Seventh Circuit Strikes Down Ban On Hormone Treatment For Transgender Prisoners

Last week, the Seventh Circuit struck down Wisconsin’s “Inmate Sex Change Prevention Act,” which, as the name suggests, prohibits transgendered prisoners from receiving hormone therapy and other medical treatments which cause their physical characteristics to match their gender identity. Significantly, the court rooted its decision in the Eighth Amendment’s bar on cruel and unusual punishment, which establishes that “[r]efusing to provide effective treatment for a serious medical condition serves no valid penological purpose and amounts to torture.”

The core of the Seventh Circuit’s decision is that gender identity disorder (“GID”) must be accorded the same respect given to other medical conditions. Left untreated, the court explained, GID leaves to severe anxiety, depression, and even suicide or mutilation of one’s own genitals. Worse, if an inmate who has previously undergone hormone therapy is suddenly cut off from those treatments, it can have severe physiological consequences including muscle wasting and “neurological complications.”

Although earlier decisions suggested that the Eighth Amendment does not require inmates to receive “esoteric” treatments like hormone therapy, the court disposed of this suggestion by noting that it lacks any basis in fact:

The court’s discussion of hormone therapy and sex reassignment surgery in these two cases was based on certain empirical assumptions—that the cost of these treatments is high and that adequate alternatives exist. More than a decade after this court’s decision in Maggert, the district court in this case held a trial in which these empirical assumptions were put to the test. At trial, defendants stipulated that the cost of providing hormone therapy is between $300 and $1,000 per inmate per year. The district court compared this cost to the cost of a common antipsychotic drug used to treat many DOC inmates. In 2004, DOC paid a total of $2,300 for hormones for two inmates. That same year, DOC paid $2.5 million to provide inmates with quetiapine, an antipsychotic drug which costs more than $2,500 per inmate per year. […] The district court concluded that DOC might actually incur greater costs by refusing to provide hormones, since inmates with GID might require other expensive treatments or enhanced monitoring by prison security. […]

More importantly here, defendants did not produce any evidence that another treatment could be an adequate replacement for hormone therapy. Plaintiffs’ witnesses repeatedly made the point that, for certain patients with GID, hormone therapy is the only treatment that reduces dysphoria and can prevent the severe emotional and physical harms associated with it.

In other words, rather than rely on stereotypical assumptions regarding the nature of GID or the cost of treating it, the court actually engaged with the medical science surrounding the condition. In this sense, the Seventh Circuit’s decision closely resembles Judge Vaughn Walker’s opinion striking down California’s Prop 8, which carefully and meticulously examined each of the anti-gay claims that same-sex couples are somehow inferior and found no factual support for any of these claims.

For this reason, both Walker’s decision and the Seventh Circuit’s transgender inmates decision reflect an important positive trend in the judiciary’s treatment of sexual minorities. The only basis for laws that single out LGBT individuals for special restrictions are outdated prejudices with no basis in reality. The sooner courts begin testing the assumptions behind those prejudices, the faster anti-LGBT discrimination will become a thing of the past.