State offers transgender inmates hormone therapy
Advocates say shift in policy welcome, but not enough.
Transgender inmates in Texas’ prisons now are able to begin hormone therapy while incarcerated, a shift in state policy that advocates call positive but far from ideal.
The decision by the Texas Department of Criminal Justice to update its policy regarding transgender inmate health care was uncharacteristic of a wider trend in Texas, where there are few laws to protect access to housing, employment or health care.
Advocates, however, said the step, although positive, was small, and raised concerns that pris- on officials have ensured the process is onerous enough that transgender inmates could have to wait months, even years, to receive treatment.
“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,” said Demoya Gordon, an attorney at Lambda Legal, a national law fifirm that specializes in lesbian, bisexual, gay and transgender issues. “By no means has this issue been resolved.”
Under TDCJ’s previous polic y, only inmates who came into the system already taking hormones could continue doing so. The change, which went into effect last August, allows transgender inmates who already are incarcerated to begin receiving hormone therapy behind bars.
TDCJ spokesman Jason Clark played down the change, saying Texas’ policy remained “among the most conservative in the nation.”
“Offenders are prescribed hormone therapy only after going through a rigorous process that includes being reviewed by a gender dysphoria specialist, an endocrinol-ogist and having an affir-mative diagnosis,” Clark said. “Only then would it be considered medically necessary and require the minimum level of treatment which is hormone therapy.”
Gordon said she was heartened by the change, but added that transgender inmates still must jump through too many hoops.
“Texas seems to have, I don’t know, some sort of vested interest in not being seen as respecting the constitutional rights of transgender people. I don’t really understand it,” she said.
Texas does not offer sex reassignment surgery to its inmates. According to the Marshall Project, a nonpartisan nonprofit focused on criminal justice issues, some states, like California, provide “ready access” to hormone therapy for transgender inmates, some provide it on a case-bycase basi s and some do not provide any access at all.
In August, TDCJ counted 212 inmates in prisons who self-identify as transgender, a term that broadly refers to someone who identifies as a different gender than their sex at birth. Of those 212 inmates, 21 are receiving hormone therapy, 10 of whom started while in prison, Clark said.
Lou Weaver, transgender programs coordinator for the LGBT-rights group Equality Texas, said hormone therapy is a simple process. For transgender men, it often involves getting recurring testosterone shots, usually once a week. Transgender women often take estrogen pills, one or two a day.
Older inmates and those who require them for medic al reasons already have access to hormones, so making them available to transgender inmates should not be such an onerous step, Weaver said. “Gay and transgender Texans need to have access to medical care the way anyone else does.”
In a document explaining TDCJ’s decision to begin classifying transgender and intersex inmates at intake, it says the change was made “to ensure offender and staffff safety” and to comply with federal prison and jail standards aimed at reducing inmate rapes.
TDCJ initiated the policy just months after the state of Georgia lost a legal challenge from a transgender inmate who sued to receive hormone therapy while in prison.
Clark said Texas’ policy was updated “to reflflect community standards of care” after the American Psychiatric Association updated its manual of mental disorders to include “gender dysphoria” as a diagnosable condition.