Nearly one year after the Department of Justice confirmed that denying hormone therapy for transgender people in prison is cruel and unusual punishment, Texas just loosened its strict guidelines for who could receive the treatment. Texas’ Department of Criminal Justice (TDCJ) policy now allows prisoners to receive hormone therapy behind bars, even though they weren’t undergoing therapy prior to their incarceration.
Until last week, TDCJ only provided the treatment plan for inmates who went through hormone therapy before they were locked up. Now, any prisoner who is diagnosed with gender dysphoria — “clinically significant distress or impairment that is associated with the marked incongruence between one’s experienced or expressed gender and one’s assigned gender” — can qualify for the treatment. Hormone therapy typically includes estrogen for trans women and testosterone for trans men.
TDCJ’s altered its policy in accordance with the American Psychiatric Association’s (APA) updated classification of gender dysphoria, which is now considered a diagnosable condition. The change marks a small breakthrough for the state’s 212 transgender prisoners, but there are still many hoops they have to jump through in order to receive the hormones.
“Offenders are prescribed hormone therapy only after going through a rigorous process that includes being reviewed by a gender dysphoria specialist, an endocrinologist, and having an affirmative diagnosis,” Jason Clark, a spokesman for the TDCJ, clarified. “Only then would it be considered medically necessary and require the minimum level of treatment which is hormone therapy.”
LGBT policy advocates believe the policy is a slight improvement, but can still keep prisoners waiting long periods of time for treatment.
Lambda Legal attorney Demoya Gordon told the Associated Press, “We’re hearing from people that, for example, if they’re not close to the point where they’re going to try to perform surgery on themselves, or commit suicide or something like that, that their needs for treatment are not being taken seriously.”
Transgender people have a much higher suicide attempt rate than people in the general population, due to rejection, discrimination, violence, and harassment. The denial of health care, including hormone therapy and sex reassignment surgery, is one of many ways prisons systematically discriminate against trans inmates, and it can fuel self-harm.
In the past few years, several trans inmates have made headlines for the drastic actions they took to change their bodies. Georgia prisoner Ashley Diamond, who was repeatedly raped and denied hormone treatments was so desperate that she attempted to castrate and kill herself. Michelle Norsworthy attempted suicide multiple times before a federal judge in California ruled that the state’s department of corrections had to provide sex reassignment surgery. That judge cited a trans woman who castrated herself in a Texas prison and forced the state to carry out the procedure. And in Massachusetts, Michelle Kosilek attempted suicide and self-castration due to the mental anguish of living in a body that didn’t align with her gender identity.