User:Mosadzi1/LGBT people in prison

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This section will provide an overview of current federal case law on gender-affirming healthcare in prisons in the United States. Incarcerated people are the only group in the United States that have a constitutional right to healthcare. Transgender people incarcerated in U.S. prisons can assert legal challenges under the 8th Amendment to access gender-affirming and gender-transition-related care under the framework first articulated in Estelle v. Gamble. Eighth Amendment claims can be brought either under 42 U.S.C. § 1983 for state prisoners or under a Bivens action to address deliberate indifference and denial of healthcare in federal prisons.

Gender-affirming Care

Gender-affirming care can be understood as encompassing both medical (non-surgical), social, and surgical interventions. Under the World Professional Association of Transgender Health (WPATH) “Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People,” gender-affirming healthcare is broadly defined as “primary care, gynecologic and urologic care, reproductive options, voice and communication therapy, mental health services (e.g., assessment, counseling, psychotherapy), and hormonal and surgical treatments.” Gender-affirming healthcare is widely regarded as a "life-saving" practice" both by physicians and members of the transgender and nonbinary community.

Legal Overview of Federal Court Decisions

Various courts have addressed the constitutionality of denying transgender people in prison gender-affirming care, including hormone therapy, mental healthcare, gender confirmation surgery, and grooming. Several U.S. Circuit Court of Appeals have held that the prison’s duty to treat serious illnesses includes the treatment of gender dysphoria. Other Circuits have held that prison bans on hormonal therapies constitute deliberate indifference in violation of the 8th Amendment. There is some disagreement among Circuits as to whether denial of gender confirmation surgery constitutes deliberate indifference. Some lower courts have affirmed that prohibitions on gender-affirming grooming are also unconstitutional.