TRANSGENDER AND NONBINARY PERSONS’ RIGHTS AND
ISSUES
EDITED BY ABBY SWEENEY, CAROL WU, ANNA BRULE, KENDALL KASKE, &
TAYLOR-RYAN NEDD
I. INTRODUCTION ........................................ 1082
II. ACCESS TO GENDER-AFFIRMING HEALTH CARE ............... 1084
A. FEDERAL LAW: THE PATIENT PROTECTION AND AFFORDABLE CARE
ACT ............................................ 1088
1. Health and Human Services Interpretations ............ 1089
2. Constitutional Challenges. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1091
B. STATE LAWS ...................................... 1092
1. Private Health Insurance Coverage for Trans Individuals 1092
2. Gender-Affirming Health Care Coverage in State
Employee Benefits Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1093
3. Criminalizing Gender-Affirming Care for Trans Youth . . 1094
C. RELIGIOUS EXEMPTIONS .............................. 1095
1. Federal Law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1095
2. Trump and Biden Administration Policies and Resulting
Legal Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1096
3. State Laws......................................... 1097
III. VIOLENCE AGAINST TRANSGENDER INDIVIDUALS .............. 1098
A. DOMESTIC VIOLENCE ................................ 1098
B. HATE CRIMES ..................................... 1100
1. Federal Legislation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1101
2. State Legislation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1102
C. GAY AND TRANS PANIC DEFENSES ....................... 1103
D. POLICE MISTREATMENT ............................... 1105
E. VIOLENCE IN PRISON................................. 1107
IV. PUBLIC ACCOMMODATIONS .............................. 1111
A. ANTI-DISCRIMINATION LAWS ........................... 1112
B. DISCRIMINATORY LAWS............................... 1115
C. DISCRIMINATION IN SCHOOLS ........................... 1116
V. HOUSING ............................................ 1120
A. FEDERAL POLICY ................................... 1122
B. STATE POLICY ..................................... 1123
VI. IDENTITY DOCUMENTS .................................. 1124
A. FEDERAL RULES .................................... 1125
B. STATE RULES ...................................... 1126
1. Drivers’ Licenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1126
1081
2. Birth Certificates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1128
VII. CONCLUSION ......................................... 1134
I. INTRODUCTION
Transgender
1
people are more visible in mainstream society than ever before
in the United States. In recent years, trans individuals have competed in the U.S.
Open, graced the cover of TIME and Vanity Fair, and presided over courtrooms
as judges.
2
Milestones in the American Transgender Movement, N.Y. TIMES (Aug. 28, 2015), https://perma.
cc/YUQ9-JQ5X.
In 2021, President Joe Biden nominated Rachel Levine, the first
openly transgender federal official confirmed by the U.S. Senate, to serve as the
Assistant Secretary of Health.
3
Samantha Schmidt, John Wagner, & Teo Armus, Biden Selects Transgender Doctor Rachel
Levine as Assistant Health Secretary, WASH. POST (Jan. 19, 2021), https://perma.cc/QYW2-XAUX.
Despite these strides, trans individuals continue to
face disproportionate rates of discrimination and violence compared to non-trans
individuals.
4
Transgender People Over Four Times More Likely Than Cisgender People to be Victims of
Violent Crime, WILLIAMS INST. (Mar. 23, 2021), https://perma.cc/3PR4-MFG9.
These rates continue even though such discrimination was found
unconstitutional by the Supreme Court. In Bostock v. Clayton County, the Supreme
Court held that Title VII explicitly protects trans employees.
5
Furthermore, high-pro-
file trans individuals such as Sarah McBride, who in 2020 became the United States’
first openly trans state senator, and in 2025 became the first openly transgender per-
son elected to Congress, are bringing heightened visibility and support to the strug-
gle for transgender rights and social acceptance.
6
Jo Yurcaba, Sarah McBride Becomes the First Out Transgender Person Elected to Congress,
NBC NEWS (Nov. 5, 2024), https://perma.cc/2JNZ-TDPT.
As trans visibility in popular
culture and media is increasing and efforts are being made to center transgender peo-
ple in social movements, backlash is growing against rights for transgender persons.
Trans people are still subject to disproportionate stigma, discrimination, and vio-
lence.
7
Federal Bureau of Investigation (FBI) data shows that the number of hate
crimes motivated by gender identity rose from 33 reported incidents in 2013, to
338 in 2022, the most recent year for which data is available.
