Fantasia Horton, a prisoner in Georgia, was first diagnosed with gender dysphoria in 2019 by a psychologist with the Georgia Department of Corrections. While in prison, she was prescribed hormone replacement therapy, commonly referred to as HRT. The treatment quickly lessened her dysphoria and improved her mental health so much that she stopped taking medication for depression and anxiety within months.
Six years later, medical providers in the same system that began her HRT treatment abruptly ended it. The decision was made to align with a new piece of legislation signed into law by Georgia Governor Brian Kemp in May. Although Horton was told she could taper off with half-doses over several weeks, she was denied medicine at her next appointment. She says it was physically and emotionally devastating.
“I felt depressed and drained. My suicidal thoughts returned, and I felt hopeless about the future,” Horton writes in a lawsuit challenging the legislation that led to the pausing of her treatment.
The law Gov. Kemp signed, Senate Bill 185, makes it illegal to use state funds or resources to treat Georgia prisoners who have gender dysphoria with hormone replacement therapy, surgery or even “cosmetic procedures or prosthetics intended to alter the appearance of primary or secondary sex characteristics,” which lawyers say includes chest binders for men and bras for trans women.
Now, after a legislative session in which Georgia lawmakers passed this and other anti-trans laws, lawyers and other trans advocates are responding with aid to those impacted inside and outside of prison walls.
In August, five trans prisoners including Horton filed a class action lawsuit challenging SB 185.
What the law does
Lawmakers speak about SB 185 as a cost-saving measure. The bill’s sponsor state Sen. Randy Robertson, a Republican, says in a social media video that the law “prohibits any taxpayer dollars to be used for transition surgery for anyone being held in the Georgia Department of Corrections.”
However, trans prisoners and their advocates say the law actually results in a much broader denial of medically-necessary forms of gender-affirming care.
“Out of desperation, I asked [my doctor] if I could continue receiving hormone therapy or surgery if my family was able to pay,” Horton writes in the suit. “He told me no, that due to SB 185, my family could not pay for my hormone therapy or surgery.”
The option of outside funding for treatment has reportedly been denied by officials charged with overseeing healthcare within the department of corrections.
Amanda Kay Seals, an Atlanta-based attorney representing the prisoners challenging the law said, “What the state said at a hearing on Friday [Aug. 29] was that, administratively, it’s too difficult to allow self-pay.”
Seals also stressed that, even though HRT is a very inexpensive medication, there are vanishingly few prisoners who have money to afford their own medical care. “You can’t make the ability to pay a prerequisite for receiving necessary medical care in a prison,” she said.
“It almost certainly costs more taxpayer money for Georgia to defend these lawsuits than it would to provide hormone care for everyone who needs it in the system,” Seals said.
As the department of corrections works to formalize regulations in compliance with the new law, its effects are already rolling out. The GDC heard public comments about their draft regulation on Sept. 3, but prisoners report they are already being forced to medically detransition.
Christy Perez is a formerly-incarcerated trans woman in Atlanta who works as a leadership and development coach at Solutions Not Punishment Collaborative, also called SnapCo. She says she is in touch with hundreds of incarcerated people, including trans prisoners in Georgia.
“I had a trans woman reach out to me, my god, five or six weeks ago, and was like, ‘Yeah, they told me today that today’s my last dose, so I won’t be getting any more estrogen, I won’t be getting any more spironolactone.’”
Perez’s advocacy work began long before her release from prison. During her 13 years inside, she earned a bachelors, masters and doctoral degrees from seminary schools. She is a doctor of theological and historical studies. While incarcerated, she also became a published journalist, with bylines in Filter Magazine, The Appeal, Modern Farmer and more.
“When I got out of prison, I had opportunities that a lot of people deserve to have. But unfortunately, the reality is that a lot of formerly incarcerated people get out and they are starting at below zero,” Perez said.
Perez says she works to create pathways that make it easier for prisoners to accomplish as much as she has. She stays afloat by staying connected to other people fighting from a place of love for trans rights and prisoners rights.
In his Facebook video, Sen. Robertson says prisoners with gender dysphoria, “will continue to receive the mental health treatment they need,” but not transition care.
However, hormone replacement therapy and surgical interventions are among internationally recognized guidelines for treatment of gender dysphoria. HRT is a well-established and effective treatment for gender dysphoria, recognized as medically necessary by the American Medical Association, the Endocrine Society and the American Psychological Association. For patients with gender dysphoria, HRT has positive mental health benefits that are not produced by psychotherapy or other mental health medications.
“There are no psychotherapeutic interventions that have been demonstrated to be effective in alleviating gender dysphoria itself,” Dr. Randi C. Ettner, a clinical and forensic psychologist with expertise in diagnosis and treatment of dysphoria, writes in the lawsuit.
Consequences of not receiving gender-affirming care including HRT can be dire, medical experts and advocates say.
According to the lawsuit, materials from Centurion of Georgia–the contracted medical provider for the GDC–acknowledge that withdrawal symptoms of discontinuing HRT include mood changes, fatigue, anxiety, irritability, depression, headaches and joint pain.
“You would intervene in this person’s ability to have their being feel complete, to feel whole, to feel well. That’s ludicrous to me, and that’s what we’re dealing with here,” Perez said.
She says that without the ability to express themselves, many trans prisoners will face anger, fall into darkness, disassociation, and suicidal ideation.
Opponents to the law have filed a class action lawsuit accusing the state of violating the Eighth Amendment because denying medically-necessary care is cruel and unusual punishment. While the case is heard, lawyers are seeking to block Georgia from denying prisoners with a gender dysphoria diagnosis from access to HRT.
Inside-outside collaboration
Beyond direct legal challenges to anti-trans laws, advocates inside and outside of prisons are working to support and uplift trans prisoners.
Pooja Gehi, a lawyer and co-founded the advocacy organization Alyssa Rodriguez Center for Gender Justice, which she describes as an “inside-outside collaboration” that includes members who are currently incarcerated in New York, Georgia, Florida and Pennsylvania. Among other initiatives, the organization provides microgrants to prisoners to become paralegals and attend law school while incarcerated.
Gehi says it’s important that incarcerated members of the organization guide the work ARC Gender Justice does.
One way the group is working to do that is by creating a guide to administrative advocacy, something Gehi says members of the organization voted to initiate. “We’re kind of preparing people to be able to respond to the pieces of legislation and regulations that impact their lives,” she said.
Meanwhile, Georgia lawmakers continue their efforts to pass more legislation that restricts trans people inside and outside of prison from accessing gender-affirming care.
Perez says, “You know, I think the difference between us and the other side is they’re fighting for what the world used to be; we’re fighting for what we believe the world could be.”