Sofia Cano, a 22-year-old transgender woman, finds herself trapped in the custody of the South Carolina Department of Corrections. Over four years have passed since prison system employees documented her gender dysphoria diagnosis, yet SCDC officials are preventing her from accessing essential medical care. This situation paints a grim picture of the state prison system's mistreatment of transgender individuals.

"Transgender Prisoner's Fight for Healthcare Rights in South Carolina"

The State of Gender-Affirming Healthcare in S.C. Prisons

The South Carolina Department of Corrections (SCDC) policy claims to provide "medically necessary care" throughout incarceration. However, there's an exception for gender dysphoria. Under a "freeze-frame" policy, hormones for hormone replacement therapy are not purchased or prescribed unless the incarcerated person was already using them before incarceration. This creates a double standard where patients can receive certain medications for other conditions but not for gender dysphoria.About 30 transgender women are currently in SCDC custody. The legal team has uncovered how the prison system fails to meet their basic needs. SCDC employees witness the suffering of transgender inmates denied healthcare like hormone therapy and basic dignity. They have even seen patients consider and attempt self-surgery due to the lack of proper care.The prison employs a Transgender Service Coordinator who had limited knowledge about transgender issues. Internal training documents refer to international standards but are often ignored.

Sofia's Story

Since July 2020, when a mental health care provider documented Sofia's gender dysphoria, the prison system has known about her serious medical need. Yet, for over four years, SCDC has cruelly denied her care, violating her 8th Amendment rights.Prison officials recognize that Sofia legally changed her name to Sofia in 2021, but they still misgender her and force her to wear a badge with her former name. Staff have heard her describe "persistent thoughts of death" due to her gender dysphoria. She even attempted auto-castration. In January 2023, the U.S. District Court ordered SCDC to evaluate her need for hormone therapy, but the chosen psychiatrist had no experience in initiating hormone therapy and ignored WPATH Standards of Care. The psychiatrist claimed there was "no evidence of distress" despite Sofia's statements and medical records.

The Broader Struggle

In recent months, Sofia has had daily thoughts of suicide. She struggles to sleep and concentrate on simple activities. Her joy in teaching fellow inmates and playing games has been overshadowed by the distress she feels about her body.During her long fight for healthcare, SCDC has offered different rationales for denying her care. First, it was based on a budget proviso interpretation. After the court rejected that, SCDC then claimed she didn't have gender dysphoria despite documentation to the contrary.SCDC's refusal to treat Sofia's medical condition is alarming. It violates the 8th Amendment and 14th Amendment. To learn more, visit the case page for Cano v. South Carolina Department of Corrections, read the blog post on her personal journey, and see the ACLU-SC v. Stirling case for the right to publish her story.