March 25, 2026 

4th Circuit Court of Appeals Ruling on Gender Affirming Care

WASHINGTON, D.C. – Doctors for America opposes the recent ruling by the 4th Circuit Court of Appeals regarding state bans on gender affirming care. On March 10th, 2026, the Court handed down a decision that deems a West Virginia statute that would restrict Medicaid coverage for gender affirming surgeries as both constitutional and non-discriminatory. The majority ruling stated that because the statute banned specific procedures that it did not violate anti-discrimination laws. Furthermore, for the majority, Judge Julius Richardson wrote, "It is not irrational for a legislature to encourage citizens to appreciate their sex and not become disdainful of their sex by refusing to fund ⁠experimental procedures that may have the opposite effect...“It is not irrational for a legislature to forgo Medicaid coverage of arguably ineffective and dangerous procedures and allocate its limited resources to covering other treatments. What’s more, States may legitimately recognize and ‘celebrat[e]’ the ‘inherent differences between men and women.’” This opinion expands the Supreme Court's ruling in United States v. Skrmetti which deemed bans on pediatric gender affirming care constitutional, by now extending this same logic to adult gender affirming care. 

Such a ruling is not only problematic in its language that describes gender dysphoria and the experiences of transgender and gender-diverse people, but it also is medically inaccurate in its claim that gender affirming care is unsafe and ineffective. The language used in this ruling indicates a fundamental misunderstanding of both the experiences of transgender citizens as well as the robust history of gender affirming healthcare. To begin with language used in this opinion, the majority state that transgender and gender-diverse people are “disdainful” of their sex. This statement conflates biological sex, which is a medical term typically used to identify the chromosomes or reproductive organs with which a person is born, with gender, a construct that is shaped by social, cultural, mental, and physical influences. Transgender and gender-diverse people are not disdainful of their sex; instead, their assigned sex at birth does not match their gender. They are experiencing a medical phenomenon, known as gender dysphoria, which is defined in the Diagnostic and Statistical Manual of Mental Disorders as, “a marked incongruence between one’s experienced/expressed gender and their primary and/or secondary sex characteristics, lasting at least 6 months.” To experience gender dysphoria is not a choice (as the use of the word “disdainful” suggests); it is a normal variation in the way people experience their gender. In fact, transgender people have existed in many iterations and cultures across history.

When a person obtains a diagnosis of gender dysphoria, they are potentially eligible for multiple social, medical, and surgical treatments to address their feelings of incongruence, colloquially known as “transitioning.” Broad reviews researching transgender health and surveys of transgender people have shown time and time again that, particularly for adults, these treatment modalities are safe, and in fact, life-saving. Those who have medically or socially transitioned report they are in better health, both physically and mentally. A recent review of the literature on gender affirming care shows it improves quality of life, stigma, utilization of health services, and mental health, with no studies identifying significant negative outcomes or harms. For the 4th Circuit Court to claim that gender affirming care is “arguably ineffective and dangerous” is a blatant falsehood and is contradicted by current medical evidence and society guidelines. 

Overall, this majority opinion is misinformed, misguided, and dangerous for the way it discriminates against transgender people and their access to life-saving care. Government officials should not have veto power that allows them to override the medical decision making that occurs between a patient and their physician, and rulings like these should raise alarm bells for those who care about the sanctity and autonomy of the doctor-patient relationship. Doctors for America strongly opposes this decision handed down by the 4th Circuit Court and urges for the restoration of access to gender affirming care in West Virginia. 

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About Doctors for America:

Doctors for America (DFA) is a national nonprofit that mobilizes over 40,000 physicians and medical trainees to advocate for policies that improve the health of patients and communities. Through advocacy training and action at the state and federal levels, DFA works to expand access to affordable care, strengthen community health and prevention, and advance health justice and equity. We do not accept funding from pharmaceutical, insurance, or for-profit health care entities, ensuring our work remains fiercely independent and patient-centered. DFA puts patients over politics–and over profits. Find out more at doctorsforamerica.org and on X @drsforamerica or Bluesky drsforamerica.bsky.social.

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