While prison is a harrowing experience for anyone—especially gender-nonconforming prisoners—the U.S. Court of Appeals for the Seventh Circuit gave trans inmates some respite today when it upheld their right to receive trans-related medical care while incarcerated. The ACLU and Lambda Legal had challenged a Wisconsin law that prohibited prison doctors from prescribing hormones or sex-reassignment surgery to transgender inmates.
“This was a discriminatory law that cruelly singled out transgender people by denying them—and only them—the medical care they need,” said attorney John Knight of the ACLU’s Lesbian Gay Bisexual and Transgender Project. “Too often the medical needs of transgender persons are not treated as the serious health issues that they are. We are glad that the appeals court has found that medical professionals, not the Wisconsin legislature, should make medical decisions for inmates.”
In April 2010, a federal district court struck down the so-called “Inmate Sex Change Prevention Act.” In today’s ruling, the court affirmed that, “refusing to provide effective treatment for a serious medical condition serves no valid penological purpose and amounts to torture.” The state had argued the ban on hormone therapy wasn’t cruel and unusual because alternative treatments like psychotherapy and anti-depressants would still be available.
“The medical needs of transgender people don’t disappear once they enter prison,” said Lambda Legal trans-rights attorney Dru Levasseur. We’re glad that the court has ruled that the legislature cannot outlaw the only effective treatment for some people with Gender Identity Disorder.”
While today’s victory is good news, there’s still more battles to be fought: In many states, inmates are housed by their birth gender, regardless of their current gender identity. Even transgender women with breasts can be housed with men, leaving them vulnerable to violence and sexual assault.
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Danny
You mean tax payers I have pay for someone to transition? No fare I don’t want my money going to that.
Dolly
@Danny: Perhaps you’re “argument” would be more effective if A: You did not insist on whining like a child who has to share a new toy, and B: If you learned how to spell “fair.”
Samuel
@Dolly: Maybe if people could tell the difference between ‘your’ and ‘you’re’ we wouldn’t have people filling up comment space with useless arguments… But seriously, hormone treatment is fine. Not giving it to them would be unethical.
Daez
@Samuel: Ok, lets give pec implants to the skinny dude and liposuction to the fat dude. They both probably want to look different in prison as well. There is no way in hell that tax dollars should go to pay for any elective surgery rather the person is in prison or out of it, and gender reassignment is ABSOLUTELY an elective surgery. Its unethical to demand that the community you screwed over (which is the reason you are in jail in the first place) then gives you a hand out.
JR
@Danny … so you don’t want your tax dollars to pay for inmates trans-related medical care. so how do you feel about inmates cardiac care? What about diabetic care? HIV cocktails? The list of medical conditions can go on and on. Your tax dollars pay for all of this. You don’t get to pick and choose which conditions you get to pay for.
Fitz
Hell, I’m not even sure I want to pay for routine medical
care for prisoners.
JayKay
@JR:
The difference is those are medically necessary.
Transitioning IS. NOT.
No matter what the bleeding heart, PC, queer theory, leftist crowd says, these people can survive just fine without having their dicks chopped off. Taxpayers shouldn’t be paying for some tranny’s medically unnecessary cosmetic surgery. The standard should be this: If you walk into an emergency room with a problem, will they treat it for you? If the answer is no, a prison shouldn’t be providing it.
And if they get suicidal, force them into therapy and take away anything they could use to kill themselves. Problem solved.
Aiden
@JayKay: Tell us more about your extensive knowledge on this subject.
JR
@JayKay … Hormone therapy IS a medicaly nesessary for the transiting inmate. Gender re-assignmnet surgery is also part of the process. Why should they be singled out for discrimination because of something the general public does not understand. If that meakes me a bleedingheart liberal, so be it then. regardless fo what they did to end up in prison, they are people first, just like you and me. If they have a medical need that needs to be addreswsed, than it should be addressed, whether you agree with it or not. EVERY person deserves the right to be treated with respect, whether they are a prisioner or not. You may not agree with everything they say or do, or not understand what it’s like to be in their shoes, but they deserve the same rights and respect, including the right to medidca care.
Danielle
Okay… the voice of the “trannies” speaks. And, yes, you oppressive queers, I’m looking at ALL of you! Your ignorance to the issues and blatant disrespect for transsexuals is, frankly, appalling!
Hormone Therapy and SEX Reassignment Surgery [My gender is JUST fine, thank you.] are medically necessary according to the American Medical Association, American Psychiatric Association, World Professional Organization for Transgender Health, World Health Organization, and several other professional organizations in the fields of medicine, mental health, and social work. So, by medical professionals (not random people with biased opinions) deem it medically necessary to receive these treatments the same as if the person was having heart trouble, a urinary tract infection, or diabetes. We treat those in prison. You can’t pick and choose who you treat. If you want to discriminate in your treatment, don’t take the Hippocratic Oath!
