Incarcerated transgender people struggle to access gender-affirming care in prisons around the U.S. and often must resort to lawsuits to get the care they need, according to a report by NPR.
Ashley Diamond, a trans prison resident in Georgia, filed a lawsuit in 2015 against the state for denying her hormone treatments she had been taking for nearly two decades before her arrest to alleviate her gender dysphoria.
The lawsuit claims that correction officials’ “refusal to provide Ms. Diamond anything beyond sub-therapeutic hormone therapy is so wholly inadequate that it is tantamount to no treatment at all,” according to the lawsuit.
Her claim resulted in a major 2016 settlement that affirmed the right for medical treatment of gender dysphoria. In addition to an undisclosed monetary payout from the state, Diamond also received assurances that staff would be trained on the treatment of trans inmates and sexual assault prevention, according to the Southern Poverty Law Center.
Access to gender-affirming care, such as hormone therapy and surgeries, is considered medically necessary to treat gender dysphoria. Without it, individuals can suffer significant mental health issues, such as heightened anxiety and depression, and some may turn to self-harm and suicide.
Despite the legal victory, Diamond was denied gender-affirming healthcare when she was re-incarcerated in 2019. Diamond violated her parole when she left the state to receive treatment for PTSD at a trans-friendly clinic in Florida.
“Imagine being a trans woman and a Black trans woman on top of that, and you’re trying to assert these rights that you were promised and guaranteed in your first case,” she said, adding that trying to address her complaints to prison officials was like talking to a wall.
After filing a second lawsuit, the U.S. Justice Department weighed in on Diamond’s case, saying in a statement of interest that prison officials have an “Eight Amendment obligation to provide all prisoners with adequate medical care for serious medical conditions … This includes the treatment of gender dysphoria.”
According to health experts, attorneys, and incarcerated and formerly incarcerated individuals who spoke with NPR, getting gender-affirming care in prison often comes only after legal actions or threats of lawsuits. Prisons that do provide gender-affirming care are often inconsistent, regardless of stated policies, they said.
Diamond said she experienced severe physical and mental anguish because she was denied her hormone treatments, which she said was “catastrophic.” Because she was denied that care, Diamond said, she repeatedly tried to castrate herself while in prison. Now, she has difficulty urinating, her lawyers alleged in court documents.
Extreme measures like this are common for trans women when denied gender-affirming health care, said Randi Ettner, a psychologist who works with the World Professional Association for Transgender Health.
“I have seen far too many individuals engage in auto-castration, auto-penectomy, as attempts to ‘surgically self-treat,’” Ettner said, adding that these drastic actions can often turn deadly.
Diamond’s anguish is “just a reality when you get fed up and when you’re hurting, and when you’re sick and when no one is listening,” she said.
In a 2015 nationwide survey of trans people, 58% of incarcerated respondents had been taking hormones before being imprisoned. Of those, 82% had a prescription for hormones.
More than a third of those who took hormones prior to their incarceration said they were not allowed to continue taking their hormones while imprisoned.
Star, a transgender resident at San Quentin, said her gender-affirming care has been a successful journey. She advised other transgender SQ residents to consider getting the care they need.
She also said to “make sure that it’s exactly what you want because it’s nothing to play with and there is no going back.”