Trans Kentucky Prisoner Loses Bid to Block State’s New Ban on Hormone Replacement Therapy
On September 12, 2025, the U.S. District Court for the Eastern District of Kentucky rejected a desperate plea from a transgender state prisoner who had been receiving hormone replacement therapy (HRT) for her gender dysphoria for nine years before a new anti-trans state law was passed, and her medication was discontinued.
The prisoner, Maddilyn Marcum, had been receiving HRT since 2015. But her dosages were tapered down to nothing in August 2025 by employees of Wellpath, the private firm contracted to provide healthcare to those confined by the state Department of Corrections (DOC). The DOC, in turn, said that its hands were tied by Ky. Rev. Stat. § 197.280, a new law that took effect on June 27, 2025, which specifically banned the use of state funds for “[p]rescribing or administering cross-sex hormones,” as well as “[p]erforming any gender reassignment surgery.”
With the aid of attorneys from the American Civil Liberties Union (ACLU), Marcum filed suit against DOC Commissioner Cookie Crews, calling the move to discontinue her HRT a violation of her Eighth Amendment guarantee of freedom from cruel and unusual punishment. As the district court noted, that meant her complaint challenged the constitutionality of the new law, both on its face and as applied to her; for the former reason, her complaint was further styled as a putative class-action to represent both Marcum and all others similarly situated.
Marcum asked for a temporary restraining order (TRO) to keep her HRT from being discontinued. But the district court denied that request, setting briefing for a preliminary injunction while the merits of her case were considered. The state intervened in the case to defend its statute, opposing both the injunction and granting class certification to the case. The district court sided with the state and refused all of Marcum’s requests, and the reasons provide important guidance to other prisoners faced with similar circumstances.
The biggest obstacle that Marcum faced, it turned out, was procedural: She simply failed to supplement the record with sufficient facts to support her case. Marcum had a declaration from a provider with Appalachia Regional Healthcare (ARH), the DOC’s mental health care contractor, which said that it was his understanding that a gender dysphoria diagnosis existed for her (as the district court emphasized). But that was insufficient. Crucially, there was no official diagnosis presented, not even a letter from a medical provider qualified to offer an opinion on it. Without such evidence in the record to support the prisoner’s contention that she suffered from gender dysphoria, the district court said that her argument was “resting on inference, rather than proof” that a serious medical need was being ignored, and it was therefore impossible to find any violation of her Eighth Amendment rights.
Kentucky will likely not be the last state to come after trans prisoners’ HRT, so it is important to note a declaration offered on Marcum’s behalf by Dr. Dan H. Karasic, a Professor Emeritus of Psychiatry at the University of California and contributing author of the Standards of Care, Versions 7 and 8, of the World Professional Association for Transgender Health (WPATH). He said that § 197.280 was “contrary to widely accepted evidence-based medical protocols for the treatment of gender dysphoria and puts these individuals at risk of significant harm, including heightened risk of depression, self-harm, and suicidality.” The district court said that it found his declaration credible. Unfortunately for Marcum, her lack of a gender dysphoria diagnosis left the court with “doubts as to the relevance of some of his conclusions as it pertains to this case.”
Also noteworthy for prisoners in Marcum’s position, the district court found credible a declaration from Defendant’s expert, endocrinologist Dr. Michael Laidlaw, who ridiculed WPATH “as an advocacy organization for promoting social and political activism rather than as a strictly scientific organization.” As the ruling noted, “[c]ases involving dueling medical experts will typically not support an Eighth Amendment claim.” To tip the scales in her favor, Marcum relied on three experts to contest Laidlaw—Karasic and two ARH mental health providers. But the district court ultimately faulted that strategy because she offered no evidence that anyone but Karasic was qualified to render an expert opinion.
Accordingly, Marcum’s request for a preliminary injunction was rejected. A subsequent request for a temporary injunction while she pursues an appeal was also denied on September 19, 2025. See: Marcum v. Crews, 2025 U.S. Dist. LEXIS 178596 (E.D. Ky.); and 2025 U.S. Dist. LEXIS 184135 (E.D. Ky.).
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Related legal cases
Marcum v. Crews
| Cite | 2025 U.S. Dist. LEXIS 178596 |
|---|---|
| Level | District Court |
Marcum v. Crews
| Year | 2025 |
|---|---|
| Cite | 2025 U.S. Dist. LEXIS 184135 (E.D. Ky.) |
| Level | District Court |