Keri Renault

HRT in Prison: Life or Death?

Filed By Keri Renault | April 03, 2010 12:00 PM | comments

Filed in: Living, Politics, Transgender & Intersex
Tags: gender dysphoria, hormone replacement therapy, incarceration, inmate, Judge Charles Clevert, Republican, sex-reassignment surgery, SRS, transgender, Wisconsin, Wisconsin penal code

Inmates aren't denied life saving drugs or medical care in Wisconsin prisons. Insulin is in ready supply for the diabetic inmate. Angina sufferers receive nitro quick same as asthmatics have access to an inhaler.

Even in prison the right to life remains inalienable, unless the inmate happens to be transgender and in need of hormone therapy.

Yesterday Wisconsin's exclusionary medical care model, practiced in prisons across America's Dairyland was found guilty in Federal Court. U.S. District Judge Charles Clevert declared Wisconsin's discriminatory policy unconstitutional and unenforceable.

Republican Rep. Scott Suder called the verdict a "travesty of justice."

One of the measure's original sponsors, Sen. Ted Kanavas, (R-Brookfield), labeled the ruling "absurd."

A spokesperson for Republican Attorney General J.B. Van Hollen said the decision was being reviewed for possible appeal.

Since 2006 Wisconsin has denied transgender inmates hormone therapy, described by transgender plaintiffs as critical medical care prescribed to treat "gender dysphoria."

Although the original measure to ban hormone therapy eventually received bipartisan support, it was signed into law by Democratic Governor Jim Doyle after a transgender inmate filed suit to have the state cover sex reassignment surgery.

Therein lays the real fear: Taxpayer outrage.

It should come as no surprise then, if someday another proposal rises from the dark recesses of a calculating, voter-starved politico, demanding the light of day. The next-generation of spending-conscious legislation hailed to end tax funding of all inmate surgeries, from kidney, liver and heart transplants to cancer treatments.

As the saying goes, they shoot horses, don't they?

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Angela Brightfeather | April 3, 2010 1:17 PM

I w3ould appreciate your letting me know of any contacts that are available who went through this court battle in WI.
The state legislature in NC denied HRT to inmates diagnosed as having GID about 8 years ago and I would like to investigate the posibilities of overturning that vote in NC.

I think this is a HUGELY important ruling and I hope that we queer folk we sooner than later be able to see attitudes change (as well as have legislation to speed that along) regarding HRT no matter where the person is----in prison or not. And I have a problem with the idea of medical care being denied period---for anyone, anywhere. Having said that, I again take issue with your first paragraph.

I thank you for the link for further reading. And I would encourage you to do further reading as well. Your statement:

"Inmates aren't denied life saving drugs or medical care in Wisconsin prisons. Insulin is in ready supply for the diabetic inmate. Angina sufferers receive nitro quick same as asthmatics have access to an inhaler."

is what bothers me. My concern is that you have stated this as fact and perhaps I misunderstand you (because I don't see any sort of citation or reference to where you've gathered it). This is NOT a fact and is quite contrary to reality. The ACLU has a few good examples of problems related to medical care for those incarcerated across the country. Here is a link to a ruling that comes from several women in Wisconsin, the state in which we have this HRT ruling:

This decision and order came just a few months ago so I would guess that the changes are currently being implemented unless there has been an appeal. So the issue of medical care for the incarcerated in Wisconsin is an issue on its own and not just for HRT. I get that the point of your article is that HRT is important medical treatment that ought not be denied simply because of those who receive it being seen as electing it, or any other number of things in relation to their being a member of our queer community.

My point is that we, as queer folk (and really we as humans) can see this as another arena in which we must fight for rights. Denial of medical treatment in prisons is a HUGE issue. It isn't something that trans people must work on alone, or queer folk must work on either. We can work on it with (as some of us already do) others who fight for the rights of the incarcerated. But making statements like yours regarding the ease with which all other inmates receive care isn't winning people over and is, and I say so with much respect, a display of ignorance regarding prison health care.

