Journal Club: The Horrifying Consequences of Forced Detransition
Veronica examines a 1988 paper covering forcible detransition of incarcerated trans women.
by Veronica Esposito
As attacks against trans people continue to ramp up throughout the United States, the State of Florida has taken the radical step of medically and socially detransitioning incarcerated individuals. The American Civil Liberties Union reports that this includes withdrawing HRT, forcibly shaving the heads of trans women, and removing female clothing from them. There have also been reports of trans women in federal prisons losing similar access to gender-affirming medication and other items such as clothing.
These moves are extreme, as it is considered a settled part of both national and international law that prisoners should have their medical needs treated with care and dignity.
Decades before the Republican Party decided to forcibly detransition incarcerated trans women, the State of California was already doing it. A bizarre research paper from 1992 appears to document that the State of California unilaterally detransitioned all trans women inmates in 1988—seemingly based on the research conducted in that paper. If this is in fact true, the undoubtedly horrifying consequences for the trans women who were experimented on should be more widely known, especially since one of the three researchers involved—Edward Stanley Domurat—appears to still practice medicine.
To add to the bizarreness, the paper’s lead author, Lubomir J. Valenta, resigned from UC Irvine in the 1980s following allegations that, among other things, he participated “in illegal experiments on humans.” Valenta refuted the charges and was subsequently awarded cash compensation in a jury trial for wrongful termination.
Let’s dig into this horrifying paper. The authors conducted research on 86 trans women incarcerated in the California Medical Facility, a medical prison in Vacaville, CA, that exclusively houses male inmates. Valenta and colleagues explained that the CMF was the sole California prison housing female transsexual inmates, as the state had decided to consolidate them there. Up to the point of the research, these women were on HRT and presumably living as female, making it terrible to imagine that they were forcibly incarcerated with men.
Beyond subjecting trans women to incarceration alongside men, the CMF had other reasons to be considered a hellhole. A 1987 investigation of the facility found that it “deprived inmates of their right to be free from deliberate indifference to their serious medical needs.” It was also the subject of multiple lawsuits in the 1980s and ‘90s due to extremely poor conditions at the facility. One lawsuit alleged that it was “a filthy, vermin-infested, overcrowded prison.”
The 86 trans women incarcerated there ranged from 19 to 49 years old and had been on HRT from ages ranging from 12 to 41. Most of them had been on HRT for over seven years, and a third of them had been on HRT since their teenage years. Three of them were HIV positive, and more than a quarter of them reported having intercourse more than three times per week. Notably, Valenta and colleagues did not report whether or not this intercourse was consensual, even after finding that the vast majority of these women indicated that they had no libido.
According to Valenta et al., the following is why these women were detransitioned by the State of California in 1988:
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.
Nobody asked for these women’s permission or consent when they were detransitioned—it was just done to them. Notably, the authors of the paper make no efforts to rule out if elevated blood pressure (hypertension) or elevated concentration of lipids (hyperlipoproteinemia) could have been due to other factors than the provision of feminizing hormones. For one thing, hypertension could be due to many different factors, and it is generally not considered a side effect of feminizing HRT. In addition, the supposedly elevated concentration of lipids was only found in 7 of the 86 women and remained unchanged after cessation of HRT, bringing doubt as to whether this was even due to HRT.
Meanwhile, the researchers documented a horrifying array of “adverse symptoms” that resulted from taking away the medication from these women.
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.
It seems highly unlikely that nearly a third of the women studied reported no ill effects of having the HRT that they had been taking for years withdrawn. One also notes that 28 of the women in this study started HRT before the age of 20, meaning that they would have managed to avoid most of the ill effects of masculine puberty—cessation of their medical care would have had even more disastrous consequences than for those who had already experienced irreversible changes to their bodies.
Throughout, the authors of the paper misgender their subjects, referring to them as “males” and “homosexuals.” They define a “transsexual” as “an effeminate male intent on assuming the female phenotype.” The researchers also displayed a strange fixation on genitals, as the term “normal-sized penis” appears in three separate places in the paper. Imagine the violation these women must have felt as their penises were repeatedly measured in the name of science.
Comparisons can be drawn between the work of Valenta and colleagues and the infamous Tuskegee experiment, in which African American men infected with syphilis were lied to about their condition and given no treatment for the disease (despite penicillin being known at the time as an effective cure for syphilis). One of the key differences was that the perpetrators of the Tuskegee experiment agreed that untreated syphilis could have disastrous results, whereas it is clear that Valenta et al. did not view gender dysphoria as a real illness worthy of treating. Even if that was the case, as Zinnia Jones notes, the harms of leaving gender dysphoria untreated were known at the time:
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.”
This experiment, and the complementary practice of housing trans women in an all-male prison, are certainly black marks on the history of California—since then the state has made great strides, becoming much more friendly to LGBTQ+ people. Unfortunately, many parts of the United States are currently regressing back to those dark days. Valenta et al. 1992 gives an unfortunate look at the kinds of barbarity that may be in store for currently incarcerated trans people—and possibly those not in prison as well, as many U.S. states make increasingly aggressive efforts to deprive trans people of needed medical care.
Veronica Esposito (she/her) is a writer and therapist based in the Bay Area. She writes regularly for The Guardian, Xtra Magazine, and KQED, the NPR member station for Northern California, on the arts, mental health, and LGBTQ+ issues.