Students hold flags at a protest in Texas.Brett Coomer/Houston Chronicle via AP, File
Six days after President Donald Trump’s inauguration in January, Alishea Kingdom went to a medical appointment at the federal prison in New Jersey where she’s incarcerated. It was time for her to take the hormonal medication she’d been prescribed years before to treat her gender dysphoria. But prison staffers would no longer give her the medicine—or the bras, underwear, and other feminine items she’d gotten used to wearing. Without her hormone therapy, Kingdom started having panic attacks, struggled to sleep, and experienced suicidal thoughts.
Kingdom is one of about 2,000 transgender people in federal prisons who have lost access to medical care or may soon lose access to it because of the Trump administration’s new policies. Now she’s part of a class-action lawsuit filed last week against the president and his team. On Monday, her attorneys at the ACLU asked a federal judge in DC for a preliminary injunction that would allow trans people in federal prisons to continue receiving hormone therapy or other prescribed medical care as the litigation unfolds.
“Denying people needed medical care is going to be unbelievably devastating.”
The lawsuit follows other recent suits against the Trump administration by a smaller group of trans women prisoners; those other case are ongoing and primarily seek to stop the women from being transferred to men’s prisons. Trump’s policies are “part of a broader agenda of hatred for trans people and attempts to erase them from society,” says Corene Kendrick, deputy director of the ACLU’s National Prison Project, which is representing Kingdom in the class-action litigation.
“Denying people needed medical care is going to be unbelievably devastating,” adds Shannon Minter, legal director of the National Center for Lesbian Rights, who is involved with the other cases.
On his first day in office, Trump signed an executive order that declared war on trans people across the country, as my colleague Madison Pauly put it—instructing the federal government not to acknowledge their existence or protect them under anti-discrimination laws. Trans people make up about 1 percent of the incarcerated population in federal prisons. Trump ordered the Justice Department to keep trans women, whom he described as “males,” out of women’s detention facilities.
The executive order also prohibited federal officials from spending money on health care to treat gender dysphoria, the potentially life-threatening psychological distress that arises when a person’s gender identity differs from the sex they were assigned at birth. Under the Biden administration and during Trump’s first term, doctors in the federal prison system regularly prescribed hormone therapy and sometimes approved surgeries to treat the condition, in keeping with recommendations from the American Medical Association and other major medical associations. Most trans women still stayed in men’s prisons prior to Trump’s inauguration, but more than a dozen of them were approved to live in women’s prisons, where they were less likely to be sexually assaulted.
After Trump’s executive order, incarcerated trans people described “chaos and mistreatment” as federal prison staffers rushed to implement the new rules, according to Susan Beaty, an attorney in California who represents some of them. Different prisons have implemented the orders differently—a result of the broader disorganization and confusion at the Bureau of Prisons, which is also reeling from the departure of its director and other top managers.
Beaty’s clients at a federal prison in Texas said trans women were put into segregation and warned that they would soon be transferred to men’s facilities. In February, federal judges temporarily blocked the administration from moving 17 trans women who’d sued from various prisons around the country, but those orders didn’t protect the other incarcerated trans women who hadn’t. This month officials sent at least a couple of them to men’s prisons, according to Minter of the National Center for Lesbian Rights. He notes that the Prison Rape Elimination Act views trans women as particularly vulnerable to rape in men’s prisons: “Because of this new Trump policy, more people will be sexually assaulted,” he says.
Trump’s transfer orders affect a small portion of federally incarcerated trans people, but the ban on gender-affirming health care would change the lives of the vast majority. In late January, after Trump issued his executive order, the Bureau of Prisons announced that it was disbanding the Transgender Executive Council, the agency’s official decision-making body on all issues affecting the trans incarcerated population, including their medical care.
Then in late February, the agency issued memos that prohibited trans prisoners from buying “items that align with transgender ideology,” such as chest binders and hair removal devices, or obtaining undergarments that matched with their gender identity. Prison officials were ordered to refer to prisoners with pronouns corresponding with their sex assigned at birth, and male guards started patting down trans women. Books about LGBT identity were removed from prison library shelves. And the memos banned the use of federal funds for any medical procedure, treatment, or drug that would “conform an inmate’s appearance to that of the opposite sex,” including hormone therapy.