Queer and trans folk can reinvent the wheel and start being involved in advocating for the rights of incarcerated alone or join with others who advocate (tirelessly and with their own stigma) for inmate health care. Statements like that with which you open do nothing to win over those who have begun the fight. And really do little to help those who have been denied HRT. Please consider this.

Also, as the ACLU mentioned in the link I include, the 8th and 14th amendments as well as legislation such as ADA would be great examples of why health care cannot be denied to any ward of the state.

I hope that you are right about inmates in Wisconsin prisons receiving medical treatment without hesitation of any kind. That certainly isn't the case in all of the states. Inmates and inmates' families fight regularly for medical care----a broken leg might require a few weeks' worth of calls for treatment to be given. That's not an anecdote; that's a concrete example, I've got the names. I hope that your example of medical treatment in Wisconsin prisons is equally solid and not anecdotal.

I, too, see hormone treatment being denied a huge problem. No one should be denied medical treatment inside or outside prison. I simply had to make this comment after having spent far too many hours of my own time fighting to get some sort of medical treatment for inmates in a certain prison. Plus, the Amnesty International photo of Troy Davis is just to the right and I know his sister has recently had to fight not only for his life but also for his medical treatment.

This isn't just a battle for we queer folk. This is a battle for all who are incarcerated. And for everyone on the outside advocating for family members in prisons, too.

That was the ruling. It's unfortunate there's not a clear legislative mandate that would federally regulate and assure equality of care. However, you might refer to the link I listed for Angela for further fact.

Our condition is considered elective by most people who do not wish to understand the condition. Until that is changed, we will always be told we do not have a right to treatment or some bean counter trying to deny paying the bill for it. It is much like the same example used by insurance companies to deny the cost of hormones and surgeries, or those who are on assistance getting hormones if it is associated with GID. Many doctors call it a hormonal imbalance to get around this but it still is often denied under GID. It will be interesting to see what excuse they will start using now they cannot deny for being pre-existing, ineffective, or whatever.

Excellent insight. I agree. In fact, I drafted a follow-up which addresses the issue to which you speak. I'll post to Bilerico later Sunday.

I wish there was enough trans activists in Wisconsin to get someone to put together a bill to outlaw all medical treatments in prison until everyone is treated equally. It'd go nowhere in the legislature, but it'd make a for a great press gimmick.

Leave it to your brilliant mind Bil! That's 180 degrees from what I'd advocate, but your point is stunningly, loudly, crystal clear. Equality. I'm posting a followup later today.

I doubt that this decision will survive an appeal. Even if it does, the WI legislature can easily tweak the language to allow for doctors to make the final call, but to narrowly restrict the use of hormones.

Also, the decision does not support the silly comparison of hormone therapy to cancer treatment or insulin injections. No one should be fooled by this favored trans activist canard. When the day comes that you can walk into an emergency room and demand hormone treatment, let me know.

If being incarcerated poses difficulties in getting hormones, the best solution is not to commit crimes and get incarcerated.

I look forward to a follow-up post on Bilerico about the victims of the trans convict plaintiff in the case. Maybe one of those highly empathetic trans writers Bilerico will care if those people are getting medical care.

If being incarcerated poses difficulties in getting hormones, the best solution is not to commit crimes and get incarcerated.

You do realize that there's no end to that argument? The exact same justification could be used for beheading everyone who commits a crime, including jaywalkers. And I know you'll respond: don't be ridiculous, blah blah blah.

But that's exactly the point; you see "ridiculous" in beheading jaywalkers (if they want their heads to stay attached to their bodies, the best solution is not to commit crimes. Seriously, it's not like anyone is forced to jaywalk), I see "ridiculous" in the state intervening in someone's body chemistry in a way that alters their appearance, the way they feel, and can lead do suicide. Personally, I see that as a clear example of cruelty, but for you it's perfectly reasonable.

I don't know how to argue those point - it seems some people have a larger tolerance for cruelty (when inflicted upon others, of course) than others, and it's more related to upbringing, experience, and ability to empathize with others than it is to logic and reason. All I can say is that we have a criminal justice system, not a criminal revenge system, and, no, there are punishments that are not OK, no matter whether people know about them ahead of time or not, no matter whether people committed a crime or not.

