Margie Fishman

The News Journal

Lakisha Lavette Short last year became Delaware’s first transgender inmate granted right to change his name.

Taxpayers are footing the bill for his weekly testosterone injections at an estimated cost of $1,320 a year.

Short is one of two Delaware inmates to receive hormone therapy in prison as directed by his doctor.

Getting locked up, Kai Short explains, actually set him free.

A former drug dealer with soulful eyes and sparse stubble, Short is serving a 55-year prison sentence for robbery and weapons charges. He characterizes his time spent behind bars as "one of the best experiences in my life."

"This place kinda saved me," adds the 35-year-old transgender inmate, a history maker twice over.

Last year, Short — born Lakisha Lavette Short and assigned to Baylor Women's Correctional Institution near New Castle — became Delaware’s first transgender inmate granted the right to change his name. Then, last month, he became the state's first transgender inmate to begin hormone therapy in prison. He has not undergone gender reassignment surgery. Taxpayers are footing the bill for his weekly testosterone injections at an estimated cost of $1,320 a year for the remainder of his sentence.

(This article identifies Short as male based on his gender identity).

Short, of Ellendale, is one of two Delaware inmates to receive hormone therapy in prison as directed by his doctor, according to the state Department of Correction. The other inmate, whom state officials declined to identify, is believed to have started treatment before getting incarcerated, said department spokeswoman Chelsea Hicks.

The state's decision to offer trans-related health care to prisoners was influenced by a series of national lawsuits in which inmates successfully argued they were entitled to medical treatment of diagnosed gender identity conditions. "Gender dysphoria," or gender identity disorder, is a term recognized by doctors and psychologists to describe people who experience significant distress because they feel their bodies don't reflect their true gender.

Last year, the U.S. Department of Justice sided with a Georgia inmate who was refused hormone therapy. The federal department cited protections outlined in the Eighth Amendment, which prohibits the government from imposing cruel and unusual punishment.

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Prisons have faced public backlash for offering taxpayer-backed hormone treatments to transgender prisoners, especially for those who waited until after they were locked up to seek medical advice.

"Taxpayer money shouldn't be used to find elective procedures for those who broke the law and are serving time, regardless of what those elective procedures are," said Nicole Theis, president of the Delaware Family Policy Council, a group that advocates "for principles of life, marriage, family, religious liberty, and biblical stewardship of government."

Prisoners "have the opportunity to go through these procedures after they serve their time at their own expense if they so choose," Theis added.

Theis questioned how the state could sufficiently protect other inmates' privacy rights and prevent male prisoners from claiming gender identity confusion to access female prisons. She also expressed concern that taxpayers would be forced to fund subsequent "de-transition" procedures. Her organization was the leading group to oppose a 2013 state law that gave transgender Delawareans equal rights and prohibited discrimination against a person on the basis of gender identity.

Delaware's prisoners are still housed according to their biological sex and none has petitioned for sex reassignment surgery, according to prison officials. Nationally, about one-third of transgender individuals undergo sex reassignment surgery at an average cost of $20,000.

Of the state's roughly 6,000 incarcerated adults, fewer than six at any given time have reported to the Department of Correction that they are transgender.

In a recent interview, Short said he is more focused on getting his sentence commuted after serving a dozen years than he is on sex reassignment surgery or being housed with men. He also worried about the side effects of his hormone treatments, such as aggression.

A 200 mg/ml testosterone solution injection costs the state $55, Hicks said. She declined to release Short's specific dose, citing medical privacy. The standard adult dosage in men is 200 mg/ml every two weeks, according to medical research.

At Philadelphia's Mazzoni Center Family & Community Medicine, which serves LGBT clientele, clinical operations manager Dane Menkin warns patients transitioning from women to men about an elevated sex drive and appetite, along with increased risks of high blood pressure and cardiovascular disease. Men transitioning to women by taking estrogen are at higher risk of blood clots, he said.

Hormone treatments are a lifetime commitment and injections are the most efficient, cost-effective treatment, Menkin said. Short will begin to notice changes, such as increased facial and body hair and a cracking voice within three months. It will take three to five years for full "masculinization," he said.

"The people that I meet who want to medically transition are desperate to do so," said Menkin, a nurse practitioner. "It's an 'I'll do anything' mentality.'"

Hormone therapy, like medication used to treat high blood pressure or diabetes, is not an "elective" treatment, said Lisa Goodman, founding president of Equality Delaware, a lesbian, gay, bisexual and transgender advocacy organization.

"Just because someone has violated the laws of the state and the state has deprived them of their liberty, that does not mean they should be deprived of medically necessary care," she said.

Goodman lauded Delaware's march toward providing full transgender rights under Gov. Jack Markell's administration. The First State is home to an estimated 2,800 transgender people, based on national population statistics.

Last summer, Markell signed legislation allowing prison inmates to seek a name change based on their gender identity, making Delaware the first state in the nation with such a law, according to the American Civil Liberties Union. The law followed a two-year legal fight initiated by Short. Previously, inmates were permitted to change their names based only on religious beliefs.

Then in March, Delaware became the 15th state to ban insurance companies from limiting or excluding health care coverage for transgender individuals. Previously, private policies could exclude coverage for trans-related health care such as facial surgery, hair replacement and genitalia reassignment.

