Texas says transgender prisoners can keep their hormones — unless they’re under 18

Texas prison officials say adults already receiving hormone therapy can continue treatment under a revised policy. Incarcerated minors, however, must eventually be weaned off it.

The Texas Department of Criminal Justice’s policy on treating incarcerated people with intersex conditions or diagnosed gender dysphoria was reviewed in July. The agency provided the revised document to Austin NBC affiliate KXAN this week. Under the policy, adults entering state prison can continue a documented hormone regimen unless the treatment is medically contraindicated.

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“Hormone therapy will be requested with indefinite refills through the non-formulary process to ensure that continuity of care is maintained during the initial evaluation process,” the policy says.

Advocates had feared treatment would be cut off after the policy disappeared from the department’s website. Those concerns came amid a separate change in state law requiring transgender prisoners to be housed according to their sex assigned at birth. Transistics reported that the disappearance signaled an end to gender-affirming care for roughly 1,100 incarcerated people. The document provided to KXAN shows that hormone therapy remains available to adults under the revised policy.

The rules are different for incarcerated people younger than 18. The policy permits a minor to continue medication begun before June 1, 2023, only if they attended at least 12 counseling or psychotherapy sessions over at least six months before starting treatment. Even then, the policy requires that the medication eventually be discontinued.

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“However, the inmate must be weaned off the prescription drug over a period of time and in a manner that is safe and medically appropriate and that minimizes the risk of complications,” the policy says.

It also bars minors from switching to or beginning another treatment prohibited under Texas law. The policy calls for prison medical staff to obtain patients’ prior records and conduct medical evaluations, with referrals to a specialty clinic provider as needed. The revised document still does not appear in the department’s online policy manual.

Major medical organizations, including the American Medical Association, American Academy of Pediatrics, American Psychiatric Association, and Endocrine Society, support access to individualized gender-affirming care for transgender adults and young people under clinical guidelines. Such care can include hormone therapy when appropriate for a patient.

Related: The horrific reality of transgender individuals in Texas prisons

A gradual taper does not eliminate the risks of ending treatment. In earlier reporting on a federal prison policy, Dr. Carl Streed, a primary care physician and transgender health researcher, told The Advocate that withdrawing hormones can cause mood changes, difficulty concentrating, and longer-term cardiovascular, metabolic, and bone health problems. Incarcerated people whose bodies no longer produce adequate hormones after surgery may face particular risks, he said.