On Friday, the 7th Circuit Court of Appeals upheld a decision striking down a Wisconsin law that banned transgender inmates from accessing necessary medical care while in prison.

Wisconsin is the only state with a law expressly banning medical care for trans inmates. However, according to Injustice at Every Turn, the national trans discrimination survey, 12% of trans inmates in the US have been denied routine health care and 17% have been denied hormones. Dr. Jill Weiss runs through some other cases over at The Bilerico Project.

The 7th Circuit rightly called cutting off an inmate’s hormone treatment “cruel and unusual punishment,” recognizing the severe side effects, including mental health side effects and “muscle wasting, high blood pressure, and neurological complications.” All three plaintiffs in the case, Andrea Fields, Jessica Davison, and Vankemah Moaton, experienced some of these effects. The state tried to argue that alternative therapies were available, but the court pointed out both that this was not true and that it was just plain cruel:

Surely, had the Wisconsin legislature passed a law that DOC [Department of Correction] inmates with cancer must be treated only with therapy and pain killers, this court would have no trouble concluding that the law was unconstitutional. Refusing to provide effective treatment for a serious medical condition serves no valid penological purpose and amounts to torture.

The appeals court decision is notable, as Think Progress points out, for being based in medical science instead of stereotypes and assumptions about trans folks. I know, progress! The court rebutted an old decision that called hormone therapy and sexual reassignment surgery “esoteric” treatments that are “protracted and expensive.” The court responded with facts:

[T]he 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. Sex reassignment surgery is significantly more expensive, costing approximately $20,000. However, other significant surgeries may be more expensive. In 2005, DOC paid $37,244 for one coronary bypass surgery and $32,897 for one kidney transplant surgery. 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.

The 7th Circuit also dismissed the disingenuous claim that the law was meant to protect trans prisoners, since inmates on hormones are more prone to harassment. The court again pointed out that this is not true, and trans inmates face increased harassment across the board. Hmm, maybe we should do something about the mass incarceration of trans folks and how dangerous prisons are for them, including addressing the fact that trans inmates are usually housed with folks of the wrong gender, instead of “protecting” them by refusing medical care.

It’s worth noting the 7th Circuit decision relies heavily on on the Gender Identity Disorder (GID) diagnosis in the DSM-IV. The DSM, which classifies mental health disorders, is currently being revised and the state of GID has been in flux throughout the process. This case is an important reminder of the links between different institutions that determine trans people’s access to medical care.