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Prisoners getting hormone therapy

Six RCI inmates now receiving treatments after court decision

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STURTEVANT — Along with inmates receiving insulin and heart medication in the Racine Correctional Institution, a handful of inmates are now receiving gender hormone medications, due to a 2010 federal court case. 

The federal court case means some accommodations have had to be made at prisons for those inmates receiving hormone therapy, which masculinizes or feminizes the body.

There are 18 inmates incarcerated in the Wisconsin Department of Corrections facilities receiving hormone treatment, according to Department of Corrections data the state provided in an email Friday.

Six of those inmates are at the Racine Correctional Institution — the most in the state — and one is incarcerated at the Sturtevant Transitional Facility, the DOC said.

Previously, the state had a law called the Inmate Sex Change Prevention Act, which prohibited the state from paying for any inmate’s hormone therapy. But that law was ruled unconstitutional and compared to denying other medical help such as cancer treatment. Since then, Wisconsin prisons including the Racine Correctional Institution in Sturtevant have had to make accommodations.

The Department of Corrections declined to allow The Journal Times to interview the warden at the Racine Correctional Institution about the accommodations.

New physical characteristics

But Joy Staab, a DOC spokeswoman, said in an email that inmates taking cross-gender hormones can end up developing new physical characteristics, such as a biological man developing breasts. Those inmates taking those hormones or who develop those characteristics shower separately from other inmates, she said in an email. Facility and housing assignments for those inmates are made on a case-by-case basis, she said.

“The inmate’s health and safety as well as potential management and security concerns are all taken into consideration. An inmate’s own views regarding safety are also given serious consideration,” she said in an email about what accommodations are needed.

Department of Corrections policy also states staff are encouraged to use gender-neutral names such as a person’s last name to address a person with gender dysphoria, a clinical diagnosis of distress relating to their gender.

Appropriate undergarments

Also, inmates with characteristics of the desired gender will be required to wear appropriate undergarments. For instance, someone with developed breasts will be required to wear a bra and shirt when outside their cell, but inmates in male facilities are not allowed to wear makeup, according to the policy.

Dr. Joshua Safer, an endocrinologist who works with hormones at Boston University Medical Center, said being transgender is a biological condition where a person’s gender identity does not match the body parts he or she was born with.

Most effective treatment

Hormone therapy is by far the most effective treatment to help the person look the way they feel, said Safer, who is considered an expert in treating transgender individuals. Some of the patients he has treated were incarcerated in the Massachusetts state prison system, where they have had legal battles similar to those in Wisconsin.

“The individuals ... for the most part, they cannot live the way they feel,” he said. “It’s like convincing someone not to eat or do some other natural behavior.”

Jolie McKenna, the executive director of the LGBT Center of Southeastern Wisconsin, who used to work in corrections, agrees with the court decision to allow hormone therapy. She knows all about the benefits it can bring.

When she was born, she said she was considered “intersex,” where it was hard to determine what her gender was.

Her parents determined she was a male, and throughout her childhood she received what her mom called “strong man medication,” which she later learned was testosterone.

Learned late

But McKenna didn’t learn any of that until she was 33, married and wanted to enlist in the Army. “I was like, ‘That explains a lot,’ ” said McKenna, who later started taking hormones to transition into a female.

“You cannot live and put up the (presentation) forever,” she said referring to a false outward presentation, hiding who you are.


What led to hormone treatment in the prisons?

Previously, the state had a law referred to as the Inmate Sex Change Prevention Act, which Gov. Jim Doyle signed in 2006 as a prohibition against using state or federal funds for any hormone therapy or sexual reassignment surgeries for inmates. However, in March 2010, a U.S. eastern district court judge ruled that was unconstitutional in the case Fields v. Smith. 

The 7th Circuit Court of Appeals affirmed it in 2011 and the U.S. Supreme Court declined to accept the case. According to the Department of Corrections, no further legal challenge to the decision can be taken.

In the 7th Circuit Court of Appeals’ decision, the court said, “It is well established that the Constitution’s ban on cruel and unusual punishment does not permit a state to deny effective treatment for the serious medical needs of prisoners ... Just as the legislature cannot outlaw all effective cancer treatments for prison inmates, it cannot outlaw the only effective treatment for a serious condition like GID (gender identity disorder).”

How much does it cost? 

The Department of Corrections could not provide a cost estimate for how much it spends on hormone treatment for immates. However Joy Staab, a DOC spokeswoman, said generic brand medications are used as a cost-saving measure. While she did not know how much the therapy cost, according to the appeals court decision, the cost of hormone therapy is between $300 and $1,000 per inmate, per year.

Sex reassignment surgery is significantly more expensive, costing approximately $20,000, according to the appeals court decision. But Staab said no Wisconsin Department of Corrections inmates have received gender reassignment surgery.


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