When a transgender woman named Sarah went to prison, the Texas Department of Criminal Justice did not allow her to bring her hormone treatments with her because she didn't have a prescription.

For transgender men and women who rely on hormone therapy for both their mental and their physical health, this deprivation can have some serious consequences. In Sarah's case, prison officials had to put her on Reglan for nausea and vomiting. They had to put her on suicide watch in a solitary cell, where the fluorescent lights stayed on 24 hours a day, after she tried to hang herself. A few years later, she tried to self-castrate with a key. Only then would TDCJ finally agree to give Sarah the hormone therapy she had been requesting for five years.

Her story is exactly why Nell Gaither, president of Trans Pride Initiative, was glad to see TDCJ amend its policies last year to finally allow transgender inmates to receive hormone therapy even if a free-world doctor had not prescribed it before they were shipped off.

Now, if inmates alert their supervisors that they’re transgender and need hormones, TDCJ will send them to see an actual specialist on gender dysphoria. TDCJ spokesman Jason Clark said that, since the policy has taken effect, ten inmates have started receiving hormone therapy.

Before TDCJ updated its policy last year, Gaither said, she had been hearing from a handful of transgender inmates who were sent to a psych ward; prison officials too often viewed being transgender as a mental illness, she said. The doctor Sarah saw just gave her some Zoloft. Gaither heard from another transgender woman who didn’t even stay long enough to see the doctor because she could no longer handle being in the psychiatric unit.

But while the policy change is good, Gaither says there's still much that needs to be done to ensure transgender inmates receive adequate care in prison. She has been corresponding with Sarah and a handful of other transgender inmates for years and hearing about sometimes harrowing barriers transgender people have faced when seeking protection or health care. With this new policy alone, she's still concerned about various “hoops and barricades” that the new process involves. Even Clark made obtaining hormone therapy sound particularly onerous. According to Clark:



“The current Correctional Managed Health Care policy, among the most conservative in the nation, ensures that 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. Only then would it be considered medically necessary and require the minimum level of treatment which is hormone therapy.”



Gaither has been corresponding with one transgender woman who was sent to see a specialist in Galveston and felt like the visit was going smoothly — until she mentioned she was bisexual. “That’s when the doctor took a step back,” Gaither said. She said that some doctors still abide by old-school principles according to which, to be transgender, you have to be heteronormative, meaning the trangender woman (in the doctor's mind, at least) should be attracted only to men. “He started asking her strange questions, like whether she’s ever had sex with her kids,” Gaither said, referencing a letter she received from the woman in prison. “He declined to give her hormones.” Gaither questioned whether a woman who had entered menopause and needed hormones for her health would have encountered the same difficulty.

Providing transgender people adequate medical care and simple protections against harassment has been a mounting struggle over the years in prisons across the country. Last spring, we told the horrific story of a transgender woman named Passion Star who, despite repeated complaints that she had been raped, beaten and harassed by fellow inmates, was not placed in safekeeping — designated areas for particularly vulnerable or young inmates — for more than a decade. It wasn't until five months after she filed a lawsuit that prison officials finally listened to her complaints.

“There is a culture of condoning and not taking seriously sexual assault and harassment [among transgender inmates],” said Demoya Gordon, an attorney representing Star who's on the staff of the organization Lambda Legal, which fights for transgender rights. “They get these complaints and say it ‘wasn’t substantiated.’ We would like to see a systemic change across the board.”

Gordon also said she wasn't yet convinced that the policy change regarding hormone therapy, while good in theory, would be effective in practice. She heard from one inmate who felt his unit supervisor would take requests for hormone therapy seriously only if inmates were suffering to the point that they might harm themselves. “This still remains a fairly restrictive policy, and I think intentionally so,” she said. “In writing but also in practice, it still erects unnecessary barriers to hormone treatment for transgender people.”

If TDCJ wanted to make some real progress, Gordon said, it could also stop denying transgender people genital reconstruction surgery, something it has refused to do regardless of whatever medical treatment a transgender inmate was receiving before entering the prison. Clark with TDCJ said the policy was only updated to reflect the community standard of care. Gordon, however, argues that for some transgender people, surgery is the only standard of care that makes sense.

Both Gordon and Gaither said that conservative lawmakers are an obvious barrier to further reform in Texas. Both pointed to Clark's description of the policy as "among the most conservative in the nation" as evidence that TDCJ, fearing backlash, wanted conservatives to rest assured that, don't worry, Texas isn't being that generous to transgender inmates.

Gaither said she is in touch with three inmates preparing lawsuits against TDCJ in order to receive surgery — including Sarah.

