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"People often have a knee-jerk reaction that public money shouldn't be spent on this," said Shannon Minter, a board member of the Transgender Law and Policy Institute.

"If people are not treated, they suffer tremendously," said Minter. "It's just as cruel to withhold treatment for gender identity disorder as it is to withhold treatment for any other medical issue."

Some states allow inmates to continue hormone treatments if they are already on hormones when they begin their sentences. But most do not allow inmates to initiate hormone therapy while in prison, and many states do not have any written policy for the treatment of transgendered inmates, said Cole Thaler, a transgender-rights attorney for Lambda Legal, a national advocacy group for homosexual, bisexual and transgendered people.