I’m sick and tired of hearing from the queers as much as our opponents that it’s all “elective”, suggesting CHOICE. I mean, come on! Queers advocating that something inherent to a person is a choice? What is WRONG with this world?!
JayKay
@JR:
It is not a medical necessity. It’s a medical want. They can keep on living without transitioning.
Danielle
@JayKay: Are you a psychological professional or a transsexual? If not, what do you know?
From personal experience, I can tell you with absolute certainty that NO, THEY CAN’T. The trans community experiences some of the highest rates of suicide of ANY minority group. For those of us in the transsexual camp, that means that if we cannot express ourselves in a meaningful manner for us, then we cannot continue living. The psychological stresses of living in the wrong body are something you just cannot fathom. The worst part about it is the fact that some transsexual out there has a brother just like you. You can’t see past the nose on your own face long enough to see the pain you are causing people.
For comparison, how would you like it if I sat here telling you that you’re not really “gay”, you’re just “choosing a lifestyle”. If you’d just quit having sex with men, you could go on living, marry a woman, have dozens of babies… and die a miserable old man. That is, if you manage to not kill yourself before that happens.
Fitz
It really doesn’t matter what any of us think– the judges have already decided.
JayKay
@Danielle:
“Being born in the wrong body” is not a fatal condition. Having a penis you don’t want won’t kill you. They’re killing themselves, their condition isn’t. Put them in 24 hour solitary confinement and take away anything they could use to kill themselves if they’re so desperate to commit suicide.
Tiffany_M
JayKay:
As a trans woman who’s fought and fought for the civil rights of the gay and lesbian population (and will continue to in spite of people like you)
I find it disgusting that you would be so quick to judge transsexuals, in most cases it’s transition or die. The suicide rate that it sounds like you feel is more or less a joke is very real and not something a person would do over a choice.. In fact on numerous occasions I held a bottle of strong painkillers in one hand… and a strong beer in the other with other beers right in front of me in case of need. It was only the fact that I didn’t want to put my father through a second suicide (his brother killed himself in 1985) that kept me going… if he hadn’t already experienced someone close to him killing themselves any my knowing what it did to him… I wouldn’t be here today.
I continued ‘living’ if you want to call it that, wasn’t really living at all. Still continued to have constant thoughts of death.. random crying spells you name it.
Only earlier this year when I actually decided to do something about it and see a therapist and start HRT did I begin to find happiness.
Ruhlmann
In Canada the basic surgery is paid for by all the provincial governments that ultimately get their money from the federal government. The arguments against this procedure on this board are the same ones that were presented to Parliament. Parliament sided with the doctors who deemed this to be medically necessary. That’s good enough for me.
I hate it when I am called a “liberal” like it’s a dirty word because I believe that a wealthy nation should do everything in its power to alleviate suffering of any kind. I resent my tax dollars going to all kinds of things that I don’t think are necessary. I am glad that some of my dollars go to keeping people healthy, physically and psychiatrically.
How a society treats its poor, ill and vulnerable is the face of that society. To conciously consign a person to these things is repulsive on every level humanity can be repulsive. Corporate bailouts, tax breaks for billonairs, and a war in Iraq that your great grandchildren are going to be paying for is where you should be begrudging your hard earned money, not making people well.
o
I’m so embarrassed that I used to dislike the ACLU when I was conservative.
Zoe Brain
In this case, the “Inmate Sex Change Prevention Act” was passed as a cost-cutting measure.
One problem – the medical personnel in the jails testified that the costs in anti-depressants, suicide watches, funerals and medical costs associated with suicide attempts, let alone the cost of dealing with heart failure, liver failure, and brittle bones caused by hormonal deficiencies, far outweighed the dollar-a-day cost of hormones.
The question was – how many extra dollars was the Wisconsin taxpayer expected to pay to make sure that Transsexual prisoners suffered and died? Their position was that the legislature had passed this law, then failed to give them the extra tens of thousands of dollars needed to implement it.
Here’s what the AMA has to say on the subject:
“Whereas, GID, if left untreated, can result in clinically significant psychological distress, dysfunction, debilitating depression and, for some people without access to appropriate medical care and treatment, suicidality and death “
Yes, people do die from it. At least 1 in 3, without effective treatment, and “talking cures” or “reparative therapies” are utterly ineffective.
To quote from the standards of care version 6, the medical “best practices”:
In persons diagnosed with transsexualism or profound GID, sex reassignment surgery, along with hormone therapy and real-life experience, is a treatment that has proven to be effective. Such a therapeutic regimen, when prescribed or recommended by qualified practitioners, is medically indicated and medically necessary. Sex reassignment is not “experimental,” “investigational,” “elective,” “cosmetic,” or optional in any meaningful sense.
