Gender-Affirming Care, Incarceration, and the Eighth Amendment

As outlined in Estelle v Gamble (1976), the 8th Amendment to the US Constitution requires that states provide adequate care for people who are incarcerated-but what constitutes "acceptable" care under professional guidelines is frequently at odds with the standard of care used by clinicians outside of carceral facilities. Outright denial of standard care runs afoul of the Constitutional prohibition on cruel and unusual punishment. As the evidence base that undergirds standards of care in transgender health has evolved, people who are incarcerated have sued to expand access to mental health and general health care, including hormonal and surgical interventions. Carceral institutions must transition from lay administrative to licensed professional oversight of patient-centered, gender-affirming care.