Indiana Begins to Allow Hormone Therapy Treatment for Transgender Inmates

By Tonie. N Loveday

I would like to relay my story of how I, a transgender woman and inmate doing time at the Indiana State Prison in Michigan City, took on the Indiana Department of Correction (IDOC).

Not being on hormone treatment prior to incarceration, the IDOC would not allow transgender inmates to begin them. I was not diagnosed with gender dysphoria until June 2015, seven years into my sentence. Gender dysphoria is the medical diagnosis for experiences of distress and discomfort connected to a difference between one’s gender identity and their sex assigned at birth. Diagnosis by a psychologist, psychiatrist, or doctor is often required to receive gender-affirming care, such as hormone therapy and gender-affirming surgeries. A diagnosis of gender dysphoria is not needed to identify as transgender or be a part of the community. However, it is often needed to access treatment.

After over a year of talk therapy, the lead psychologist at the time, Dr. Renaldo Matias, suggested I request hormone treatments, even knowing the state’s position on the matter.

The American Civil Liberties Union (ACLU) of Indiana could not intervene until l had fully exhausted my grievance remedies within the prison. The following is the procedure I followed, along with the responses I was given. Hopefully, this may be a guide for others in the same fight:

1. Beginning with a request for healthcare form, I wrote: “I have been diagnosed with gender dysphoria, and I want to begin taking hormone treatments.” Response from the health care staff stated:
“We have reviewed your request with the Regional Mental Health Team, and it was determined that hormone treatment is not appropriate for your situation.”

2. I followed up with an informal grievance but received no response.

3. After filing a formal grievance, the state issued the following response:

“Dr. Matias advised; Wexford medical staff and the Indiana Department of Correction has an informal policy (it is informal as far as he is aware) that if an offender did not enter the IDOC already on hormones, neither the contracted medical staff nor IDOC are under any obligation to provide hormone therapy for offenders who discover they are transgender while incarcerated. Grievance Addressed.”

4. Not agreeing with the state’s resolution, I wrote the following lengthy appeal:
“The response to my grievance stated due to an ‘informal policy’ my diagnosis of gender dysphoria will not be treated with hormone therapy because I was not receiving treatment prior to incarceration.

The American Medical and American Psychological Associations have each officially recognized gender transition treatments like hormone therapy as medically necessary treatments for gender dysphoria.

Also, in response to a federal lawsuit filed in February 2015, the U.S. Department of Justice intervened, declaring the state prison’s continued denial of the complainants hormone therapy a violation of the Eighth Amendment to the U.S. Constitution. Also mandating individualized assessment and care for gender dysphoria in all trans prisoners, suggesting that trans inmates who were not undergoing hormone therapy prior to incarceration should also be eligible for access.

By taking action, the Justice Department is reminding the Department of Corrections (of each state) that prison officials have an obligation to assess and treat gender dysphoria, just as they would any other medical or mental health condition. Acting Assistant Attorney General Vanita Gupta explained in the DOJ’s statement: ‘Prisoners with gender dysphoria should not be forced to suffer needlessly during their incarceration simply because they were not receiving care or could not prove they were receiving care in the community.’

I do suffer anxiety, depression, and suicidal ideation due to my gender dysphoria, and not being afforded the proper treatment for my diagnosis is truly a violation of my Eighth Amendment right prohibiting cruel and unusual punishment.”
The grievance appeal was denied, stating that the initial response was appropriate.

5. I contacted ACLU of Indiana on November 7, 2017. The ACLU of Indiana filed Complaint for Injunctive and Declaratory Relief, No. 1:17-cv-04123 in The United States District Court; Southern District of Indiana: Indianapolis Division, Against the Commissioner of the Indiana Department of Correction in his official capacity; Defendant.

Two weeks later, ACLU of Indiana attorney Jan Mensz informed me that the IDOC was amenable to resolve the issue of my complaint without going through the courts.

I was prescribed testosterone blockers on January 25, 2018 after a physical, blood work, and signing a consent and counseling form. Thirty days later, I was finally allowed to begin taking estrogen.

6. Due to my efforts and ACLU of Indiana’s filings, the IDOC has adopted a written policy regarding transgender inmates: Decisions about prescribing hormone therapy for gender dysphoria are now reviewed by a team from IDOC staff and contracted medical staff and psychologists. If the criteria for gender dysphoria has been sufficiently documented, the inmate can be prescribed hormones.

Since winning the fight for access to hormone therapy, IDOC is now allowing gender-appropriate undergarments and clothing as of late 2020. Additionally, in the past year, I have been allowed to purchase the same cosmetics available at Indiana women’s prisons.

I have also successfully scheduled gender-affirming surgery for later this year, with the support of the ACLU of Indiana. After filing for gender affirmation surgery in the 7th U.S. District Court, the IDOC and health care providers have settled and will agree to my surgery.

I am determined to continue the fight in Indiana for all transgender inmates and to assist in any way all transgender women and men, incarcerated or free. Thank you for allowing me to share, and perhaps this may be a guide for other trans inmates nationwide who are hoping to become their true selves.