Did California state prisons perform unethical medical experiments on transgender women in 1987?

Zinnia JonesOver the past few years, I’ve made a regular habit of seeking out and compiling nearly any published research that’s relevant to trans people and our well-being in society. Often I focus specifically on the medical side of the transgender experience, looking into the past and present of which treatments are available to us and their physiological and psychological effects. Some of it provides useful insights into details of transness that not many people are aware of; much of it is repetitive, redundant, or mundane.

Very rarely, I find something horrifying.

When I pulled up “Hormone pattern in pharmacologically feminized male transsexuals in the California State prison system” by Valenta, Elias, & Domurat (1992), I expected to find data on the hormone treatments used at the time, physical measurements and blood parameters, and so on. And while that data was presented, this wasn’t the interesting part.

The study group consisted of all trans women in the California state prison system who were on hormone therapy, 86 in total:

Eighty-six transsexuals who were inmates of the California Medical Facility (CMF) were studied. The term “transsexual” used in this report describes an effeminate male intent on assuming the female phenotype initially by hormonal therapy and ultimately by surgical means. The individuals studied were not always transvestites; they represented the total transsexual population of the California State prison system who were treated with female sex hormones as of the end of 1987, because all such inmates were transferred statewide to CMF. According to prison policy at the time of study, inmates who presented proof of being treated with estrogens or progestogens prior to incarceration continued to receive treatment while in prison. . . . None of the males included in this study had been castrated, and all of them were known to have functioning testes as evidenced by male pubertal development and history of prior androgenization.

These trans women, who continued receiving HRT while in prison, had previously been on hormones for up to 21 years, with some having started at the age of 12:

The average age (± SD) of the inmates at the time they started hormone therapy was 21 ± 5 years (range: 12 to 41). The individuals were taking the hormone for 1 to 21 years, with a mean duration of therapy (± SD) of 7.3 ± 4.7 years. The hormone therapy might have been intermittent prior to their incarceration, but all received estrogen and progestogen consistently during their stay in prison, which was for at least 6 months prior to the present study. . . . Of the 86 inmates, 28 started hormone therapy before the age of 20 and had taken medication for 3 to 17 years (mean ± SD, 9.7 ± 5 years). Almost all these individuals were very poorly androgenized; most of them had never shaved regularly and their voices were high-pitched. However, there was no clear correlation between their lack of androgenization and their feminization. A subgroup of six individuals started the hormone therapy before the age of 14.

The study population was given a regimen of synthetic estrogen (ethinyl estradiol), conjugated equine estrogens (Premarin), and medroxyprogesterone acetate for a period of 6 months, with measurements taken of their hormone levels.

Here’s the kicker: every trans woman on HRT in the California state prison system was then taken off hormones, apparently indefinitely. Why?

In all individuals, hormone therapy was discontinued at the beginning of 1988 after it was decided that treatment was not beneficial to the inmates’ general health and could increase the risk of hypertension, hyperlipoproteinemia, and thromboembolic disease.

The nature of this decision, how it was reached, the evidentiary basis for such a policy change, and who ultimately made this decision are never explained. Arbitrarily and abruptly discontinuing a trans person’s hormone therapy is an unjustifiable medical choice even by the standards of the time: HRT has been known to be beneficial, effective, and medically necessary for the treatment of appropriately diagnosed gender dysphoria for decades prior to 1988. Three versions of the WPATH Standards of Care had already been published by this time; the DSM-III-R, published in 1987, notes under the diagnosis of transsexualism that “without treatment, the course of the disorder is chronic” and that “many people function better for years after such treatment”. No widely accepted standards of care, even at the time, would possibly support imposing this denial of care across the board on dozens of individuals – some of whom had been taking HRT for over 20 years, some since before they were teenagers, and all with the prior approval of the prison system.

What happened next? Masculinization, depression, anorexia – even seizures.

Withdrawal of therapy was also associated with adverse symptoms in 60 of the 86 transsexuals. Rebound androgenization, hot flashes, moodiness, and irritability or depression were the most frequent complaints, followed by headaches, sweats, weight loss, anorexia, tiredness, feeling “ill,” paresthesias, seizure, constipation/diarrhea, and skin changes. Androgenization evidenced by return of penile erections and progressive return of male body hair pattern usually occurred after several weeks of sustained therapy withdrawal.

No rationale is given for how the risks associated with HRT were so significant as to outweigh the reality of what these women experienced when this treatment was abruptly stopped. Yes, the study authors gathered physiological data on the women’s hormone levels after their HRT was withdrawn. But they exhibit no concern for the ultimate fate of 86 vulnerable incarcerated trans women who were suddenly deprived of a medically necessary treatment they’d been receiving for years.

The study makes no note of any institutional review board that approved these experiments, only stating that one of the authors obtained “informed consent” from these women. It is questionable whether any of these women – again, many of whom had been taking HRT for decades – would indeed consent to having this treatment completely withdrawn. And no information is given on when or whether these women were ever able to obtain HRT again while incarcerated.

Did California state prisons perform unethical medical experiments on trans women? Yes. And that’s really, really bad.

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About Zinnia Jones

My work focuses on insights to be found across transgender sociology, public health, psychiatry, history of medicine, cognitive science, the social processes of science, transgender feminism, and human rights, taking an analytic approach that intersects these many perspectives and is guided by the lived experiences of transgender people. I live in Orlando with my family, and work mainly in technical writing.
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