Not every patient requires it. For those who do, it’s a matter of life and death. Most require at least hormones though, or they die.
xander
@Ruhlmann : That was much too thoughtful and sane of a response, are you sure you’re on the right site? 🙂 Canada’s policies in this regard seem to reflect what happens when science rather than religion informs how prisoners with medical conditions are treated.
@Tiffany M : Thank you for telling us your story. So many LGB people haven’t taken the effort to listen to and speak with Trans~ individuals about their lives and transitions. At least, in my experience those conversations help personalise otherwise ‘abstract’ concepts like what it means to be Trans, or Bi, or lesbian or gay.
Samuel
@Daez: I never said anything about surgery. I said hormone treatment. besides, unless you have lived a day in the body of a transsexual, there is no way you have any right to claim that it is elective.
Samuel
@JR: Never said anything about picking and choosing, either. I have no idea what these inmates are in jail for, but if they need care, I have no problem paying tax dollars to pay for their transitions or HIV medications or any diabetic care. I would never pick an choose. All or nothing.
Ruhlmann
@xander: Its my favourite place to get pissed off. No religion please, we’re Canadian.
inoits2
The government should definitely provide trans people with gender reassignment surgery. Not because I like the idea that tax dollars pay for it but because it is the right thing to do. However trans people should not be allowed to walk around with breast (hormone treatments) without the goal being surgery. People with penises belong in the ladies room. Period.
I really struggle with the idea that incarcerated people should be given elective surgery. I suspect all that “evidence” that trans people MUST have treatment for what is basically not a physical illness is something liberal lawyers have managed to convince the government is an emergency. Whatever happened to the idea that people breaking the law are there to be punished?
I struggle with transgendered issues. At my church is a transgendered individual. I take great pains to talk to “her”. But it is very hard because she is 6′ 4″, has a deep voice and looks like the ugliest man I have ever seen with pancake makeup. her clothes look like someones idea of what women going to church in the 50s would wear. She says she had always been a woman and had left her wife and grown kids. She is also straight!
I have lots of inner work to do to reconcile my doubts about all this because all I see is a crazy person.
Jill
The ruling involved hormonal treatment. Hormones are cheap in comparison with surgeries, cheaper than anti-depressants.
@Ruhlmann: My understanding is that only BC and Quebec currently pay for GRS, but there are advocacy efforts going on in many other provinces to enable or restore coverage.
@inoits2: It takes tremendous inner reserve and social support to transition. Trans woman are not born knowing fashion, and many may need coaching to attain an appearance where they blend well. Imagine a person-born-female transitioning from girl to woman – often they have the support/coaching of their mother, older sisters, and peer group in understanding fashion, effective use of makeup, knowing what works with their body shape, how to carry themselves with confidence. Trans women need all that, plus vocal training, training in gestures/gait. For some it comes easy, for others it is a great deal of work, often made worse by the damage suffered in navigating life to get to the point of transition. Facial surgeries are expensive and almost always out-of-pocket, and unemployment rates are very high for trans people. Take the quotation marks from “her” and imagine the church goer as a woman born female who was raised in great difficulty – raised by wolves, perhaps. How would you help this woman to be more graceful? Or would you just decide she is crazy, to be ignored? You don’t say anything about your church’s religions beliefs, but surely they say something about helping people in need?
I would also add that you know other trans women – you just may not know that they are trans, that they were born male.
missanthrope
@JayKay:
Ever check out trans suicide rates? They’re off the charts even compared to (cis) queers. Unless you’ve ever suffered from gender dysphoria, don’t presume about what it like.
Gender dysphoria is a medical condition, it inflicts severe psychological trauma in many people. Transition is a cure for this with a 98% effectiveness rate and prisoners have the right to basic medical care. It doesn’t get any simpler than that despite your uninformed personal opinions on what trans people need as medical treatment. Period.
inoits2
@Jill: Thank you…great response. We at the church are very supportive being Unitarians. I totally understand what you mean. But how satisfying can it be to transition at 60. Unfortunately a person with a lifetime of living as male is probably never going to be very passable. If a person transitions at an early age I am sure it would work much better because the super heavy 5 o’clock shadow hasn’t set in. I am one of the few people that really makes an effort to talk to her and often she is left standing around by herself at coffee hour. I can’t stand seeing people ignored. Unlike others I don’t bombard her with constant questions about what it’s like to be trans. It would take lots of nerve for me to actually take her to lunch, as I would genuinely fear for my life. She has to be the bravest person in the world because I can’t imagine she can go anywhere without horrified stares.
Jill
@inoits2: I transitioned at 56. I work in three schools. I have never been harassed. I have had people look shocked if I tell them my history and they didn’t know me before. I am under no illusions that I “pass”, or that all people think I was born female all the time. People are kind to me, and I have had great coaching from my family, from other trans people, and from female friends at work.
