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Barriers to post-transgender surgery care in the federal prison system

Garcia, M1; Goldbold, P2

1: Cedars-Sinai Medical Center, United States; 2: Prison Law Center

Objectives: The Prison System in the U.S. (both Federal and for most for most State Prison Systems) 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. 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. 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. We conclude by offering practical approaches to providing the needed care we describe within the prison environment.

Methods: 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, and interviews with prison administrators.

Results: 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 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.

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


Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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