Similarly, Medicare has lifted its ban on coverage for sex reassignment surgery. Medicaid covers medically necessary trans-related health care on a case-by-case basis, according to a Delaware Department of Health and Social Services spokeswoman.

In an email Thursday, Markell said it was important to position Delaware as a safe and welcoming place to live, visit and do business.

"Those in our transgender community are people first and they're worthy of dignity and respect," he wrote. "That's why it's so important that Delaware be among the states leading the effort to affirm that 'We the People' means all of us, regardless of where we were born, who we love, or the gender with which we identify."

Obstacles remain

Last year ushered in several milestones for transgender inmates. Among them, California became the first state to provide sex reassignment surgery for inmates, Rikers Island in New York began operating a separate housing unit for transgender women, and federal immigration officials released new guidelines allowing transgender detainees to be housed according to their gender identity.

Transgender advocates say it's more common for transgender prisoners to be housed according to their biological sex, as is the situation in Delaware, which puts them at risk for violence. Forty percent of transgender people in state and federal prisons reported being victimized sexually in a 2014 report by the Bureau of Prisons. That same year, 44 percent of transgender inmates reported being denied hormones.

Outside prison walls, states are cracking down on transgender protections. South Carolina is considering a bill to ban transgender people from using public bathrooms, showers or changing rooms of their choice. Sen. Lee Bright, R-Spartanburg, who sponsored the bill, said his proposal mimics a law passed in March in North Carolina.

Earlier this month, school districts, including in Delaware, were put on alert by the Department of Justice and Department of Education that federal law requires them to treat transgender students without bias, permitting them to use locker rooms and bathrooms based on their gender identity.

Charles Smith, serving a life sentence at the all-male James T. Vaughn Correctional Center in Smyrna, said her self-esteem isn't tied to what bathroom she uses, the color of the uniform she wears or where she is housed.

Like Short, the 38-year-old transgender inmate has petitioned for a name change. One day soon, Charlese Anne Smith will grace her badge, replacing the Charles decorated with a flower sticker.

But Smith is hesitant to ask for hormone therapy.

"I don't think this institution is ready for that," she said, explaining that she would pose a threat to the convicted sex offenders on-site.

For now, Smith wraps her wavy, waist-length hair in a mini bouffant— she demonstrates using a handmade scrunchie — and lines her eyelids with an electric purple watercolor pencil. Her hairspray is nothing more than sugar water.

Growing up in Browntown, Smith was never satisfied with Batman & Robin Underoos. She yearned for Wonder Woman.

"I've been a woman trapped inside of this body since birth," she said.

As a child, Smith watched her father die in a car accident and she was sexually assaulted. She began using heroin at age 13. After getting caught for multiple burglaries, she was sentenced under the three-strikes law tolife in prison at age 23.

The last time she was arrested, she ran from the cops for 17 blocks wearing stiletto boots and silicone breast inserts.

In prison, Smith's fellow inmates call her Brittany but don't violate her space. "I was born in a rough neighborhood," she explained. "The would be a fool to try me."

Deprived of perfume and hair accessories, she shaves her 6-foot-tall frame top to bottom to feel more like a woman. An aspiring cosmetologist, she keeps her almond-shaped nails immaculate and eyebrows expertly plucked.

She is aware of only one other transgender inmate at the facility, who uses the same beauty tricks and also got her name changed.

"We're unicorns," Smith said.

Short was not as comfortable in his own skin when he first set foot in Baylor at age 17. Had he been diagnosed with gender dysphoria earlier, he said, perhaps he wouldn't have ended up here. Like Smith, he has become active in educational workshops and anti-violence programs while in prison.

A poet who hopes to self-publish a book on gender identity issues, Short spoke before the vice president's wife, Jill Biden, and daughter Ashley Biden at a TEDxWilmington event last summer at Baylor.

"A new day comes but old things remain, remain a constant reminder that we are not perfect," he told the audience.

"Although it's still too early to see any improvements, I already feel like a new man," he wrote in a recent letter to a friend that was provided to The News Journal.

"Someone once said, 'A person often meets his destiny on the road he took to avoid it," he said. "My story does not end here."

Contact Margie Fishman at (302) 324-2882, on Twitter @MargieTrende or mfishman@delawareonline.com.

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How hormone therapy works

Once a standard treatment for women with menopause and men with low testosterone, hormone therapy has become an efficient and affordable treatment for transgender individuals. Injectable, topical and oral medications are all available.

Topical testosterone, for instance, is believed to provide a steadier level of hormone than through intramuscular injections. For men transitioning to women, estrogen doses are recommended several times higher than those used for contraception or post-menopausal treatment.

Patients must be regularly monitored by a doctor and are warned about possible side effects, including high sex drive, acne and emotional volatility.

Once hormone therapy is initiated, it must be continued for the patient's lifetime or else the body will eventually revert to its original state, according to Dane Menkin, clinical operations manager at the Mazzoni Center in Philadelphia.

In the most comprehensive study to date, Boston University School of Medicine researchers recently found little evidence of medical problems stemming from hormone treatment in transgender individuals. As reported earlier this year in the Journal of Clinical and Translational Endocrinology, researchers found increased risk of blood clots among male to female transgender individuals and increased blood counts among female to male transgender individuals. But researchers found no increase in cancer prevalence or mortality.

Sources: News reports and Fenway Health



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