Denial of Gender-Affirming Care Does Not Qualify as Sex Discrimination, Eleventh Circuit Holds
On September 9, 2025, in Anna Lange v. Houston County, Georgia, et. al ., the U.S. Court of Appeals for the Eleventh Circuit held that the denial of coverage for gender-affirming surgery was not discriminatory. This decision directly departed from the court’s 2-1 ruling by a three-member panel in 2024, which held that such an exclusion was, on its face, a form of sex discrimination prohibited by Title VII of the Civil Rights Act of 1964 . It also conflicted with other recent federal court opinions that have construed the exclusion of gender affirming care as unlawful. 1 Background The plaintiff, a transgender woman, has served as a deputy with the Houston County Sheriff’s Office in Georgia since 2006. In 2017, the plaintiff began openly presenting as female in the workplace. As an employee of the Sheriff’s Office, the plaintiff was enrolled in the County’s health insurance plan. As part of her gender-affirming treatment, the plaintiff underwent hormone therapy, consu...