Just as a note, about 5 months ago, i walked into an Emergency room, waited about 13 hours, and then asked for hormones.

I got them, too.

Seems that the medical concern is too keep you on them once you start, as stopping is physically detrimental to one's health.

You asked.

Regan DuCasse | April 4, 2010 3:43 PM

Will someone please enlighten me? And this might be a stupid question, but how is this therapy NOT elective?

I'm post menopausal, I had a hysterectomy at the fairly youngish age of 41 and HRT was an OPTIONAL therapy. After a few short months, I stopped taking it.
Even say, for emotional balance, it would depend on how extreme the stressors would be.

Sometimes this hormone has been attributed to some cancers, like breast cancer (which men can get too).

The 'R' is for replacement, meaning MAINTAINING levels of hormones your body no longer produces, but previously did.
Still, gender isn't a life or death situation or condition.
And because of the stigma on the gender variant, in so many ways, this issue does create some contradictions in terms and purposes.

I find it an interesting kind of dichotomy, that a chemical used as a punishment (chemical castration) against who was defined as a 'sexual deviant'. Hence the drug was advocated AGAINST as something that no longer should be a part of criminal penalty, is now advocated for as a therapeutic remedy (as it was for the initial purpose for incarcerated men in the first place.)
So if I'm guessing correctly, then keeping HRT FROM a man undergoing the process of being a woman WANTS to be a woman, so therefore withholding this therapy would be considered stressful for them?
As opposed to the OPPOSITE mental/emotional aspect of chemically castrating a man who DOESN'T want it?
Which STILL isn't a life/death medically NECESSARY type of situation because of a PHYSICAL issue, but more of a MENTAL/EMOTIONAL one?

Just today, the LATimes had a article that pointed out an old law that said that the state was REQUIRED to cure homosexuals, pretty much by any means necessary and medically approved of at the time.

Bear with me now.

But here's the nit grit of what I'm trying to understand. In the sense of incarceration and criminals with certain needs, this issue almost smacks of this specific population being exceptionally fragile and qualified for a therapy that essentially advocates are saying is SO important that...
That what? What WOULD be the results if they are off this therapy for anywhere from several months to several years?
Raging, violent, impossible to control inmates, or tranquil, rational ones?

It seems to lend fuel to an already rigid stereotype that the gender variant aren't able to function BUT for the intervention of hormones.
And considering that there are several of us women on this blog mature enough to know and have personal experience with HRT, it's not helping US and the image of women without estrogen (or too much of it) are like.

I'm with Bil. But the thing is NO medical conditions are equal. Some ARE life or death, some are not. Some are temporary, some are permanent.

But to be frank with you all, what does it say about priorities when demanding equal quality medical care for criminals, to be paid for by law abiding people who can't really afford it for themselves?
One doesn't have to have anything against the trans community to resent that reality.
Not only that, but HRT as opposed to insulin, AREN'T an equal medical condition, requiring equal sets of concerns and urgency.

Renee Thomas | April 4, 2010 7:52 PM


With respect to your comments and questions, have you ever personally experienced gender dysphoria? Have you experienced first hand the effects of the cessation of medication prescribed to address severe cases of clinically diagnosed gender dysphoria? Are you aware of the texts of recently published recommendations by the AMA and APA as to the efficacy and appropriateness of medical interventions (which include HRT) for transgender individuals?

When deemed medically necessary (as the approved and accepted treatment models do), what motivation would you have in denying HRT to transgender inmates but to inflict additional discomfort and distress. Might a case be made that if prision officials pursued such a course of action would it not rightly constitute legally actionable "cruel and unusual punishment"? I would offer that the answer is an unambiguous yes when compared to the fact that medications to address cardiac and diabetic conditions are routinely prescribed to incarcerated inmates throughout the federal prison system. The issue is not will they die if HRT is denied them. If that were the logic you prefer, then I would offer that water-boarding is not likely to cause death either but it is undeniably torture.

Alternatively, to put the question more directly - who are you to decide?

You ask: "When deemed medically necessary (as the approved and accepted treatment models do), what motivation would you have in denying HRT to transgender inmates but to inflict additional discomfort and distress."

