Texas Department of Criminal Justice policy G-51.11, reviewed in July 2026, confirms that adult transgender and intersex inmates with an existing gender dysphoria diagnosis will continue hormone therapy unchanged. However, inmates under 18 must now be weaned off hormone medications under Texas's 2023 ban on youth transition care. Even Texas, in this narrow corner, has acknowledged that withdrawing hormone therapy from someone already on it causes harm, and that acknowledgement sits in sharp contrast to the broader picture of care being stripped away from trans people across the country.

What the revised policy actually says

The story begins with a disappearance. Advocates noticed last month that TDCJ's policy on hormone therapy for transgender and intersex inmates had vanished from the agency's online manual. KXAN asked questions in late August. TDCJ responded earlier this week by releasing the updated version of policy G-51.11, stamped with a July 2026 review date, replacing the July 2025 version.

For adult inmates, the core protection holds. Anyone who arrives with an existing gender dysphoria diagnosis continues on the same documented hormone regimen, with indefinite refills. The revised policy also removes a previous requirement for a mental health evaluation to identify comorbid conditions, though a designated Gender Dysphoria Specialty Clinic provider must still make or confirm the diagnosis and monitor medication. That second change is, in practice, a small reduction in bureaucratic gatekeeping, and is not unwelcome.

For inmates under 18, the picture is starkly different. They must now be weaned off hormone medications "in a manner that is safe and medically appropriate and that minimises the risk of complications." The mechanism is Texas's 2023 ban on gender-affirming care for minors. The policy applies it here too. A young person who arrived at a TDCJ facility already on hormones, possibly having been on them for years, is now having that care removed while they are incarcerated and have no power to seek it elsewhere.

The policy still isn't on the website

Here is the thing that should give everyone pause. Despite all of this, the policy is still not publicly visible on TDCJ's website. The 2026 disease management guidelines no longer include gender dysphoria monitoring guidance, even though the 2025 edition did. The approved medications list, which does include HRT for gender dysphoria, can be found by searching, but doesn't appear where it should on the agency's publications list.

A policy that only exists because a journalist filed a public information request is not really a public policy. The TDCJ communications director told KXAN that "medical providers evaluate patients and prescribe medication in accordance with medical standards of care." That sentence is doing a great deal of quiet work. It says nothing about whether the policy is in effect, nothing about how practitioners are being directed, and nothing about the young people being weaned off treatment right now.

What Texas has, however reluctantly, admitted

There is something in this policy that is easy to miss. The decision to continue hormone therapy for adult inmates, rather than halt it, reflects a basic clinical reality: withdrawing hormones from someone who has been on them causes harm. TDCJ's own policy, even in Texas, even in 2026, acknowledges that. The continuation is not described as an act of generosity or affirmation. It is described as medical continuity. And medical continuity is, at its core, the argument that has always been made for gender-affirming care. Starting someone on a medication and then pulling it away arbitrarily is not neutral. It causes physical and psychological harm. Texas knows this. The policy says so, implicitly, every time it mandates a safe and gradual winding-down for the young people it is removing from care, rather than simply cutting them off.

That is not a vindication but a contradiction. The state that has spent years insisting that hormone therapy for trans young people is dangerous and unproven is quietly running a managed withdrawal programme for incarcerated teenagers, precisely because it knows abrupt cessation is harmful. It cannot have it both ways, and I hope someone says so in court.

The people inside this policy

Fewer than 2,000 transgender people are incarcerated in Texas prisons, according to TDCJ figures from August. That is 0.11% of the total prison population. A small number, easy to overlook if you are looking for a reason to overlook them. Since Senate Bill 8 passed in 2025, they are housed in units matching their sex at birth, which for trans women means the male estate, with everything that brings.

I think about what it means to be a trans young person in that system right now. Incarcerated, housed in a unit that denies your identity, and now being told that the hormones you may have been on for years are being taken away. Not because your doctor decided it was clinically appropriate. Because the state of Texas decided it was politically convenient. The policy presents this in careful language about medical safety and managed withdrawal, and I suppose managed is better than abrupt. But no version of this is care. It is the removal of care, in measured steps, by a system that does not believe trans young people deserve it.

The adult inmates fare better, and I am glad for that. It is a real protection, however narrowly it was preserved and however reluctantly it was confirmed. But a protection that exists only in a document nobody can find on a website, confirmed only because a journalist kept pushing, is a fragile thing. The moment the political wind shifts, or the next legislative session arrives, that protection will be tested again.

What TDCJ said publicly this week is that medical providers prescribe in accordance with medical standards of care. I would like to believe that. I would like to believe it applies equally to every person in their custody, regardless of age, regardless of gender, regardless of how inconvenient their healthcare needs are to the people in power. The evidence of the last few years suggests I should not assume it without checking.

If there is a news story you would like me to cover then just let Sammy know.

Dr Helen Webberley is a gender specialist, medical educator, and founder of GenderGP. She writes about gender diversity, trans healthcare, and the lives at the centre of both.