Imagine that as a child you thought you had been born in the body of the wrong gender. If you were biologically male, in your mind you really thought of yourself as female. Likewise, if you were born in a girl’s body, you thought that you were actually a boy.

Yes, you were probably more interested in children’s role-playing games more often associated with the opposite gender as well, but the issue went much deeper than that. It was your core identity that was at stake. You knew that you were the other sex, at least in all ways except for the reproductive organs of your body.

You felt this way during childhood, but nobody seemed to understand or accept this about you. But you were dressed in the clothing of your biological gender and expected to participate in the activities stereotypically associated with it as well. Imagine that as your body matured in adolescence, you hated your penis if you had one, or likewise, you wanted to hide your developing breasts. You simply felt that you were trapped in the wrong body.

This experience is the gist of what transsexual or transgender persons face every day.

To some who have never met a transgender person, the concept itself may seem bizarre. I can assure you, though, that transgender people are not freaks; they are human beings who were born with a challenge that no person would choose to have.

Both in the community and in prisons, I have worked with several transgender patients over the years. They have taught me more about the challenges that they face every day than any book ever could have. Their life challenges, though, are magnified several-fold in jails and prisons.

The terms transgender and transsexual have approximately the same definitions, but transsexual is a medical term. However, please note that there is a great deal of debate and controversy about terminology that will be beyond the scope of this article. A brief overview can be found here.

Transgender does not imply anything about sexual orientation; it is all about gender identity.

Unfortunately, society can be a cruel place for anyone perceived as “different” from the norm. This issue could not be truer than in a prison environment.

Prisons in general are very black and white places. There are rules and regulations to handle different situations, and shades of gray tend to create confusion.

Men go to men’s prisons, and women go to women’s prisons. So, where do transgender people go?

Well, it depends. As far as I can tell, in most systems, those with a penis (present from birth or surgically constructed) go to men’s prisons. Those with a vagina go to women’s prisons. Sounds simple, right?

Not at all. First, assuming that the transgender person has not been taking hormones and has not had sex reassignment surgery (sex-change operation), he or she will likely have to psychologically endure being housed in an institution for those that the person perceives as being of the opposite sex.

What if a person with male genitalia who believes himself/herself to be female has started taking female hormones before the incarceration and has fully-developed breasts? Then, the person would likely end up in a men’s prison. That’s right, a penis and breasts, in jail with a bunch of men.

It is pretty easy to see how there are various possibilities that present challenges since transgender people do not easily fit into male and female categories.

Once incarcerated, regardless of the gender of their inmate peers, there are other challenges.

How can they avoid discrimination? My guess is that most security personnel in most institutions are not well-versed in working with transgender inmates. People often fear what they don’t understand, and there is a significant risk of these prisoners not being treated fairly. Likewise, I believe it’s rather obvious how transgender inmates potentially face significant harassment, intimidation, and violence from other inmates.

What about hormone treatment in prisons? Should inmates who are already receiving it on the outside be prescribed these medications in prison, too? What about sex reassignment surgery? Should taxpayers bear the burden of this for long-term prisoners? Some have argued that they should.

How should one address a transgender person: “he” or “she”? I’d suggesting asking them how they wish to be addressed. However, I will say that every transgender patient I’ve ever worked with wanted to be addressed as the sex they felt they really were, not as the gender into which they were born. This presents an interesting dilemma in a correctional environment because referring to any inmate as “she” in a men’s prison or vice versa elicits shocked and confused reactions from prison staff.

My purpose of this post is to raise awareness about challenges faced by transgender inmates, an issue that I rarely hear discussed and about which there is much ignorance. Transgender people deserve to be treated with dignity and respect just like anyone else. They deserve not to be discriminated against, and they deserve to be safely housed if incarcerated. However, there are many details involved in their custody and health care that will never be simple to solve.

Jeffrey Knuppel is a psychiatrist who blogs at Lockup Doc.

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