- Well the whole issue is whether it is medically necessary. Prisons are not a solution to all of one's medical needs. You are only entitled to basic care, not all care that would be medically beneficial.

There are many procedures that are medically justifiable, but which not medically necessary. TS's go years and decades before they get hormone therapy. It doesn't result in death or injury, just frustration. No trans person can walk into a hospital emergency room and demand hormone treatments.

If a trans prisoner is frustrated over losing access to hormones, that is a consequence of incarceration. Not the taxpayers' problem. Not a gay problem. And it certainly shouldn't be Lambda Legal's problem. How ridiculous that limited gay resources are being wasted on this issue.

Yet another LGB person that doesn't even want to try and understand the 'T' folk.

I don't think that reassignment surgery should be an option while incarcerated but hormone therapy should most definitely continue. The hormones are relatively cheap and the number of incarcerated transpersons cannot be of a very significant number. Depending on how long the person has been on hormones, there can be adverse side effects.

From Lambda Legal's website:
"Lambda Legal is a national organization committed to achieving full recognition of the civil rights of lesbians, gay men, bisexuals, *transgender* people and those with HIV through impact litigation, education and public policy work."

Sorry that us poor trans folk are pilfering your resources.

"The hormones are relatively cheap and the number of incarcerated transpersons cannot be of a very significant number."

Great. So you pay for it, since it is so cheap. Maybe you and your fellow trans activists can hold a garage sale. Most hardworking people don't want their taxes used to pay for hormones for criminals.

Regan DuCasse | April 5, 2010 3:30 PM

Hi Renee,
No, I haven't experienced gender dysphoria. But as I just stated, I HAVE been on HRT.

Which was subsequent to a HYSTERECTOMY. So I know what cessation of hormones feels like, I know what expectations there are to adjusting to such changes in levels with or without artificial intervention.
And it's NOT a life or death situation, but more of a matter of emotional balance (whatever THAT means and would be extremely difficult to define for the purposes of the incarcerated.)
And even then, as I asked, is this emotional difference similar to those who are bi polar, as in the case of lithium?
Where it's the difference between functioning, or becoming someone with a serious behavioral problem the prison staff would consider irrational?
Does gender dysphoria render a person irrational and emotionally dangerous?

I think not.
Because I know what hormonal changes can do, whether is male OR female in older men and women.

Which, isn't a LIFE THREATENING situation and considering the LIMITS of what a prison can do for an inmate, it's understandable that HRT is low on the list of priorities.
Consider this:
HRT isn't even an option for post menopausal females in prison. It's not THAT vital, and there is a good reason why.

Prisons still segregate according to gender which is a REQUIREMENT. And using an artificial means to change the gender of the inmate, wouldn't be so cost effective either in requiring setting up separate facilities for those with GID or transitioning.
Prison isn't the place to expect accommodation for this particular medical issue.
They don't exist to make things easy for the incarcerated, but for the prison and the non criminal population on the outside.

I think the emotional aesthetic (if not physical) here, really isn't on a level of concern for the aforementioned reasons that other disorders are.
Even my own HRT went to the bottom of the pile of priorities in maintaining my health.
Because nothing extreme really happens whether you're taking it or not to warrant that concern.

And in a prison population, funded by other people, even less so.

CatherineCC | April 5, 2010 5:29 PM

Does gender dysphoria render a person irrational and emotionally dangerous?

Uhh... yeah, it does. Check the suicide / depression / substance abuse rates. Half of us attempt suicide by 20 years of age? Nobody knows how many of us kill ourselves before we come out to anyone.

I went off for a few days about 6 months ago and found myself right back in that horrible place of
"before", depressed, suicidal, ugly.

If I was facing a long sentence without hormones, I'd climb that fence and let them shoot me off it.
I mean, if you're cool with that, at least you're honest, and aren't like these "allies" we have that backstab us when we need their support the most. Just know what you're advocating for and have the guts to stand up and say it instead of being all wishywashy about it.

HRT for transpeople isn't the same as HRT for postmenopausal women.

