Advocacy — United Nations
On 11 October 2026 Eden Openly submitted written evidence to the UN Independent Expert on protection against violence and discrimination based on sexual orientation and gender identity, for the Independent Expert’s report to the Human Rights Council on LGBT persons deprived of liberty. Our evidence addresses one question: what should happen to a trans adult’s established hormone therapy when they are arrested, detained, transferred or released.
Our central point
In custody, an established hormone regimen should be changed or stopped only at the person’s request or for an individual clinical reason. Uncertainty does not make a non-clinical interruption neutral; it is the interruption that needs justifying.
In custody, the detaining authority controls access to medication. Arrest, admission, transfer and release are each points at which a prescription can lapse without any clinician deciding that it should. In interviews with ten trans women in one US county jail, seven reported using hormones and six reported disruption at intake, largely because they could not produce a prescription. That shows the failure happens; it does not show how often.
What the evidence shows, and what it does not
We set out the evidence at its true strength, including where it cuts against the case for continuity.
- After removal of the ovaries or testes, prolonged inadequate hormone replacement is an established risk to bone. The skeletal effect of short interruptions has not been measured.
- Supplying only part of a regimen can cause hormone deficiency, but whether it does depends on the drugs. Withholding oestradiol while a long-acting GnRH-agonist depot is still suppressing the gonads is not the same as withholding it alongside spironolactone.
- The one trial of stopping followed 19 trans women aged 59 to 78, all after gonadectomy, who chose to stop oestradiol for about 12 weeks. Off treatment, 37% reported hot flushes and 26% mood swings; average depression, anxiety and quality of life did not change. The trial was small, uncontrolled and voluntary, and says little about involuntary interruption in custody.
- Two scoping reviews of healthcare for incarcerated trans people, covering 15 and 57 publications, found no study designed to estimate how often interrupting an established prescription causes harm, or how much. Reports of such harm are qualitative.
Thin evidence is not evidence of safety. Our conclusion is a human-rights one, not a scientific finding.
What we asked for
- Reconcile medication on arrival from every available source, and continue an established, appropriate regimen without undue delay. Where documents are incomplete, decide clinically on interim supply rather than let paperwork cause a gap.
- Change or stop established treatment only at the person’s request or for an individual clinical reason, with medication-specific assessment, documentation and monitoring.
- Treat indicated hormone therapy after removal of the ovaries or testes as medically necessary chronic treatment.
- Supply clinically coherent regimens: do not keep the gonads suppressed while withholding the hormone replacement prescribed with the suppression.
- After prolonged loss of hormone replacement following gonadectomy, assess bone health and measure bone density when clinically indicated.
- Ask national preventive mechanisms and national human rights institutions to monitor continuity of hormone treatment, including at transfer and release.
- Include an adequate bridging supply of medication, and linkage to community care, in release planning.
What happens next
The Independent Expert’s report is due to be presented to the Human Rights Council at its 65th session, in 2027. Submissions are normally published on the website of the UN Office of the High Commissioner for Human Rights; we will link ours here when it appears.
Read our submission in full (PDF, 4 pages, with all 23 references).
The submission draws only on published literature and guidance, and names no individuals. Eden Openly receives no funding from, and has no commercial relationship with, any provider of gender-related healthcare or any pharmaceutical company. The author is a transgender woman receiving gender-affirming hormone therapy, and declares her interests in full on our declared interests page; see also our statement of independence. The submission and this page are licensed CC BY 4.0. Corrections and queries: [email protected].
Version history. v1.0, 11 October 2026 — first published.
