Medicine Under Pressure: Gender Ideology in Clinics and Courts

Religion and science align on the fact that there are only two sexes. Genesis 1:27 states this plainly, and basic biology confirms that males have XY chromosomes and females have XX chromosomes. Despite this, making such statements publicly has become grounds for termination, expulsion, or lawsuits in the United States.

People and institutions have been sued for refusing to use preferred gender pronouns, with many conservatives arguing, and some courts agreeing, that compelled pronoun use violates the First Amendment.

The medical field has not been immune to gender ideology. The framing “assigned male at birth,” now standard in clinical settings, implies that biological sex is a subjective determination rather than an observed biological fact. More consequentially, courts and insurers have been drawn into litigation by biological males claiming they were denied female medical care, and by biological females identifying as male after being denied sex change procedures.

In Tovar v. Essentia Health, filed in 2016, Brittany Tovar, a nurse practitioner, and her teenage son Reid Olson, a biological female diagnosed with gender dysphoria, sued Essentia Health and its insurer HealthPartners for categorically excluding gender reassignment services from the employee health plan. The case proceeded on an ACA Section 1557 sex discrimination theory and settled out of court, with Essentia and HealthPartners agreeing to cover sex changes going forward.

In Flack v. Wisconsin Department of Health Services, filed in 2017, transgender Medicaid recipients challenged a 1997 Wisconsin regulation that categorically excluded coverage for surgical and hormone treatments for gender dysphoria. In August 2019, a federal judge granted summary judgment to the plaintiffs on all claims, permanently barring Wisconsin Medicaid from enforcing the exclusion. The state did not appeal, and a $2.2 million settlement followed.

In Minton v. Dignity Health, Evan Minton, who was born female but masqueraded as a male, was scheduled by her doctor for a hysterectomy at Mercy San Juan Medical Center, a Catholic hospital near Sacramento, in August 2016. Two days before the procedure, the doctor informed the hospital that she was transgender, and the hospital canceled the surgery. The hospital’s position was that the surgery was elective, part of a “transition,” and that, as a Catholic hospital, they could not participate in sex change operations.

The ACLU filed suit under California’s Unruh Civil Rights Act. The California Court of Appeals ruled in 2019 that Minton had standing to proceed, and in 2021, the U.S. Supreme Court declined to hear Dignity Health’s appeal, leaving that ruling intact.

In the end, the San Francisco County Superior Court entered the following judgment: “It is adjudged that plaintiff Minton, Evan take nothing from defendant Dignity Health dba Mercy San Juan Medical Center.” Minton lost. She was awarded nothing.

In Hammons v. University of Maryland St. Joseph Medical Center, the ruling went the other way when a federal court subsequently ruled that the hospital’s refusal to perform a hysterectomy on a woman who dressed as a man violated the Affordable Care Act.

On the insurance side, three transgender women filed a federal class action against Aetna in 2024, alleging the insurer covered facial reconstruction surgeries for non-transgender patients while classifying identical procedures for transgender patients as cosmetic. On March 8, 2026, a federal judge denied Aetna’s motion to dismiss and granted preliminary injunctive relief, requiring the insurer to reconsider coverage for two of the plaintiffs.

In Lange v. Houston County, Georgia, a biological male identifying as female, employed as a patrol officer, sued after being told the group insurance plan would not cover a sex change. The Eleventh Circuit affirmed the lower court’s ruling that the blanket exclusion constituted sex discrimination, holding that cost savings do not excuse discrimination under Title VII.

Separately, Skyler Jay, a woman pretending to be a man who appeared on Netflix’s Queer Eye, sued the University of Georgia over a similar health plan exclusion, while transgender government employees in Wisconsin and Iowa won comparable cases totaling $900,000 in jury awards.

California regulators fined Anthem Blue Cross $850,000, the largest penalty in state history for denying sex change procedures, and required the insurer to hire a dedicated case manager for patients with gender dysphoria, with over 150 denied claims sent back for review. From 2017 to 2020, Anthem had categorized more than 20 procedures, including facial implants, hair removal, voice therapy, and breast augmentation, as not medically necessary when sought by transgender patients, while covering the same procedures for non-transgender patients.

The legal framework underlying all of these cases has shifted repeatedly with each change in administration. The 2016 Obama administration rule interpreted Section 1557 of the Affordable Care Act’s sex discrimination prohibition to include gender identity. The Trump administration eliminated that definition in June 2020, narrowing Section 1557 protections.

The Biden administration reversed course in May 2021 and codified gender identity protections in a May 2024 final rule, though that rule was quickly stayed by a federal court. On January 20, 2025, the current Trump administration rescinded Biden-era guidance, and on May 14, 2025, HHS formally rescinded the 2021 interpretation of Section 1557, returning to the position that sex discrimination protections do not extend to gender identity.

Jessica Simpson, a Canadian transgender activist who retains male genitalia, filed a complaint against a gynecologist who refused to treat her, claiming discrimination. The complaint was filed with the College of Physicians and Surgeons of British Columbia in 2019, though no resolution has been publicly reported.

A report by Advocates for Trans Equality states, “If a transgender woman’s health care provider decides she needs a prostate exam, an insurance company can’t deny it because she is listed as female in her records. If her provider recommends gynecological care, coverage can’t be denied simply because she was identified as male at birth.”

It seems that it would just be a matter of time before someone is sued for denying a Pap smear to a male, and until insurance companies are forced to pay for testicular examinations for women.

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