of sex and withdraws federal recognition of trans people.

ā€œIt is the policy of the United States to recognize two sexes, male and female,ā€ the order states. ā€œā€˜Sex’ shall refer to an individual’s immutable biological classification as either male or female. ā€˜Sex’ is not a synonym for and does not include the concept of ā€˜gender identity.ā€™ā€

Appropriations committees in both chambers are expected to begin hearings in the coming weeks.

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Markwayne Mullin confirmed as next DHS secretary

Okla. senator to succeed Kristi Noem

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The U.S. Senate confirmed Markwayne Mullin as the next secretary of Homeland Security on Monday, as the agency continues to grapple with what lawmakers have described as a ā€œnever-endingā€ funding standoff, with Democrats attempting to withhold funding from one of the nation’s largest and most costly agencies.

Mullin — a Republican senator from Oklahoma, former mixed martial arts fighter, and plumbing business owner — was confirmed in a 54–45 vote. Two Democrats — U.S. Sens. John Fetterman (D-Pa.) and Martin Heinrich (D-N.M.) — sided with Republicans in supporting his confirmation.

The new agency head is expected to follow the policy direction set by President Donald Trump, emphasizing stricter immigration enforcement. This includes proposals to support immigration agents at polling sites and to cut funding to so-called ā€œsanctuary cities.ā€

Mullin replaces Kristi Noem, who was fired earlier this month following a widely scrutinized 2-day congressional hearing on Capitol Hill.

During the hearing, Noem faced intense questioning over her response to several crises, including the fatal shooting of two American citizens in Minneapolis by U.S. Immigration and Customs Enforcement agents, a $220 million border security advertising campaign that featured her on horseback near Mount Rushmore amid one of the largest federal workforce reductions in U.S. history, and the federal response to major natural disasters such as the July 2025 Texas floods and Hurricane Helene in 2024.

Noem had previously drawn criticism for a series of policy decisions in South Dakota that broadly focused on restricting the rights of LGBTQ individuals. In 2023, she signed House Bill 1080, banning gender-affirming medical care for transgender minors. She also signed legislation and executive orders restricting trans athletes’ participation in women’s sports, as well as the state’s ā€œReligious Freedom Restoration Act,ā€ which critics argued enabled discrimination against LGBTQ individuals. Additionally, the state canceled contracts related to LGBTQ support services — including suicide prevention and health care navigation programsā€š and later agreed to a $300,000 settlement with trans advocacy group, The Transformation Project.

Despite her removal from DHS, Noem will remain in the Trump-Vance administration as a special envoy for the ā€œShield of the Americas,ā€ an initiative aimed at promoting U.S. influence in the Western Hemisphere, including efforts to counter cartel networks, reduce Chinese influence, and manage migration.

The new head of DHS has served in Congress since 2013, in both houses of the federal legislature. While in the Senate and a member of the Health, Education, Labor, and Pensions (HELP) Committee, Mullin has been a vocal critic of policies aimed at expanding LGBTQ inclusion. He led a group of lawmakers in urging the Administration for Community Living to reverse a rule requiring states to prioritize Older Americans Act services based on sexual orientation and gender identity, arguing the policy could have unintended consequences.

Mullin also makes history as the first Native American — and a citizen of the Cherokee Nation — to lead the Department of Homeland Security. He was also among the 147 Republicans who voted to overturn the 2020 presidential election results despite no evidence of widespread fraud, and was present in the U.S. House of Representatives chamber on Jan. 6.

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