8
Compare FED. BUREAU OF INVESTIGATION, U.S. DEP’T OF JUST., UNIFORM CRIME REPORT: HATE
CRIME STATISTICS, 2013 4 (2014), https://perma.cc/HT5M-BZNP, with U.S. DEP’T OF JUST., CMTY.
RELS. SERV., 2022 FBI HATE CRIMES STATISTICS (2023), https://perma.cc/4BBS-JMF7.
Lack of uniform docu-
mentation procedures, failure to properly identify and distinguish gender identity
from sexual orientation, and questionable reporting rates cast doubts on the accuracy
of current data, and may suggest that hate crimes motivated by gender identity are
more common than statistics indicate.
9
See Daniel Engber, The FBI Says Hate Crimes Are Soaring. It Actually Has No Idea, SLATE (Nov.
14, 2018), https://perma.cc/EU93-JZXL.
These hate crimes can have serious
1. The term “transgender” is used interchangeably with the term “trans” throughout this Article.
2.
3.
4.
5. Bostock v. Clayton Cnty., 590 U.S. 644, 651–52 (2020).
6.
7. NAT’L ACAD. SCI., ENG’G, & MED., MEASURING SEX, GENDER IDENTITY, AND SEXUAL
ORIENTATION 27, 59 (Nancy Bates, Marshall Chin, & Tara Becker, eds. 2022).
8.
9.
1082 THE GEORGETOWN JOURNAL OF GENDER AND THE LAW [Vol. 26:1081
implications for the health of transgender people, who suffer disproportionately high
rates of serious mental health issues.
10
SANDY E. JAMES, JODY L. HERMAN, LAURA E. DURSO, SUSAN RANKIN, & RODRIGO HENG-
LEHTINEN, EARLY INSIGHTS: A REPORT OF THE 2022 U.S. TRANSGENDER SURVEY 5 (Nat’l Ctr. for
Transgender Equal. 2024), https://perma.cc/XZN2-K926 [hereinafter EARLY INSIGHTS OF THE 2022 U.S.
TRANSGENDER SURVEY].
For example, 44% of respondents in the U.S.
Transgender Survey reported “serious psychological distress” in the previous
month.
11
The movement for trans rights is also largely focused on the state level, result-
ing in differential treatment and recognition of trans people within the United
States. Varying levels of protection are afforded to transgender individuals in
regard to their legal rights based on each state’s law. State laws both negatively
and positively affect trans rights.
12
Snapshot: LGBTQ Equality by State, MOVEMENT ADVANCEMENT PROJECT, https://perma.cc/
H6AA-DD5E.
Sixteen states and D.C. have high gender iden-
tity equality status, five states and Puerto Rico are medium equality status, five
states have fair equality status, nine states and the U.S. Virgin Islands have low
equality status, and fifteen states and three territories (American Samoa,
Commonwealth of the Northern Mariana Islands, and Guam) have negative
equality status.
13
Notably, laws and regulations explicitly granting protections for
gender identity lag significantly behind those covering sexual orientation.
14
This Article uses the terms “transgender” or “trans” to refer to a person whose
gender identity is different from the sex assigned to them at birth. Gender identity
is distinct from sex and sexual orientation. Gender identity refers to each person’s
feelings and expression of their gender, including clothing, appearance, and
behaviors, which may not correspond with their sex assigned at birth.
15
Sex and Gender Identity, PLANNED PARENTHOOD, https://perma.cc/4UXM-DSVB.
Sex refers
to “a classification, generally as male or female, according to the reproductive
organs and functions that derive from the chromosomal complement.”
16
Carolyn M. Mazure, What Do We Mean by Sex and Gender?, YALE SCH. MED. (Sept. 19, 2021),
https://perma.cc/4DBH-LT24.
Sexual
orientation refers to an individual’s emotional, romantic, and sexual attraction to
individuals of the same gender, a different gender, or more than one gender.
17
Sexual Orientation, PLANNED PARENTHOOD, https://perma.cc/XVV8-P9D6.
On both the state and federal level, trans people lack the legal protections that
are necessary to lead healthy, safe, and dignified lives. This Article addresses the
current state of legal protections for transgender people. Part II discusses access
to gender-affirming health care, including discussion about access barriers cre-
ated by insufficient insurance coverage and the discrimination trans people may
experience when accessing care, such as hormone replacement therapy (HRT),
under the Affordable Care Act and its state-level companions. Part III provides
10.
11. Id.
12.
13. Id.
14. See id. (classifying fourteen states and three territories as negative equality regarding gender
identity and four states as negative equality regarding sexual orientation).
15.
16.
17.
2025] TRANSGENDER RIGHTS & ISSUES 1083
