U.S. News

05.14.14

Yes, Chelsea Manning Should Get Hormone Replacement Therapy on Our Dime

Hey, Fox News: Gender dysphoria’s real, and an appeals court has ruled the standard treatment is more cost effective than other options for transgender people like the WikiLeaks leaker.

The cast of morning talk show Fox and Friends gave voice to conservative bigots everywhere Wednesday morning with a segment on the U.S. Army’s request to transfer transgender national security leaker Chelsea Manning to a federal prison.

“This person right here is about to get some special treatment from the Defense Department, and it’s on our dime,” said Steve Doocy of the Army’s move to help Manning begin hormone therapy to treat her gender dysphoria. Brian Kilmeade chimed in: “Right. He’s already cost us enough, hasn’t he?”

Chelsea Manning announced her intention to transition from male to female in a statement read on NBC’s Today show in August 2013, a day after being sentenced to 35 years for leaking classified national security information to WikiLeaks. The Army private, who legally changed her name from Bradley in April, has been diagnosed by more than one military doctor with gender dysphoria—a condition marked by a conflict between a person’s physical gender and one he or she identifies with—for which hormone replacement therapy is the standard treatment. No military prison, including the all-male Leavenworth, where Manning is incarcerated, offers treatment for transgender people.

The conservative backlash to Manning’s proposed treatment takes two forms: The first is that gender dysphoria isn’t a real thing; the second, the “not on our dime” argument, is purely economic. Both are cruel and ignorant.

“Some moron in the Pentagon thinks it would be considered ‘cruel and unusual’ punishment to keep ‘her as a him’!” wrote Tea Party darling Joe the Plumber. The failed congressional candidate seems to think Manning simply wants to be a woman. But according to the National Institute of Health, gender dysphoria is real and comes with risks of depression, anxiety, emotional distress, self-mutilation, and suicide.

“They cannot live the way they feel,” said Dr. Joshua Safer of the condition. “It’s like convincing someone not to eat or do some other natural behavior.”

Manning’s treatment, if she receives it, will likely be to take some form of estrogen taken orally, through injection, or by a skin patch, the health benefits of which are well documented. A 2011 study in the Journal of Gay & Lesbian Mental Health associated hormone therapy with lower levels of depression, anxiety, and stress, and higher levels of social support and an improved quality of life.

Lauren McNamara, a transgender woman who testified at the WikiLeaks trial, says she is a testament to the power of hormones for someone living with gender dysphoria. “I don’t think people understand what hormone replacement therapy does,” she said. “This is something that’s the best anti-depressant, anti-anxiety drug I have ever been on.”

As for whether treatment is too costly, it might behoove penny pinchers on the right to consider the return on investment. In 2011, the 7th Circuit Court of Appeals affirmed a ruling that struck down Wisconsin’s Inmate Sex Change Prevention Act, which banned the use of state or federal funds for hormone therapy or sexual reassignment surgeries for inmates. The appeals court ruled that hormone replacement was both necessary and cost-effective compared to other treatments offered as viable by Wisconsin’s Department of Corrections.

Hormone replacement therapy is the cheapest, most effective treatment for a condition that causes severe psychological distress.

From the ruling:

“The cost of providing hormone therapy is between $300 and $1,000 per inmate per year. The district court compared this cost to the cost of a common antipsychotic drug used to treat many DOC inmates. In 2004, DOC paid a total of $2,300 for hormones for two inmates. That same year, DOC paid $2.5 million to provide inmates with quetiapine, an antipsychotic drug which costs more than $2,500 per inmate per year. Sex reassignment surgery is significantly more expensive, costing approximately $20,000. However, other significant surgeries may be more expensive. In 2005, DOC paid $37,244 for one coronary bypass surgery and $32,897 for one kidney transplant surgery. The district court concluded that DOC might actually incur greater costs by refusing to provide hormones, since inmates with GID might require other expensive treatments or enhanced monitoring by prison security.

In other words, hormone therapy is the cheapest, most effective treatment for a condition that causes severe psychological distress. To withhold it not only is barbaric but in violation of the Constitution.

It was in the 1976 case Estelle v. Gamble that the Supreme Court ruled that “deliberate indifference” to a prisoner’s serious illness violates the the Eighth Amendment and constitutes cruel and unusual punishment.

So whether Chelsea Manning is transferred to a federal prison or the military will have to address for the first time the medical treatment of a prisoner with gender dysphoria, the end result will likely be hormone replacement therapy. And yes, taxpayers will pay for that treatment just like we would for any other necessary medical condition.