Trudy Ring

A Christian-owned spa in Washington State can’t discriminate against transgender women, a federal appeals court has ruled.

Olympus Spa, which has locations in Lynnwood and Tacoma, has historically had a policy of admitting “biological women” only, “excluding, in addition to men, preoperative transgender women who have not yet received gender confirmation surgery affecting their genitalia,” notes the ruling from a three-judge panel of the U.S. Court of Appeals for the Ninth Circuit.

After Olympus turned away a trans woman fitting this description in 2020, the woman filed a complaint with the state’s Human Rights Commission, which enforces the Washington Law Against Discrimination. The law does not explicitly ban discrimination based on gender identity, but the state says the ban on sexual orientation discrimination includes gender identity.

The commission told Olympus Spa’s owners they had to change their policy to a more inclusive one. They did so, and they reached a settlement with the woman in 2021. Under the settlement, however, reserved the business’s right to file a constitutional challenge, which it did in 2023, represented by the Pacific Justice Institute, a right-wing legal group. The lawsuit argued that being forced to admit trans women who hadn’t had genital surgery violated the owners’ First Amendment rights to free speech, free association, and free exercise of religion.

“The family run business is owned by Korean Christians who hold sincere faith-based convictions against allowing persons whose genitals are external (males) to be present with persons whose genitals are internal (females) while in a state of partial or full undress if such persons are not married to one another,” the lawsuit said, according to the Seattle Times.

The U.S. District Court for the Western District of Washington dismissed the suit, finding that complying with the state antidiscrimination law didn’t interfere with the owners’ First Amendment rights. For instance, changing the language in its admissions policy was incidental to the business’s operations, and the state law is neutral with regard to religion, the court found. The owners then appealed to the Ninth Circuit.

A three-judge panel of the Ninth Circuit upheld the district court’s decision in a 2-1 ruling issued May 29. Because the Human Rights Commission’s enforcement of the state law “does not impermissibly burden the Spa’s First Amendment rights to free speech, free exercise, or free association, we affirm the district court’s dismissal of the Spa’s complaint,” Judge M. Margaret McKeown wrote for the majority. She was appointed by President Bill Clinton, as was Judge Ronald M. Gould, who joined her in the opinion.

Judge Kenneth Lee, appointed by Donald Trump during his first term, dissented. He said the state targeted “members of a racial minority group who want to share their cultural heritage and provide a safe space for women and girls.”

“Ultimately, this case is not just about the fate of a family-owned business. It is about power — which groups have it and which do not,” added Lee, is Korean-born. “And Asian Americans in Washington have historically lacked political clout.”

Attorney Kevin Snider of the Pacific Justice Institute told the Times he will ask for the full Ninth Circuit to hear the case. “Safeguarding the dignity of unclothed women in their intimate spaces implicates the right to association and the free exercise of religion,” he said in a statement. “We are committed to pressing forward to vindicate those rights.”

The Southern Poverty Law Center has designated the Pacific Justice Institute an anti-LGBTQ+ hate group. The Sacramento-based group’s actions include filing a friend-of-the-court brief with the U.S. Supreme Court supporting California’santi-marriage equality Proposition 8, opposing a California law protecting trans students in public schools, and suing California over its ban on conversion therapy.

The Centers for Medicare and Medicaid Services, headed by Mehmet Oz, has sent a letter to some hospitals demanding information on their provision of gender-affirming care to transgender youth.

The CMS, like all of Donald Trump’s administration, is opposed to this care, falsely claiming it is experimental and is not supported by evidence.

The letter, dated Wednesday, expresses “urgent concerns with both the quality standards adherence and profits related to these harmful procedures,” says a CMS press release. The release quotes Oz as saying, “These are irreversible, high-risk procedures being conducted on vulnerable children, often at taxpayer expense. Hospitals accepting federal funds are expected to meet rigorous quality standards and uphold the highest level of stewardship when it comes to public resources — we will not turn a blind eye to procedures that lack a solid foundation of evidence and may result in lifelong harm.”

“The United States government has serious concerns with medical interventions for gender dysphoria in children,” the letter reads. “These interventions include surgical procedures that attempt to transform an individual’s physical appearance to align with an identity that differs from his or her sex or that attempt, for purposes of treating gender dysphoria, to alter or remove an individual’s sexual organs to minimize or destroy their natural biological functions. These interventions also include, but are not limited to, the use of puberty blockers, including GnRH agonists and other procedures, approaches, or modalities, to delay the onset or progression of normally-timed puberty for purposes of treating gender dysphoria, as well as the use of sex hormones, such as estrogen, progesterone, or testosterone, and androgen blockers to align an individual’s physical appearance with an identity that differs from his or her sex. … CMS believes that these interventions were initiated with an underdeveloped body of evidence, lack reliable evidence of benefits for minors, and are now known to carry serious risks of long-term and irreparable harm.”

In reality, the procedures are not harmful and are often lifesaving. Studies by the Trevor Project, which assists LGBTQ+ youth in crisis, and other researchers have found that access to gender-affirming care reduces the risk of suicide among young trans people. Also, such care is endorsed by every major medical association, including the American Academy of Pediatrics, the American Medical Association, and the American Psychiatric Association.

Also, genital surgery is almost never performed on minors, although some undergo top surgery or facial surgery. The effects of puberty blockers are reversible, and the effects of cross-sex hormones usually are as well. Regret about transition is rare.

The letter goes on to ask about “the adequacy of informed consent protocols for children with gender dysphoria, including how children are deemed capable of making these potentially life-changing decisions and when parental consent is required.”