I can tell you that transitioning at 56 is much better than not to transition. I have no thoughts of going back. I knew I was different at age 4, and I knew what I was was called “transsexual” at age 11, the year I started reading intensely anything I could find. I wanted to transition at 13, but I had no idea how to do it safely. I became a psychologist, and was highly disappointed that trans issues were ignored in my profession. I realize now that to have come out at 13 would have risked involuntary hospitalization.
So, I don’t doubt that transitioning at 60 is at least as highly satisfying as it was for me at 56. It’s true, our bodies become less responsive to hormones the older we get, but that does not mean it is an uninhabitable life. 5 o’clock shadows can be removed by electrolysis, although it is long, painful and expensive. At 56, my whiskers had gone so white that my co-workers insisted I had no signs of a shadow at 5 PM, with my last shave at 4:30 AM.
You are doing a good deed by conversing with her. It is quite possible it is something separate from her being trans that makes you uncomfortable. Perhaps talking to another friend about the two of you taking her to lunch might make that easier. People can blossom under kindness.
Ruhlmann
@Jill: That could be, the government has silently slashed all kinds of things. Thing is if the federal government approves a medical procedure the provinces have to provide it or risk confrontation over transfer payments. I don’t really know although I know years ago this was an issue in Ontario and Ottawa said “do it”.
A good friend of mine who is F-M had this done in B.C. and payment wasn’t an issue because had it been he wouldn’t have been able to afford it. He now has his own business and employs eight people and students in the summer. The money he generates for the Employment Insurance, Canada Pension Plan and Income Tax programs have paid for his transition and then some I am sure. He has been in business for twenty years. Before this he was a general labour wage slave working in factories for little better than minimum wage. The difference in his self esteem and confidence was a relief for everyone who knew him.
I don’t know much about this issue beyond what I have read here and my personal experience with my friend and even then we didn’t actually talk about it beyond his issues with general depression. I know in the late seventies the Canadian government was pretty liberal in its attitude and treatment of this issue. This may have changed with the cuts they have made over the last few years. If funding has been cut I am sure it was easily justified by the same mean spirited ignorance of peoples suffering as I read here on this page. I’ts just money, if it can’t buy me happiness I won’t begrudge it buying someone else a small measure of comfort or some kind of happiness.
Jill
@Ruhlmann: financial austerity may have something to do with it, but I would imagine there are other reasons. It may be the “low hanging fruit” to make it look like you’re cutting wasteful spending, but in fact paying for transitions is quite cost effective in the payoff in worker productivity and taxes. When San Francisco decided to cover trans medical benefits, they planned that it would raise premiums by 4 cents per worker per year, but at the end of 5 years, they had more money than was needed. These services are catastrophic for many workers when paid out of pocket, but for insurance pools they are inexpensive, because it is a small group of people who make claims.I know private employer-based insurance in the States is very different than Canadian style medicare, but the cost savings of providing coverage is widely misunderstood. At my employer, we have five insurance plans, none of which have covered any trans benefits – even psychotherapy for Gender Identity Disorder is not covered. My employer is a school district. People just buy their hormones on the internet, and dose themselves without any lab work or medical supervision.But I just asked our union negotiator, and three months later we had benefits.
panther
@JayKay: I hope you wake up with a vagina in the morning. And DDD breasts as well. Then tell us getting rid of them is elective. You need an education and I think you having to endure gender dysphoria will be the only way for you to get it.
Opinionated
I support paying for the hormones, but not surgery.
Suzanne
Stories like this have nothing to do with gay and lesbian people. We don’t want or need hormone therapy. In fact, hormone therapy has been used against us as a torture device, as happened to the gay mathematician Alan Turing. Stories like this only underscore how fundamentally different are GLBs on the one hand, and Ts on the other. Lumping them all together into LGBT is a sham and an insult to both communities. I will never use that term. The people who came up with LGBT should be ashamed of themselves.
As for the case itself, it makes no sense to say that hormone therapy is medically necessary when no trans person could show up at a hospital or free clinic and demand it. Although I understand that hormone therapy is not cosmetic, like a nose job, that doesn’t mean that it is medically necessary. If you are trans and not a criminal, you have to make do. Either get insurance or raise the money yourself or find a discounted or charitable treatment program. And it doesn’t matter if this “depresses” you; you still can’t get free hormones.
It makes no sense to say that this procedure is now available as of right to convicts. This decision came from a panel that had only 2 actual members of the 7th Circuit on it. The decision appears to conflict with a prior decision by the 7th Circuit. I think it is a certainty that the state will appeal this to the full 7th Circuit or to SCOTUS, at which point it has a very good chance of being overturned.
xander
@Suzanne : Your definition of ‘medically necessary’ is completely at odds with the American Medical Association and the World Health Org. When you join one of those groups, you may protest the definition; meanwhile, keep your ignorance to yourself.