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Texas Revises Prison Policy on Gender-Affirming Care
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Revised Texas Prison Policy on Gender-Affirming Care
The Texas Department of Criminal Justice (TDCJ) released a revised policy governing hormone therapy for incarcerated individuals with intersex conditions or diagnosed gender dysphoria. The document, supplied to Austin NBC affiliate KXAN, states that adults already on a documented hormone regimen may continue treatment unless a medical contraindication is identified. For minors, the policy permits continuation only for medication that began before June 1, 2023 and only if the youth completed at least 12 counseling or psychotherapy sessions over a minimum six-month period prior to starting treatment. Even in those cases, the medication must eventually be tapered off safely.
Background and Recent Changes
The policy was reviewed in July and follows a separate state law that requires transgender prisoners to be housed according to their sex assigned at birth. Advocates had feared that the disappearance of the prior policy from the TDCJ website signaled an end to gender-affirming care for roughly 1,100 incarcerated people. The revised document, however, remains unavailable in the department’s online manual, prompting continued scrutiny.
Treatment Provisions for Adults and Minors
- Adults: Continuation of hormone therapy is allowed unless medically contraindicated; prescriptions are to be refilled indefinitely through a non-formulary process during the initial evaluation.
- Minors: Continuation is limited to pre-June 1, 2023 regimens meeting counseling criteria, with a mandated eventual discontinuation. The policy also bars minors from initiating new hormone treatments or switching to other prohibited therapies under Texas law.
Medical Community Position
Major medical organizations—including the American Medical Association, American Academy of Pediatrics, American Psychiatric Association, and the Endocrine Society—advocate for individualized gender-affirming care for transgender adults and youth, recognizing hormone therapy as appropriate when clinical guidelines are met.
Potential Impact on Incarcerated Population
The revised rules maintain access for adults while imposing a phased withdrawal for minors, potentially affecting the health outcomes of the estimated 1,100 transgender inmates. The lack of public posting of the policy may limit transparency and hinder external oversight of its implementation.