INTERWOVEN REMEDIES: THE HEALTHCARE–DISABILITY
OVERLAP IN GENDER-AFFIRMING CARE BEHIND BARS
D Dangaran*
ABSTRACT
This Article examines a dilemma in disability law in the prison context. The
Seventh Circuit held in Bryant v. Madigan that a disability cannot be “treated”
with medical care. That is, prescribed medical treatment cannot be a reasonable
accommodation under the Americans with Disabilities Act (ADA). Yet plaintiffs
often allege Eighth Amendment medical deliberate indifference claims and dis-
ability rights claims for the same injury. This Article situates this tension and
explains how plaintiffs have successfully navigated it. The argument is straight-
forward: if access to a medical service is discriminatorily barred or if a reasona-
ble accommodation is denied, then the plaintiff has an ADA claim. And if
medically necessary care is denied and the prison officials acted with deliberate
indifference, then the plaintiff also has an Eighth Amendment claim. The Article
illustrates how plaintiffs with gender dysphoria may navigate Bryant to pursue
reasonable accommodations under the ADA. Finally, the Article argues that
ADA claims are more advantageous than Eighth Amendment claims from a liber-
ationist perspective that resists ableism and the medicalization of trans people
and embraces the full spectrum of accommodations to gender dysphoria that
trans people may seek.
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1272
I. THE FLAWED AND OUTDATED REASONING OF BRYANT V. MADIGAN. . . 1279
A. The Supposed Dilemma Between Eighth Amendment and ADA
Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1279
B. The Inherent Tension Between Bryant and United States v.
Georgia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1283
C. Charting the Course: Bringing Simultaneous Eighth Amendment
and ADA Claims. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1285
II. SEEKING REASONABLE ACCOMMODATIONS FOR GENDER DYSPHORIA 1290
A. Reconceptualizing Reasonable Accommodations . . . . . . . . . . 1290
* Assistant Professor of Law (designate), University of Hawai‘i at Ma¯noa William S. Richardson School of
Law. With gratitude to my former colleagues at Rights Behind Bars for helpful conversations and for bringing
thoughtful litigation that has instilled my passion for disability law. I am so thankful for the feedback I received
at the West Coast Sexuality, Gender, & Law Conference 2025 from my excellent commentator Nathan Cisneros
and from Swethaa Ballakrishnen, Alexander Chen, Ederlina Co, Jill Engle, Katie Eyer, Diane Klein Kemker,
Hila Keren, and Marcelo Raimundo da Silva. Finally, many thanks to Jessica Clarke for providing very helpful
thoughts that helped to apply a final polish to the piece. I deeply appreciate the editors of the American Criminal
Law Review and the organizers of this Symposium for their generosity and attention to detail.
1271
B. Gender-Affirming Accommodations Behind Bars . . . . . . . . . . 1292
1. Major Life Activities Impaired by Gender Dysphoria . . . . 1292
2. Safety Accommodations . . . . . . . . . . . . . . . . . . . . . . . . . 1293
3. Access to Medical Services. . . . . . . . . . . . . . . . . . . . . . . 1294
III. IN DEFENSE OF ADA CLAIMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1296
A. Spectrum of Accommodations . . . . . . . . . . . . . . . . . . . . . . . . 1297
B. Ableism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1299
C. Medicalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1300
CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1304
INTRODUCTION
For nearly three years, I represented trans people in prisons across the country.
A number of my clients have filed prison grievances under the Americans with
Disabilities Act
1
(ADA) for their needs related to gender dysphoria.
2
For example,
my client Jane Doe, a trans woman incarcerated in Georgia, has used the ADA to
argue for reasonable accommodations that her prison facility could give her in
order to abate her gender dysphoric distress.
3
Specifically, I was able to help my
client receive the creative remedies she came up with in order to get her body look-
ing like it did before she was forcibly de-transitioned when her prison medical pro-
viders removed her from all hormone therapy for four years.
4
Because she could
not convince her facility to put her back onto hormone therapy, she requested
breast and buttock padding and body contouring, which would achieve the outward
gender expression of the feminized body fat redistribution that occurred on her hor-
mone therapy dosage.
5
Before she could receive the requested items, she experi-
enced severe impairment in her thinking; her mind was filled with thoughts of
suicide and self-harm, and she beat her head against the wall in order to stave off
those thoughts, until she finally gave in to them and attempted self-castration.
6
Only after enduring that painful experience, retaining attorneys who were able to
hire medical experts, and bringing a preliminary injunction motion has she been
able to receive hormone therapy again
7
and start to bring her gender expression
back to a feminine form, including with the hair removal cream and padding
awarded by the court.
