Immigration and LGBT advocacy groups continue to criticize Immigration and Customs Enforcement (ICE) which they say are failing to care for transgendered inmates, from providing them with medical assistance to protecting them from sexual assault. According to activist leaders, Latina and Latino transgendered people face a compound burden.

“On top of being incarcerated, [they suffer] the stigma of being transgendered and people of color,” said Raffi Freedman-Gurspan, a Policy Advisor at the National Center for Transgender Equality (NCTE). Because of the “underlying structural problems” that transgendered inmates face, the NCTE is calling for a halt of detentions for LGBT people awaiting immigration-related hearings.

“[LGBT detention] is never ideal, especially women incarcerated in all male facilities. [They face a disproportionate risk] for sexual assault. We don’t feel that ICE has the cultural competency to even reduce rates of assault [for this] vulnerable population”

ICE agrees that GBT detainees are a vulnerable population that merit special protections (apparently the L--lesbian--doesn’t make their list). Since 2011, ICE has been housing many GBT in a special unit in the Santa Ana Jail, in Orange County, California. At Santa Ana, GBT inmates are separated from the general population, which in theory should reduce rates of assault (though there are not any statistics to back this up). The facilities also provide population-specific medical benefits, such as free hormone therapy for transgender inmates who were on such treatments when detained.

“The establishment of the unit for GBT detainees is part of ICE’s ongoing effort to reform its civil detention system nationwide [beginning in 2009],” said ICE in a statement to the Latin Times. “Other measures include reducing detainee transfers, improving access to counsel and visitation, promoting recreation, ensuring quality medical and mental health care and carefully circumscribing the proper use of segregation.”

Advocates Call For No Detentions Of Trans People

For advocates at NCTE, a transfer would actually make things worse. Though ICE and the NCTE agree that transgendered inmates are a vulnerable population, they disagree on what protections the should have.

[Segregation] is not really a solution; it makes [transgendered] folks more vulnerable,” said Freedman-Gurspan, the Policy Advisor. “They shouldn’t be detained to begin with. Their cases should be heard, but [they don’t need to be jailed.” For inmates deemed a flight risk, he suggests that those inmates be strapped with ankle bracelets or subjected to community supervision.

Even if Santa Ana’s policies are effective, not every GTB detainee manages to get transferred there. In a recent case, transgendered Guatemalan asylum-seeker Nicoll Hernández-Polanco was unable to get a transfer out of an all-male facility. Her lawyers are trying to get her out of the facility, where she has allegedly suffered abuse from guards. They propose that she be released, not just sent to Santa Ana.

“The only thing that [ICE has] mentioned is that they consider her a flight risk because of the prior deportation,” Hernández-Polanco's attorney, Heather Hamel, told HuffPost. “But we’ve even offered that she be released subject to ankle monitoring or subject to court-ordered supervision. Those requests were denied. At this point, why she remains in detention is anyone’s guess.” ICE didn’t comment on Hernández-Polanco’s specific case, but told the Latin Times that sexual orientation is not the only criteria that determines who can or can’t get transferred to Santa Ana.

When Transgendered People Lack Access To Hormone Treatments

For decades medical science has recognized that people can be born with the “wrong” sex. That is, they’ve got one set of genitals and other characteristics but feel like their bodies set; that they’re a different gender than the one that corresponds with their psychological makeup. Experts call this “gender dysphoria,” and it’s a real and treatable disorder.

"Gender dysphoria is often accompanied by clinically significant depression, and sometimes suicidal thinking or behavior," said George R. Brown, MD and Professor of Psychiatry East Tennessee State University, in an email to the Latin Times. According to Dr. Brown's research on incarcerated trans women, undertreated inmates suffering from gender dysphoria are more likely to "experience negative medical and mental health outcomes."

Outside Santa Ana, one major concern for transgendered detainees is loss of medical care, specifically hormone treatment. When patients stop treatment, which often involves taking specific hormones multiple times per week, they regress to their original gender traits. This is not just a superficial change in their presentation, but has profound implications for their physical and psychological well-being.

“Abrupt cessation of cross sex hormones (estrogens in birth sex males, for example) can result in significant emotional and physical changes that can begin as soon as a few days after cessation,” said Brown. “Trans women in prisons where cross sex hormones are sometimes abruptly discontinued have reported to me that they experience emotional [flux] within days.

“Some inmates I have evaluated have engaged in ‘surgical self treatment’ by autocastration to get relief from gender dysphoria symptoms that worsen with an increase in testosterone levels in the absence of estrogens and testosterone blocking agents. Beard growth resumes, causing even more gender dysphoric feelings and if there was breast development prior to discontinuation, the breasts begin to decrease in size over the weeks after stopping estrogens.”

Brown’s medical opinion is endorsed by broad support in the scientific community, as well as by the courts. Last month, this was tested by the case of Michelle Kosilek, a non-immigrant transgendered woman with a life sentence for murder, who argued that the Massachusetts Department of Corrections should pay for her gender reassignment surgery to treat her gender dysphoria.

When she won the case, NCTE Executive Director Mara Keisling said that “[the decision] affirms the increasing consensus among the courts that transgender-related healthcare is just health care and that people behind bars, including transgender people, have a constitutional right to health care."

As ICE slowly evolves it’s “cultural competency,” those rights may be ensured more often.

UPDATE 2/15/2015: this article was amended to more accurately reflect Brown's conclusions an the outcoms of undertreated patients who suffer from gender dysphoria.