Georgia prisons won’t provide gender-affirming care, lawsuit alleges

State officials have denied necessary, gender-affirming care to a 55-year-old incarcerated transgender woman, causing her to attempt suicide and mutilate herself, according to a lawsuit filed today against the Georgia Department of Corrections (GDC) and the two for-profit healthcare companies that provide medical care to the state’s prisoners: MHM Services, Inc. and Wellpath.

The plaintiff, identified in court documents as Jane Doe, says she has been denied gender-affirming surgery even though three psychiatrists and a psychologist from GDC have determined she requires it.

According to the complaint, GDC’s repeated refusal to provide Doe with the gender-affirming care several health professionals recommended shows Georgia’s corrections department has an unconstitutional “blanket ban” on providing gender-affirming surgeries to transgender people in their custody.

For years, incarcerated people in Georgia have fought to receive gender-affirming medical care. In 2014, Appeal contributor Christina Lynch sued two physicians after she was denied gender-affirming care while incarcerated in Georgia. Across the country, states have considered legislation that would ban gender-affirming surgeries for incarcerated people. One such bill became law in Indiana this year. The law could impact at least 117 trans, nonbinary, and intersex people who are incarcerated in the state’s prison system.

Doe and her attorneys are asking the court to order GDC and medical providers to provide her with the gender-affirming care she requires, including gender-affirming surgeries, hormone replacement therapy, and mental health care.

They are also asking that the court order the GDC to provide Doe with items from the women’s commissary, allow Doe to shower during a separate time away from other incarcerated people and male guards, and transfer Doe out of solitary and into the general population unit of a women’s facility.

“GDC has refused to treat Ms. Doe despite her severe and overwhelming gender dysphoria, which include two castration attempts, multiple suicide attempts, and almost daily self-harm,” the lawsuit states. “GDC’s refusal to provide her with necessary care have worsened her gender dysphoria symptoms by feeding the thought that Ms. Doe might never be able to live in a body that looks like her gender identity.”

The Appeal has contacted GDC, MHM, and Wellpath and will update the story with their responses.

Doe is currently incarcerated at Phillips State Prison. She’s been in GDC custody since 1992. Her attorneys say she has identified as a woman since she was a child and experienced anguish from being forced to live as a boy when she felt like a girl.

In 1988, when she was around 20 years old, she began publicly living and expressing herself as a woman. She dressed as a woman and sought surgical reassignment but was unable to obtain it. When she arrived in GDC custody four years later, she was placed in a men’s facility. She says she has been forced to remain in men’s facilities despite identifying as a woman for the past three decades.

Two years after arriving in prison, Doe attempted suicide, according to her lawsuit. Still locked up with men and not receiving the care she needed, Doe tried to take her own life again four years later. It wasn’t until 2015 that the Georgia Department of Corrections finally began providing Doe with gender-affirming medical care.

In late 2015, Doe began testosterone blocker therapy. She received a prescription for hormone replacement medication two months later. For four years, Doe says she received a small portion of the care she needed, and as a result, some of her distress was relieved, and her gender dysphoria symptoms reduced. She developed breasts and gained weight in her hips, thighs, and buttocks. The growth of her body hair slowed. Yet still, the GDC housed her with men and refused to allow her access to female commissary items, like makeup, nail polish, or a wig.

So Doe tailored her clothes and made homemade nail polish out of wax. But Doe’s lawyers say GDC officials took those items away. When Doe grew her hair out, GDC staff allegedly held her down and shaved her head.

Even with the hormone replacement therapy, Doe’s gender dysphoria persisted. She still wanted the gender-affirming surgery she had first sought decades earlier before she was incarcerated.

In 2016, the lawsuit says, two health care providers—a psychiatrist and a psychologist from MHM—recommended Doe receive gender-affirming surgery. However, the warden denied Doe’s request to be considered for gender-affirming surgery. Doe says she appealed the decision, but the GDC’s statewide medical director also denied that request.

Distraught by the administration’s refusal to provide her with the gender-affirming care she so badly needed, the lawsuit says Doe again attempted to kill herself in 2017. In 2018, she was sexually assaulted. Then, in June 2019, a physician employed by Wellpath suddenly discontinued Doe’s hormone replacement therapy.

Doe says the abrupt cessation of crucial hormones caused significant emotional, psychological, and physical distress. Her face and chest hair returned, her breast size reduced, and she experienced severe nausea and vomiting. She felt anguished, depressed, and hopeless.

One month later, Georgia State Prison officials allegedly placed Doe in solitary confinement. In December 2019, Doe attempted suicide again. Per GDC policy, prison officials did not move Doe to a crisis stabilization unit. Instead, they left her languishing in solitary—where she remains to this day.

“Ms. Doe is one of the strongest people I’ve ever met,” said D Dangaran, director of Gender Justice at Rights Behind Bars, one of the groups representing Doe. “She endured four torturous years without hormone therapy and struggled through a deep depression as she watched her body detransition.”

Distraught by the administration’s refusal to provide her with the gender-affirming care she so badly needed, the lawsuit says Doe again attempted to kill herself in 2017. In 2018, she was sexually assaulted. Then, in June 2019, a physician employed by Wellpath suddenly discontinued Doe’s hormone replacement therapy.

Doe says the abrupt cessation of crucial hormones caused significant emotional, psychological, and physical distress. Her face and chest hair returned, her breast size reduced, and she experienced severe nausea and vomiting. She felt anguished, depressed, and hopeless.

One month later, Georgia State Prison officials allegedly placed Doe in solitary confinement. In December 2019, Doe attempted suicide again. Per GDC policy, prison officials did not move Doe to a crisis stabilization unit. Instead, they left her languishing in solitary—where she remains to this day.

Her gender dysphoria worsened in solitary without care. She says she had panic attacks, insomnia, and constant suicidal ideation. She beat her head against the wall to stop thinking about killing or castrating herself.

In April 2022, GDC transferred Doe to Phillips State Prison. Doe has repeatedly requested medical assistance and gender-affirming surgery but says her requests were denied. In June 2022, the mental health clinical director of Phillips State Prison allegedly told Doe he could not evaluate her for gender-affirming surgery and, according to the complaint, told her: “If you were to attempt self-castration again, maybe while at the hospital, they’ll just go ahead and cut your gonads out.”

In July 2022, Doe says she attempted to castrate herself by tying nylon threads around her testicles. She was transported to the hospital in excruciating pain.

Another psychiatrist employed by MHM evaluated Doe and recommended that medical providers grant Doe gender-affirming surgery. The doctor also recommended that Doe receive gender-affirming items and medical treatment.

But Doe says the Phillips State Prison administration still refused to provide Doe with life-saving treatment. Doe says the administration also refuses to transfer Doe to a women’s prison because GDC policy requires that transgender women who have not had gender-affirming surgery remain housed in men’s facilities.

“A prison sentence should not include the utter disregard for medical needs,” Doe’s attorneys wrote in the complaint. “Ms. Doe brings this lawsuit to access the gender-affirming medical care that her mental health clinicians have found she needs” and secure “a housing transfer to end the constant violence she has endured in men’s prisons, which has included rape, robbery, and constant verbal harassment.”