The answer about consent, from a Human Rights Campaign document: “If medications or surgery are part of their gender journey, they are only prescribed after further assessments to ensure they meet prescribing criteria. This can include but is not limited to documentation and referral letters, parental consent, and ongoing mental health support. At all stages, gender-affirming care is only delivered after patients and their families have been counseled, and informed consent has been given.”

The letter further asks for billing codes for gender-affirmation procedures, how much revenue these procedures generate, and what the profit margins for this care are — as if doctors and hospitals are providing it out of greed.

Dr. Kellan E. Baker, executive director of the Institute for Health Research and Policy at Whitman-Walker, an LGBTQ-focused clinic, issues a statement denouncing the letter. “This ‘request’ is a blatant attempt to intimidate providers into betraying their professional obligation to care for their patients,” Baker said. “It is vitally important that hospitals, states, elected officials, and courts stand up to these strong-arm tactics and protect patients’ right to care. And it is vital that providers recognize this document has no legal force or effect and that they continue to provide the care their patients need.”

The letter is one of many steps the Trump administration has taken to target gender-affirming care, as the administration professes not to believe trans people even exist. Trump has issued an executive order threatening to withhold federal funds from any health care provider offering gender-affirming care to people under 19; through the CMS, has advised states to stop paying for this care for young people through Medicaid, which is jointly managed by states and the federal government; and directed the National Institutes of Health to study transition regret, which, again is rare.

A recent study from the Department of Health and Human Services, headed by Robert F. Kennedy Jr., who is anti-trans, went so far as to recommend conversion therapy for trans youth rather than gender-affirming care. Conversion therapy has been shown to cause harm to young people and has been repudiated by all major medical and mental health organizations. Many states have barred licensed professionals from subjecting minors to it.

The “Big Beautiful Bill” on the federal budget, which was passed narrowly by the House of Representatives and is pending in the Senate, would attack gender-affirming care even further. It would bar Medicaid and the Children’s Health Insurance Program from covering any gender-affirming services for people of any age. It also would no longer classify gender-affirming care as an “essential health benefit” under the Affordable Care Act, explicitly excluding transition-related care from private insurance plans regulated by federal standards.

With many states and the federal government adopting anti-transgenderpolicies, nearly half of the trans people in a Williams Institute survey have moved to a more welcoming state or are considering such a move.

The institute, located at the School of Law at the University of California, Los Angeles, surveyed 302 trans, nonbinary, and other gender-diverse American adults in December to gauge the effect of Donald Trump’s election on them. They are referred to under the umbrella term “transgender” in the report. Respondents could remain anonymous. More than a third were people of color, and more than 40 percent had an annual income under $50,000. 

Forty-eight percent had either moved to a more trans-friendly state or were thinking about doing so. Twenty-three percent had already made such a move.

“Respondents who lived in less supportive local communities, those in states with laws and policies that were less supportive of transgender people, and those with concerns about the impact of Trump’s presidency on their access to health care, exposure to discrimination, and vulnerability to hate crimes, were more likely to want to move to a state they viewed as more trans-affirming,” says an executive summary of the findings, released this week. “Those with lower incomes were also more likely to want to relocate, even though they may lack the resources to do so.” (The full report is here.)

“When asked more specifically what cities or states they want to move to, most respondents mentioned progressive cities or politically liberal states, with California, Massachusetts, Minnesota, New York, and Washington Statefrequently named,” the summary continues. But many reported barriers to moving, particularly cost-related ones.

Among those working full-time or part-time in an unfriendly state, 14 percent were applying for jobs in more welcoming states, and 26 percent were considering this action.

Some respondents were considering international moves. Twenty percent said they very much wanted to move to another country, and 25 percent somewhat wanted to do so. There were barriers to this as well, including concerns about visas or other immigration regulations, health care, and language issues.

The anti-trans climate is affecting travel plans too. Thirty percent of respondents said they were traveling less frequently as a result of the 2024 election, and 70 percent said they would be much (48 percent) or somewhat (22 percent) less likely to go on vacation to states they view as less trans-friendly. About one-sixth said they had canceled travel plans to states they consider hostile or were considering cancellation.

“For those transgender people who do pursue relocating, service providers, businesses, and state and local governments should both consider the costs of losing members of their communities and support and welcome those who are making new homes,” the summary concludes. “Many transgender people will need resources to be able to move, and all will need to stay as informed as possible about what a move will and will not accomplish, given the rapidly changing policy landscape. Ultimately, whether or not most transgender people who want to move will be able to do so, the expression of a desire to move is a measure of the extreme pressure that transgender people are feeling about their and their families’ safety and health. Such pressure has mental health, physical health, and economic impacts on those who move and those who remain.”

“This survey was conducted in December 2024, so the desire to move and fears regarding travel for transgender people may be even more pronounced today,” lead author Abbie E. Goldberg, affiliated scholar at the Williams Institute and professor of psychology at Clark University, said in a press release. “Conversely, recent anti-transgender federal policies, which can affect even states with supportive laws, may have lessened the belief among transgender people that relocating will lead to significant improvement.”

“Whether or not the transgender people who want to move will ultimately be able to relocate, the desire to move is a measure of the extreme pressure that transgender people are feeling about the safety and health of themselves and their families,” added author Brad Sears, distinguished senior scholar of law and policy at the Williams Institute. “That pressure has mental health, physical health, and economic impacts on those who move and those who stay.”

An earlier release of the survey findings, which came out in March, noted that many trans people were worried about their access to gender-affirming careunder the Trump administration, were planning to downplay their trans identity, and were taking steps to protect themselves and their families.