The state of general health and post-surgical care for transgender people in the U.S. prison system who have had Gender Affirming Surgery (GAS): Where are we and what challenges do we face?

The need for, and right to, medical and surgical care as treatment for gender dysphoria is increasingly recognized in the U.S. This is reflected in Federal, state, and commercial health policies that have eliminated... [ view full abstract ]

The need for, and right to, medical and surgical care as treatment for gender dysphoria is increasingly recognized in the U.S. This is reflected in Federal, state, and commercial health policies that have eliminated exclusionary riders that historically excluded transgender people from benefits covering transgender-specific medical and surgical care.

The Prison System in the U.S. (both Federal and for most for most State Prison Systems) and in other countries around the world is an important domain of our society where the call for recognition and equal access to population-specific healthcare needs for transgender people has seen little progress. The act of removing people from society and placing them in prison takes from people their ability to care for their own basic needs such as food, water, shelter, and access to medical care. The Supreme Court of the United States has long recognized that this act creates a great responsibility on the part of government.

1. We review the challenges that transgender people entering the prison face, and examine the current policies of the U.S. Federal and State prison systems that guide how transgender people are housed and cared for under the... [ view full abstract ]

1. We review the challenges that transgender people entering the prison face, and examine the current policies of the U.S. Federal and State prison systems that guide how transgender people are housed and cared for under the prison health system.

2. We discuss transgender people’s GCS surgery-related needs after they complete masculinizing and feminizing surgery – specific care needs and the rationale for each, and common-practice care regimens.

3. And we conclude by offering practical approaches to providing the needed care we describe within the prison environment.

Review of Federal and State prison legal and procedural policies governing the housing and care of transgender people. Review of common care practices related to transgender care in general and pre and post-genital gender... [ view full abstract ]

Review of Federal and State prison legal and procedural policies governing the housing and care of transgender people.

Review of common care practices related to transgender care in general and pre and post-genital gender affirming surgery.

Interviews with prison administrators.

Policy and practices review, and interviews. [ view full abstract ]

Policy and practices review, and interviews.

Currently, in the U.S., there is no formal policy governing the assignment of trans people to gender congruent prisons. Trans people are assigned to prisons based on the presence or absence of a penis (specifically). Active... [ view full abstract ]

Currently, in the U.S., there is no formal policy governing the assignment of trans people to gender congruent prisons. Trans people are assigned to prisons based on the presence or absence of a penis (specifically). Active use of gender congruent hormones, and past history of other gender surgeries such as orchiectomy, vaginectomy, and chest surgery have no bearing on assignment to a prison of a specific gender.

We found that to date, in the U.S. prison system, while there appears to be genuine interest within the U.S. Federal Prison system for providing more humane care for transgender inmates, there is no formal policy at all governing their care with respect to pre and post-genital surgery needs.

The primary barrier appears to simply be lack of education and teaching about the transgender population as a whole, and trans people's specific needs.

Prison policies governing the assignment of transgender people to gender-congruent prisons, and their care after admission, from other countries is difficult to access (similar to as how it is in the USA).

Within the U.S., and presumably a majority of other countries, there is no provision for assignment of inmates to a gender congruent prison. In addition to the negative effect such policies have on trans inmates basic... [ view full abstract ]

Within the U.S., and presumably a majority of other countries, there is no provision for assignment of inmates to a gender congruent prison.

In addition to the negative effect such policies have on trans inmates basic dignity, this fact also serves to compound the personal safety challenges and health care challenges that transgender people face within prison.
These "challenges" are in fact in line with violation of commonly respected human rights within the prison system.

As the visibility of transgender people increases in the U.S. and around the world, and as more rights-abuse cases are argued successfully in courts, the (U.S.) prison system is more motivated than in the past to better accommodate transgender people in prison.

Our findings suggest that a key barrier to advancing better policies is simply lack of education and teaching. Another chief barrier is the practicality of proposed policy changes within the restrictions of the prison system.

We conclude that the most fruitful starting point to address such complex and challenging questions is education and dialogue between administrators of the prison system and people expert in transgender healthcare, health policy and and human rights law.