A federal judge ruled Friday that it was unconstitutional to deny hormone therapy to an inmate in a Missouri prison, issuing a preliminary injunction to ensure that she receives medically necessary care.
Jessica Hicklin, 38, was first diagnosed with gender dysphoria in March, 2015, twenty-two years into her life sentence. Her psychiatrist recommended she be referred to an endocrinologist to be assessed for hormone replacement therapy — except she wasn’t, because a Missouri Department of Corrections (MDOC) policy didn’t allow for it.
As a result, her distress and anxiety never improved. A new psychiatrist again diagnosed her with “gender dysphoria with associated panic secondary to current body characteristics” that December, recommending both hormone therapy and an electrolysis hair removal devise.
By September, 2016, Hicklin was expressing thoughts of self-harm — the onset of male-pattern baldness further agitating her gender dysphoria. She had still been given no treatment beyond talk therapy. As of the following January, her treatment plan still did not include any hormone therapy, hair removal, or even access to gender-affirming canteen items. Her psychiatrist diagnosed her with an anxiety disorder, and the record shows that she has had a history of suicide attempts and also once tried to remove her own testicles.
Nearly three years after her initial diagnosis of gender dysphoria and prescription of hormone therapy, Hicklin still had not received any treatment to assist in her transition. And according to U.S. Magistrate Judge Noelle Collins, that’s a violation of her constitutional rights.
“The Court finds that Plaintiff has met her burden to show the threat of irreparable injury,” she wrote. “Plaintiff asserts that she has and will continue to suffer irreparable harm in the absence of a preliminary injunction because she suffers from depression, anxiety, and intrusive thoughts of self-castration as a result of Defendants’ conduct.”
Hicklin demonstrated a serious medical need and the prison showed “deliberate indifference” by refusing to provide the treatment multiple doctors requested for her on multiple occasions.
The entire reason for that denial of care was what Collins describes as a freeze-frame “policy of unknown origin.” According to the “blanket rule,” if an inmate were already on hormone therapy when she entered prison, she would be allowed to continue receiving that treatment in prison. But the policy arbitrarily prohibited an inmate from beginning hormone therapy while in prison. “The Department believes the initiation of Hormone Replacement Therapy (HRT) is not appropriate in a prison environment,” it read. “An attempt at such transition in the prison venue severely compromises the safety of the offender and places them at substantial risk of sexual abuse and harassment.”
Defending their decision not to treat Hicklin, the MDOC cited a highly biased report by anti-transgender researchers Paul McHugh and Lawrence Mayer to argue that “there is a legitimate disagreement in the scientific community about what treatment is or is not appropriate for a patient with gender dysphoria.” That report cherry-picked and distorted studies in an attempt to contradict the consensuses of every major medical organization endorsing affirming treatment for transgender people.
Hicklin was first taken into the prison’s custody at the age of 16 and is serving a life sentence with no parole. In a blog post published by Lambda Legal, which represented her, she wrote about how she had always experienced gender dysphoria. “I had felt I was a girl since I was very young, even though I was assigned the male sex at birth,” she wrote.
A victim of childhood abuse and multiple sexual assaults in prison, it took some time for her to process what she was experiencing and acknowledge it for what it was. “Although I have struggled for years to name what I was experiencing, and I sought treatment for depression and anxiety, it wasn’t until several years later that I realized that I am a woman who is transgender.”
Collins ruled that MDOC’s decision to try to treat Hicklin’s depression without treating her dysphoria was inadequate. “[W]hile Defendants are correct in their assertion that Ms. Hicklin is not constitutionally entitled to the treatment of her choice, the treatment must nevertheless be adequate to address the prisoner’s serious medical need,” she wrote. “In light of treating physicians’ recommendations, psychiatric care and counseling alone are constitutionally inadequate to address Ms. Hicklin’s gender dysphoria.”
The preliminary injunction will ensure Hicklin can begin receiving the appropriate treatment while her case proceeds. Collins wrote that Hicklin is likely to succeed on her claim that her Eighth Amendment rights were violated. The Eighth Amendment protects against “cruel and unusual punishment.”
Responding through Lambda Legal, Hicklin said the decision made her feel like she could finally breathe after feeling like she’d been drowning. “Today’s decision is like someone threw me a life preserver,” she said. “It has saved my life.”
Courts across the country have arrived at different conclusions about how to treat transgender inmates. The U.S. Court of Appeals for the First Circuit ruled against a Massachusetts inmate who was similarly denied treatment, but a federal judge in California ruled that a trans inmate deserved the treatment she was prescribed.