Nicolas Talbott v. USA

Court of Appeals for the D.C. Circuit·Decided December 9, 2025·No. 25-5087·Published

Opinion

United States Court of Appeals FOR THE DISTRICT OF COLUMBIA CIRCUIT ____________ No. 25-5087 September Term, 2025 1:25-cv-00240-ACR Filed On: December 9, 2025 Nicolas Talbott, et al.,

Appellees

v.

United States of America, et al.,

Appellants

BEFORE: Pillard*, Katsas, and Rao, Circuit Judges

ORDER

Upon consideration of the emergency motion for stay pending appeal, the opposition thereto, and the reply; the Rule 28(j) letters, and the responses thereto; and the letter request to lift the administrative stay, and the response thereto, it is

ORDERED that the administrative stay entered on March 27, 2025, be dissolved. It is

FURTHER ORDERED that the motion for stay pending appeal be granted. A concurring statement of Circuit Judge Katsas, joined by Circuit Judge Rao, and a dissenting statement of Circuit Judge Pillard are attached.

Per Curiam

FOR THE COURT: Clifton B. Cislak, Clerk

BY: /s/ Selena R. Gancasz Deputy Clerk

* Circuit Judge Pillard would deny the motion for stay pending appeal. KATSAS, Circuit Judge, joined by RAO, Circuit Judge: The United States military enforces strict medical standards to ensure that only physically and mentally fit individuals join its ranks. For decades, these requirements barred service by individuals with gender dysphoria, a medical condition associated with clinically significant distress. This bar was partially relaxed in 2016, revived in 2018, partially relaxed again in 2021, and revived again in 2025. District courts preliminarily enjoined the 2018 revival as a likely violation of equal-protection principles, but this Court vacated one of those injunctions, and the Supreme Court stayed two others. This case presents equal-protection challenges to the 2025 revival.

The 2025 policy generally bars individuals with gender dysphoria from serving in the Armed Forces. The Secretary of Defense concluded that this policy would advance important military interests of combat readiness, unit cohesion, and cost control. In doing so, he consulted materials compiled to assess the 2016 and 2018 policy changes, as well as more recent studies regarding the impacts of gender dysphoria on those with the condition and on their military service. The district court nonetheless preliminarily enjoined the 2025 policy based on its own contrary assessment of the evidence.

In our view, the court afforded insufficient deference to the Secretary’s considered judgment. Accordingly, we stay the preliminary injunction pending the government’s appeal.

I

A

To join and remain in the United States military, service members must meet strict medical standards. Lengthy Department of Defense documents set out the requirements. 2 Add. 1301; see, e.g., Dep’t of Def. Instruction 6130.03, Vol. 1, Medical Standards for Military Service: Appointment, Enlistment, or Induction (May 2024), https://perma.cc/J67Q- 982F (“DoD Accession Standards”); Dep’t of Def. Instruction 6130.03, Vol. 2, Medical Standards for Military Service: Retention (June 2022), https://perma.cc/WFQ3-F229 (“DoD Retention Standards”).

Hundreds of medical conditions are “disqualifying” for accession to military service. DoD Accession Standards at 13– 54. They run the gamut from poor vision, poor hearing, asthma, and high blood pressure to various abdominal, heart, lung, neurologic, urinary, vascular, and other deficiencies. See id. at 13–50. Many mental-health conditions are also disqualifying. These include bipolar disorders, eating disorders, substance-related disorders, obsessive-compulsive disorder, and depression or anxiety disorders under certain conditions. See id. at 50–52. The military traditionally has aligned these disqualifying mental-health conditions with those listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), a diagnostic and treatment manual published by the American Psychiatric Association. See Doe 2 v. Shanahan, 917 F.3d 694, 709 (D.C. Cir. 2019) (Williams, J., concurring in the result).

These requirements advance many military objectives. Among other things, they ensure that service members can complete required training, serve in harsh or remote environments, and perform their duties as safely as possible. DoD Accession Standards at 5. The standards also reduce the

1 “Add.” citations refer to the government’s addendum, while “App.” citations refer to the plaintiffs’ appendix. 3 risk that service members will “require excessive time lost from duty” for medical reasons. Id. at 4.

B

This case involves application of these principles to gender dysphoria, a medical condition experienced by certain transgender individuals. The term “transgender” describes an individual whose self-perceived gender is incongruent with his or her biological sex. Am. Psychiatric Ass’n, Diagnostic and Statistical Manual of Mental Disorders 511 (5th ed. Text Revision 2022) (“DSM-5”). A subset of transgender individuals experience “gender dysphoria,” a psychological condition stemming from such an incongruence. See id. at 512–13. Gender dysphoria “is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning.” Id. at 513. Individuals with gender dysphoria often seek specialized treatment, including hormone therapy, surgery, or other substantial interventions. See id. For example, women with gender dysphoria may take testosterone to induce hair growth, a deepened voice, and increased muscle mass. They also may undergo surgery to remove their breasts or change the appearance of their genitalia. Men with gender dysphoria may seek comparable hormonal or surgical interventions.

Before 2016, the medical standards discussed above broadly barred transgender individuals from military service. Add. 125; see Doe 2, 917 F.3d at 696–97 (Wilkins, J., concurring). Over the last decade, however, the governing rules have changed repeatedly. One way or another, recent standards all distinguish between transgender individuals and individuals with gender dysphoria. 4 1

In June 2016, Secretary of Defense Ashton Carter issued a policy permitting military service by transgender individuals not suffering from gender dysphoria. App. 17 (“Carter Policy”). For individuals seeking to join the military, a “history of gender dysphoria [was] disqualifying” unless a licensed medical provider certified that the individual had been “stable without clinically significant distress or impairment in social, occupational, or other important areas of functioning for 18 months.” Id. at 20. Likewise, a “history of medical treatment associated with gender transition [was] disqualifying” unless a medical provider certified that the treatment had concluded and that the individual had been clinically stable for 18 months. Id. For individuals already serving in the military, the policy permitted “[g]ender transition” despite noting that it “presents unique challenges” for “military mission and readiness needs.” Id. at 21.

In significant part, the Carter Policy rested on a report by the RAND Corporation, which recommended that transgender individuals be permitted to serve in the Armed Forces. App. 116 (“RAND Report”). Despite reaching this conclusion, the RAND Report included significant caveats. It flagged as a “critical limitation” the “lack of rigorous epidemiological studies of the size or health care needs of either the U.S. transgender population or the transgender population serving in the military.” Id. at 138. Likewise, it acknowledged a lack of data “from which to estimate” how many transgender individuals have gender dysphoria. Id. at 141. Regardless, the report found that hormone treatments make an individual undeployable for a year. See id. at 202.

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