BREAKING: Federal Court Rejects Biden-Era Redefinition of Sex

The ruling could reshape the national debate over “gender-affirming care” and the reach of federal civil-rights law.

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About the Author

Dr. Colin Wright is an evolutionary biology PhD, Manhattan Institute Fellow, and CEO/Editor-in-Chief of Reality’s Last Stand. His writing has appeared in The Wall Street Journal, The Times, the New York Post, Newsweek, City Journal, Quillette, Queer Majority, and other major news outlets and scientific journals.

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A federal court in Mississippi has struck down a major Biden administration rule that would have required hospitals and doctors receiving federal funds to provide “gender-affirming care.” The decision, issued by Judge Louis Guirola on October 22, 2025, in State of Tennessee, et al. v. Kennedy, et al., found that the U.S. Department of Health and Human Services (HHS) went beyond its legal authority when it tried to redefine “sex” to include “gender identity” under Section 1557 of the Affordable Care Act.

The case centered on how the word “sex” should be understood in federal civil rights law. Section 1557 prohibits discrimination in healthcare “on the ground prohibited under Title IX,” the 1972 education law that bans discrimination “on the basis of sex.” But unlike Title IX, which was passed to stop discrimination against women, the Biden administration’s 2024 rule expanded the definition of “sex” to include “gender identity,” “sexual orientation,” and “sex characteristics.” It also required hospitals, insurance programs, and clinics that receive federal funding to provide “gender-affirming care,” such as hormone treatments and surgeries for people identifying as transgender, if those same procedures were offered for other medical reasons. For example, if a hospital performed mastectomies for women with breast cancer, it would be required to perform the same surgery for a female patient seeking to masculinize her body.