Regan DuCasse | April 5, 2010 3:50 PM

" inflict additional discomfort and distress."
Hmm...well, THAT is hardly an objective understanding of why there is a separate way to treat criminals from the law abiding.

One could argue that putting someone in handcuffs inflicts distress, being locked up does. Or having limited options on prison food and entertainment would be torture.
Or being in an overcrowded lock up and having to share a shower would with intimidating brutes.

Are you kidding me?

Yeah, in a way there IS a good reason to inflict SOMETHING on the incarcerated. Withholding hormonal intervention would be feel like torture to someone used to having it, FREELY.

It's PRISON. The point is DEPRIVATION of the comforts you're used to having. The point is understanding you're there to pay a debt, and there's a requirement and responsibility to it.
And with it, comes the price of not having what you want, or even THINK you need sometimes.

To some, the thought of prison itself is torture, which is what keeps most people on the right side of the law.

So Alex, yeah...what some people think is torture, isn't tangible or urgent enough to warrant the expense or concern demanded by some prison population advocates.

CatherineCC | April 5, 2010 6:27 PM

Do we bring back lashes and corporeal punishment too? Not the ones for infractions, just "because they're in prison"
Or do we only do this for certain groups? Say, the blacks, because, you know they're violent and primitive people. Or the irish?

Abuse by guards, etc was routine in the early part of last century and we, for the most part, have stopped it because it wasn't helpful in any way and because people in power tended to go all stupid and standford prison experment-ish. We have a lot fewer prison riots now (and a lot more people in prison)

But I'm just a libtard who feels that prisons are at least partially there for rehabilitation.

Regan DuCasse | April 5, 2010 3:55 PM

I was just wondering, perhaps this lack concern for providing HRT has no results required for there to BE concern?

Perhaps they'd need to see some statistical data on that and it couldn't be provided enough to warrant what's demanded.
Just another thought.

CatherineCC | April 5, 2010 6:52 PM

And before someone else uses the financial argument....

Kallas, a psychiatrist and mental health director for Wisconsin's prisons, testified he opposed the law banning hormones.

Kallas said patients who are taken off hormones typically need counseling, drugs and hospital stays instead, treatments that are more expensive than the hormones, which cost $675 to $1,600 a year. Kallas said he did not know of any other medical treatment that the state Legislature has banned in prisons.

That won't change anyone's mind though...

Regan DuCasse | April 5, 2010 6:57 PM

I appreciate your experience, Catherine. So it can be argued that the HRT is on a par with lithium, or psychotropics?

I don't have much sympathy for the incarcerated. I just don't.
I know there are ALL KINDS of minorities more at risk of being abused or going to prison (but that's even MORE incentive then, to get it together to avoid it).
But this has nothing to do with needing HRT, but accommodating the incarcerated and standards of care that are available and affordable.

I'm not going to argue with you about the vital nature of HRT for the reasons you described. I'm with you there and apparently have a lot to learn about it.

So the point still stands: being in prison puts one at risk of not having the same freedoms and luxury of access as the outside does, like rehab and education and vocational skills.
It's getting tougher and tougher to get those things for the LAW ABIDING, let alone the incarcerated.

And unfortunately, that reality will put all kinds of other people at risk of not having their needs met when they commit a crime.

I'm a crime scene photographer. I live in Los Angeles and I know the sorts of crimes that get someone transitioning in jail on an average. I encounter all kinds of young people on the street and what they are doing to survive, regardless of their backgrounds and how they got there.
I'm also the daughter of a juvenile probation officer and social worker respectively.

And I've had to be around prisons, inmates and VICTIMS of crime and so on because of my job.

Jails and prisons are expensive to maintain, and the comforts of inmates a VERY low priority.
Depression and so on is true of millions of them, for myriad reasons that aren't about hormone therapy, but the bars themselves. The lack of privacy and utter control over their lives.

Yeah, for MOST people THAT feels like torture, but it's an inevitable (and necessary) aspect of what being a criminal is bound to entail.
And sedatives for everyone isn't and option either.

Regan DuCasse | April 5, 2010 7:00 PM

I think the next question would be, what about segregation and how would the facility accommodate THAT effectively?