Study after study has shown that hormone therapy and other gender-affirming treatments can be life-saving, decreasing depression, anxiety, and suicidal thoughts. “Withdrawing gender-affirming health care from or denying such care to individuals for whom it is medically indicated puts them at risk of significant harm to their health,” attorneys at the ACLU wrote in the complaint. Some effects of hormone therapy are reversible, which means incarcerated trans men could lose some of their masculine features and trans women could lose some of their feminine ones without the drugs. Suddenly stopping the medication can also lead to headaches, hot flashes, and spikes in blood pressure, as well as depression, fatigue, anorexia, and muscle and joint pain. “We’ve heard from health care officials in prisons who are concerned,” Kendrick says.
“For patients for whom gender-affirming medical care is indicated, no alternative treatments have been demonstrated to be effective,” Dr. Dan Karasic, a psychiatrist who has treated patients with gender dysphoria for three decades and has consulted for state agencies and the United Nations on transgender care, told the court. Cathy Thompson, a psychologist who worked with the federal prison system for 23 years and advised it on best practices for trans prisoners before retiring in 2023, added that federal prisons lack enough clinicians to safely handle the suicide risk that would result from taking trans people off their medications. “I have grave concerns,” she wrote.
At Fairton Federal Correctional Institution, the men’s prison in New Jersey where Kingdom is incarcerated, the halting of medical care has been abrupt. Kingdom lost her hormone therapy in January and could no longer be evaluated by the Transgender Executive Council for surgery. She is 34 and has presented as female since she was a teenager. As her body adjusts to the drop in estrogen, she is experiencing extreme distress and frequently considers using scissors to castrate herself, according to the lawsuit. “After more than a month without care, my gender dysphoria has become incapacitating,” she wrote in a declaration to the court. “I frequently find myself thinking, I would rather not live than be forced to live as a man.”
“I frequently find myself thinking, I would rather not live than be forced to live as a man.”
Solo Nichols, a trans man at FCI Tallahassee in Florida, also joined the class-action suit. Prior to Trump’s inauguration, he’d been preparing to undergo a double mastectomy to masculinize his chest, having worn chest binders since he was about 15. His hormone therapy is also threatened under Trump. In February, he and some other trans men at the prison were given half their regular dose of testosterone, which led to lethargy and mood swings for Nichols. The side effects from the reduced dosage, he told a court, meant it felt “like the other transgender men and I were walking around like zombies.” Later, according to the lawsuit, prison staffers told him he could resume his entire dose “as long as the restraining order lasts,” referring to the court orders from the other lawsuits.
In Minnesota, staffers at FCI Waseca recently told plaintiff Jas Kapule that he could not receive any hormone treatments once his testosterone prescription ran out, and that he could no longer use a chest binder. He fears the return of his menstrual cycle, which caused him severe distress before his transition. “When my period ended due to the hormone therapy, I felt like I had turned over a whole new leaf and finally began feeling comfortable in my body,” he told the court.
The ACLU argues that ending medically necessary treatment for gender dysphoria in prisons violates the Eighth Amendment, the Fifth Amendment, and the Administrative Procedure Act, which governs how federal agencies enforce regulations. On Monday, attorneys for the group requested a preliminary injunction to block the implementation of Trump’s executive orders and ensure that trans prisoners can keep receiving their medical care. The goal is to “preserve the status quo,” Kendrick says, noting that hormone therapy and surgery are prescribed only after significant consultation by prison medical staff and after many layers of review.
The Trump administration has suggested that trans people in federal prisons pose a threat to cisgender women there, and that these new policies are intended to keep women safe. But as Kendrick points out, incarcerated women face a much higher chance of being attacked by male correctional officers than by trans women. An entire federal prison in California recently closed, she notes, after multiple male staffers were found guilty of routinely sexually abusing women in their care. (At least one of attorney Beaty’s trans clients was also abused by staff there.) Trump’s vilification of trans prisoners? “It’s propaganda,” Minter says. “They are the ones who are extremely vulnerable.”
As the litigation continues, incarcerated trans people are living in fear. “I am scared that I will be forcibly detransitioned and taken back to a very bad place, mentally,” Kapule wrote to the court.
“There’s so much harm happening right now to many different groups of people and to trans people generally,” Minter adds, “but there’s something uniquely horrific about the situation of incarcerated transgender people—because they’re trapped.”
