Sex-segregated systems

Primary Author(s): 
Dan Karasic, MD
Publication Date: 
June 17, 2016

A guiding principle in sex-segregated systems is to give people the autonomy to use the facilities and programs most aligned with their gender identity. This includes using restroom facilities, inpatient and residential beds, and locker rooms concordant with experienced gender (Grading: X C S). When available and preferred by the individual, non-gendered facilities can be utilized, but services should not be dependent on their availability.

The legal right to access to programs according to gender identity has expanded with recent state and federal regulation. Schools are required to allow students to use facilities and programs concordant with their gender identity, under the laws of some states, including California.[1] Under California law, students should be able to choose facilities according to their gender identity, or to use a private facility. Students should be able to participate in athletic programs and facilities according to gender identity. Students should be referred to according to preferred name and pronoun, and be listed according to gender identity in data systems. The Department of Education, under Title IX, has ruled that the students must be able to use programs and facilities according to their identity.[2]

The U.S. Department of Health and Human Services now requires shelters and other housing programs to provide housing and other accommodations and services to trans people according to their gender identity.[3]

WPATH SOC 7 addresses the care of people in institutional environments, stating that all aspects of transition care should be available to people living in institutions, and states that sex segregation by external genitalia may be inappropriate and place trans people at risk for victimization.[4]


  1. California School Boards Association (CSBA). Final Guidance: AB1266, Transgender and Gender Nonconforming Students, Privacy, Programs, Activities and Facilities. 2014 Mar [cited 2016 Mar 25].
  2. U.S. Department of Education; Office for Civil Rights. Questions and Answers on Title IX and Single-Sex Elementary and Secondary Classes and Extracurricular Activities. 2014 [cited 2016 Mar 25].
  3. U.S. Department of Housing and Urban Development (HUD). FR-5863-P-01 Equal Access in Accordance With an Individual's Gender Identity in Community Planning and Development Programs. - Proposed Rule Document. 2016 [cited 2016 Mar 25].
  4. World Professional Association for Transgender Health (WPATH). Standards of care for the health of transsexual, transgender, and gender nonconforming people, 7th Version. WPATH; 2012 [cited 2016 Mar 10].

Medical Referral Disclaimer

The CoE is unable to respond to individual patient requests for medical guidance. If you need medical advice, please contact your local primary care provider. If you need clarification, seek a second opinion locally or have your provider contact us for more information.