The refusal of the state to provide medically necessary care — including hormone therapy, permanent hair removal and access to “gender affirming” care products — was arbitrary and unconstitutional under the Eighth Amendment, which bars cruel and unusual punishment, Hicklin’s attorneys argued.

Hicklin was diagnosed in 2015 with gender dysphoria, according to the lawsuit. The medical term, listed in the American Psychiatric Association’s diagnoses manual, refers to the distress a person feels because of a conflict and disconnect between their gender at birth and the gender with which they identify.

In May 2018, Collins issued a permanent injunction ordering the Department of Corrections to provide care deemed “medically necessary” by Hicklin’s doctors as long as she was in state custody.

The order also enjoined the state from enforcing its “freeze frame” policy.

Karen Pojmann, spokeswoman for the Department of Corrections, said nine inmates were currently undergoing hormone replacement therapy.

She did not say how many inmates had started the therapy in prison after the court’s ruling.

“We contract with Corizon Health to provide all medical services for offenders,” Pojmann said in an email. “Hormone replacement therapy doesn’t entail an additional cost; it’s part of our overall offender health care budget.”

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