A federal judge in Florida on Wednesday issued the most affirming judicial opinion about transgender people I’ve ever read.

For several years, the Florida prison system denied Reiyn Keohane access to hormones and prevented her from following the dress and grooming standards that all other women are subjected to, because she is a woman who has been placed in a male facility.

Despite the fact that she was diagnosed with gender dysphoria and had been receiving hormone therapy prior to her incarceration, Florida told her she would never get access to hormones in prison. Even though she began to live publicly as her true self at age 14, years before she was incarcerated, prison officials buzzed her hair short, made her wear boxer shorts, and confiscated her women’s underpants and bras as contraband. The refusal to allow her to express her femininity caused her severe distress that resulted in several attempts at self-castration and suicide.

Under the Constitution, the state can’t be “deliberately indifferent” to the serious medical needs of prisoners. It’s a tough standard to meet, but after listening to the evidence the ACLU and ACLU of Florida put on at trial, Judge Mark E. Walker, the chief judge for the Northern District of Florida, saw a clear constitutional violation. He wrote:

And if Ms. Keohane’s treatment in Defendant’s custody isn’t deliberate indifference, then surely there is no such beast. Ultimately, this case is about whether the law, and this Court by extension, recognizes Ms. Keohane’s humanity as a transgender woman. The answer is simple. It does, and I do.

Judge Walker concluded his opinion stating “Ms. Keohane is not an animal. She is a transgender woman. Forthwith, Defendant shall treat her with the dignity the Eighth Amendment commands.”

Compassion for people in prison is so rare, those passages make me tear up. 

This is one of very few decisions to hold specifically that social transitioning — the ability to live as a woman in daily life — can be part of medically necessary care for transgender people in prison, just as it is in the outside world. The judge explained:

For purposes of this order, “social transitioning” refers only to Ms. Keohane’s request for access to Defendant’s clothing and grooming standards for female inmates. To be clear, Ms. Keohane is not requesting permission to wear stiletto heels or costume jewelry while in Defendant’s custody. Instead, she’s only ever sought to be treated like any other female inmate in this state. This includes the ability to possess and wear the same bras, panties, hairstyles, and makeup items permitted in Defendant’s female facilities.

And he made clear why this is so important: “All inmates, male and female, are severely limited when it comes to self-expression. For Ms. Keohane, aside from using the appropriate pronouns, the only way she can express her gender identity in prison is by wearing women’s undergarments and grooming like a woman.”

The portion of the decision that requires the state to let Reiyn follow the women’s hair length standards is particularly important — and a legal first. This decision was issued five years to the day after Chelsea Manning came out as transgender and was told by the United States government in no uncertain terms that she would not get any treatment for her gender dysphoria while she was in prison. In Chelsea’s case, the Department of Defense, which was holding her in a military prison, ultimately treated her with hormones after we sued, but forced her to maintain male hair-length standards until her release. 

The decision in Reiyn’s case shows how important — and how powerful — the judicial system can be. It can force the state to change its policies and thereby transform the lives of people like Reiyn. And it can also inspire all of us to live up to the ideals in our Constitution. Here’s hoping this decision not only creates concrete change on the ground, but that it inspires more people — in prisons and elsewhere — to open their hearts to our fellow human beings, including our transgender friends, colleagues, and community members.

James Esseks, Director, ACLU Lesbian Gay Bisexual Transgender & HIV Project