8
If the ADA grievance process worked the way it ideally
1. Americans with Disabilities Act of 1990, Pub. L. No. 101-336, 104 Stat. 327 (codified as amended at
42 U.S.C. §§ 12101–12213 and at 47 U.S.C. § 225).
2. See Edmo v. Corizon, Inc., 935 F.3d 757, 769 (9th Cir. 2019) (per curiam) (“Gender dysphoria is a serious
but treatable medical condition. Left untreated, however, it can lead to debilitating distress, depression,
impairment of function, substance use, self-surgery to alter one’s genitals or secondary sex characteristics, self-
injurious behaviors, and even suicide.”).
3. See Doe v. Ga. Dep’t of Corr., 730 F. Supp. 3d 1327, 1333, 1335 (N.D. Ga. 2024).
4. Id. at 1333, 1340–42.
5. Id. at 1340–42.
6. Id. at 1333–35.
7. Id. at 1335–36 (noting Doe restarted hormone therapy).
8. Id. at 1341–42.
1272 AMERICAN CRIMINAL LAW REVIEW [Vol. 62:1271
should, she would have been able to gain these simple accommodations in com-
missary items years ago.
Jane Doe’s symptoms of gender dysphoria continue to be more manageable as
she utilizes these various accommodations and higher dosages of hormone therapy
that new medical providers have decided to give her. Although she does not have
everything she has asked for—and she still lives in a men’s prison—her gender
dysphoria has become less disabling. Her thoughts are less fixed on ideating self-
injurious behavior. There are still some serious waves of overwhelming suicidal
ideation, because her gender dysphoria is not fully treated, and maybe never will
be. It would take a miracle for her to truly reduce her dysphoria while still in a sex-
segregated facility. She will not be able to experience freedom and gender libera-
tion while incarcerated. Prison has an inherently disabling effect on all,
9
and makes
her gender dysphoria symptoms worse.
The Eighth Amendment’s cruel and unusual punishment clause
10
is the tradi-
tional pathway for seeking necessary medical treatment that has been denied in
prison.
11
The U.S. Supreme Court has held that the deliberate indifference to seri-
ous medical needs of an incarcerated person violates the Eighth Amendment.
12
To
support such a claim, an incarcerated person “must establish ‘an objectively seri-
ous [medical] need, an objectively insufficient response to that need, subjective
awareness of facts signaling the need, and an actual inference of required action
from those facts.’”
13
Courts have found an Eighth Amendment violation, for exam-
ple, when states enforced a complete ban on providing medically necessary care
for transgender people seeking to treat their gender dysphoria.
14
But even if Jane
Doe can’t fully treat her gender dysphoria, she should be able to accommodate it.
9. See LEAH LAKSHMI PIEPZNA-SAMARASINHA, THE FUTURE IS DISABLED: PROPHECIES, LOVE NOTES, AND
MOURNING SONGS 24 (Lisa Factora-Borchers ed., 2022) (“Prisons are spaces where people get disabled, or more
disabled.”). For a broader view of the criminalization of transgender people, as well as a summary of sociological
studies of incarcerated transgender people, see Valerie Jenness & Alexis Rowland, The Structure and Operation
of the Transgender Criminal Legal System Nexus in the United States: Inequalities, Administrative Violence, and
Injustice at Every Turn, 2024 ANN. REV. CRIMINOLOGY 283, 285–97 (2024).
10. U.S. CONST. amend. VIII (“Excessive bail shall not be required, nor excessive fines imposed, nor cruel
and unusual punishments inflicted.”).
11. See Estelle v. Gamble, 429 U.S. 97, 104 (1976).
12. Id.
13. Kuhne v. Fla. Dep’t of Corr., 745 F.3d 1091, 1094 (11th Cir. 2014) (quoting Taylor v. Adams, 221 F.3d
1254, 1258 (11th Cir. 2000)).
14. See, e.g., Fields v. Smith, 653 F.3d 550, 554–59 (7th Cir. 2011) (affirming permanent injunction enjoining
statute that banned hormonal therapy and gender-affirming surgery); Edmo v. Corizon, Inc., 935 F.3d 757, 803
(9th Cir. 2019) (per curiam) (“[W]here, as here, the record shows that the medically necessary treatment for a
prisoner’s gender dysphoria is gender confirmation surgery, and responsible prison officials deny such treatment
with full awareness of the prisoner’s suffering, those officials violate the Eight Amendment’s prohibition on
cruel and unusual punishment.”); Rosati v. Igbinoso, 791 F.3d 1037, 1039–40 (9th Cir. 2015) (per curiam)
(holding transgender plaintiff alleged deliberate indifference where prison denied gender-affirming surgery
because of a blanket policy); see also Colwell v. Bannister, 763 F.3d 1060, 1063 (9th Cir. 2014) (holding that a
“blanket, categorical denial of medically indicated surgery solely on the basis of an administrative policy . . . is
the paradigm of deliberate indifference”); Kothmann v. Rosario, 558 F. App’x 907, 911–12 (11th Cir. 2014) (per
curiam) (denying qualified immunity when a prison health official intentionally refused to provide accepted,
2025] INTERWOVEN REMEDIES 1273
