Denying transgender prisoners transition-related health care violates their Eighth Amendment rights, according to a final ruling from a federal judge in Missouri, in an important win for transgender people in the prison system.

Back in January, U.S. Magistrate Judge Noelle Collins issued a preliminary injunction requiring the Missouri Department of Corrections (MDOC) to begin providing transition-related care and accommodations to inmate Jessica Hicklin. Three years prior, Hicklin had been diagnosed with gender dysphoria and prescribed hormone replacement therapy, but had never actually received any treatment or feminine canteen items in the time since.

That’s because MDOC had instituted a “freeze-frame” policy for transgender inmates: If an individual was already receiving hormone therapy when they entered the MDOC system, they were allowed to continue receiving that treatment, but if they weren’t already receiving treatment, they were not allowed to begin it.

For Hicklin, that denial of care led to “serious psychological and physical symptoms (including panic attacks, anxiety, racing heartbeat, shortness of breath, sleep disturbance, lack of appetite, headaches, and excessive sweating) and put her at substantial risk of self-harm, including auto-castration and suicidal thoughts or acts.”


In Tuesday’s order, Collins made clear that such an approach is a clear violation of the Eighth Amendment, which protects against cruel and unusual punishment:

The Court finds that Plaintiff has presented evidence to show that the freeze-frame policy at issue fails by its very nature to account for the individual medical needs of transgender prisoners who suffer from gender dysphoria, and therefore violates the Eighth Amendment both on its face and as applied to Ms. Hicklin.

As a result, MDOC is permanently blocked from enforcing its freeze-frame policy.

The legal landscape for transgender people in prison is varied. Earlier this month, the Trump administration announced it was rolling back federal protections for transgender inmates, and other courts have disagreed about what kind of care transgender inmates deserve.

Lambda Legal, which represented Hicklin, praised the decision. According to Transgender Rights Project attorney Demoya Gordon, “The court’s decision to strike down this policy will save Ms. Hicklin from pain and anguish and spare so many others from the same abuse. To keep life-saving treatment from transgender people suffering needlessly in prison simply because they were not receiving that treatment before they entered the facility is cruel and unlawful.”


Hicklin said it felt like she had been drowning, but the rulings allowing her to receive the care she deserves helped her feel like she “could finally breathe.”