Dallas Voice (Dallas, Tex.), Vol. 28, No. 21, Ed. 1 Friday, October 7, 2011 Page: 24 of 68
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U.S. prisons officials OK hormone
treatments for trans inmates
Memo says 'current, accepted
standards of care' must be applied
LISA LEFF I Associated Press
SAN FRANCISCO — Transgender inmates
who did not begin treatment prior to entering fed-
eral custody can now receive hormones, special-
ized mental health counseling and possibly
gender reassignment surgery while they are in
prison, according to new rules adopted by the U.S.
Bureau of Prisons as part of a court settlement.
A May 31 memo issued to wardens at the na-
tion's 116 federal prisons and made public by gay
rights groups in announcing the settlement on
Sept. 30 Mate.--, "current, accepted standards of
care" will be applied to inmates who believe they
are the wrong gender.
Under the bureau's previous policy, issued in
2005, only federal inmates with a pre-existing di-
agnosis were eligible for transgender-related care,
which was limited to treatments that would main-
tain them "only at the level of change which ex-
isted when they were incarcerated,"
The new guidelines mean prisoners who were
previously disqualified from treatment because
they had not received any on the outside will now
be eligible to begin hormone therapy to feminize
or masculinize their features and to dress and live
accordingly as part of individualized treatment
"The treatment plan may include elements or
services that were, or were not, provided prior to
incarceration, including, but not limited to: those
elements of real life experience consistent with the
prison environment, hormone therapy and coun-
seling," the memo from bureau medical director
Newton Kendig states.
The policy memo does hot mention surgical in-
tervention, but National Center for Lesbian Rights
Legal Director Shannon Minter said the agree-
ment would permit surgery as a treatment option
if prison doctors agree it is necessary for individ-
The May guidance specifically advises war-
dens that "treatment options will not be pre-
cluded solely due to level of services received, or
lack of services, prior to incarceration."
That language, as well as the reference to ac-
cepted standards of care is significant since the
World Professional Association for Transgender
Health, the professional organization that issues
guidelines for treating gender identity disorders,
considers genital reconstruction surgery "essen-
tial and medically necessary" for some patients
suffering from "gender dysphoria."
Jennifer Levi, director of the Transgender
Rights Project at Gay & Lesbian Advocates and
Defenders, said that because the memo does not
prohibit surgery, "It leaves open the possibility
that the full range of appropriate medical care
must be considered in adopting an individual
"There is no reason why an incarcerated person
should be excluded from receiving surgery if it
turned out to be medically necessary for that in-
dividual," Levi said.
Bureau spokesman Ed RoSs said there are cur-
rently 48 federal inmates who have been diag-
nosed with gender identity disorders. Ross did
not respond to attempts by The Associated Press
on Friday and Monday to clarify other aspects of
the policy, including confirmation that inmates
could be eligible for sex reassignment surgery that
would necessitate their move to a new prison. All
state and federal prisons in the United States as-
sign inmates to men's or women's prisons based
on their genitalia.
The policy shift resulted from a two-and-a-half-
therapy for Vanessa
Adams, who began
serving a 20-year
sentence as Nicholas
Adams and was di-
agnosed with gen-
der identity disorder
in 2005 by doctors at
the U.S. Medical
Center for Federal
Prisoners in Spring-
After she was de-
nied treatment because of the rule requiring pre-
vious care for gender identity disorder, Adams,
41, tried to castrate herself with a razor and at-
tempted to and ul timately succeeded in amputat-
ing her penis, according to court papers.
Prison officials agreed to put Adams on a
course of hormones in August 2009 after a federal
judge in Massachusetts, where Adams briefly
was imprisoned and her lawsuit was filed,
agreed that her lawyers could retain an inde-
pendent expert to evaluate her. The same judge
refused almost a year later to dismiss Adams'
claim that the Bureau of Prisons' policy on trans-
gender health care constituted cruel and unusual
punishment, a decision that paved the way for
The agreement also calls for transgender in-
mates to be notified of the new policies and for
prison doctors to be trained to identify and treat
gender identity disorders.
Levi said prison officials have typically been
hostile to transgender inmates and that she antic-
ipates more legal action to ensure the bureau's
policy is put into practice^
"This should have a very significant effect on
the lives of trans inmates. It means people will be
receiving appropriate medical care," Levi said. ■
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Nash, Tammye. Dallas Voice (Dallas, Tex.), Vol. 28, No. 21, Ed. 1 Friday, October 7, 2011, newspaper, October 7, 2011; Dallas, Texas. (digital.library.unt.edu/ark:/67531/metapth239188/m1/24/: accessed April 25, 2017), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT Libraries Special Collections.