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National Commission on Correctional Health Care Transgender Health Care in Correctional Settings 2009

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National Commission on Correctional Health Care
Transgender Health Care in Correctional Settings
Transgender people face an array of risks to their health and well-being during incarceration.
They are commonly placed in correctional facilities according to their genitals and/or sex
assigned at birth, regardless of their safety needs or gender presentation. Incarcerated transgender
people are often targets of physical assault and emotional abuse. The health risks of
overlooking the particular needs of transgender inmates are so severe that acknowledgement of
the problem and policies that assure appropriate and responsible provision of health care are
The term transgender refers to a diverse group of people who identify or express their gender in a
way that does not match traditional ideas about the sex they were assigned at birth. Transgender
women are people who were assigned the sex of male at birth and who now identify as women.
Transgender men are people who were assigned the sex of female at birth and who now identify
as men. Transgender people may identify as men, women, neither, both, or as another gender.
Transgender people can be any race, sexual orientation, age, religion, body type, socioeconomic
background, or national origin.
The National Commission on Correctional Health Care publishes Standards for prisons, jails,
and juvenile justice facilities, which address Board approved recommendations for an adequate
health care delivery system and address issues such as patient confidentiality, discharge
planning, qualified health care professionals, medication availability and delivery, and staff
training. Position statements are intended to provide information on the management of specific
problems not addressed in the Standards.
Position Statement
Prisons, jails, and juvenile justice facilities have a responsibility to ensure the physical and
mental health and well-being of transgender people in their custody. Correctional health staff
should manage transgender inmates in a manner that respects the biomedical and psychological
aspects of a Gender Identity Disorder (GID) diagnosis. The National Commission on
Correctional Health Care recommends that the following principles guide correctional health
care professionals in addressing the needs of transgender inmates:


Transgender Health Care in Correctional Settings, Page 2 of 3


The management of medical (e.g., medically necessary hormone treatment) and
surgical (e.g., genital reconstruction) transgender issues should follow accepted
standards1 that have been developed by professionals with expertise in transgender
health. Determination of treatment necessary for transgender patients should be on a
case-by-case basis. Ideally, correctional facility health professionals should be
trained in transgender health care issues. Alternatively, correctional health staff
should have access to other professionals with expertise in transgender health care to
help determine appropriate management and provide training in transgender issues.


Because inmate-patients may be under different stages of care prior to incarceration,
there should not be blanket administrative or policies that restrict specific medical
treatments for transgender people. Policies that make treatments available only to
those who received them prior to incarceration, or limit GID treatment to
psychotherapy should be avoided. Policies that attempt to “freeze” gender transition
at the stage reached prior to incarceration are inappropriate and out of step with
medical standards, and should be avoided.


Diagnosed transgender patients who received hormone therapy prior to incarceration
should have that therapy continued without interruption pending evaluation by a
specialist, absent urgent medical reasons to the contrary. Transgender inmates who
have not received hormone therapy prior to incarceration should be evaluated by a
health care provider qualified in the area of transgender health to determine their
treatment needs. When determined to be medically necessary for a particular inmate,
hormone therapy should be initiated and sex reassignment surgery considered on a
case-by-case basis. Regular laboratory monitoring should be conducted according to
community medical standards.


Treatment for genital self-harm, and for complications arising from prior surgery or
from forms of self-treatment, should be provided when medically necessary.


Correctional health care providers should provide patient education materials to help
transgender patients cope with their diagnosis and treatment.


Psychotherapy such as “reparative” therapy or attempts to alter gender identity should
not be employed. Reparative therapy inappropriately portrays GID as a mental illness
and not a medical condition.

Patient Safety

In matters of housing, recreation, and work assignments custody staff should be aware

The Standards of Care for Gender Identity Disorders by the World Professional Association
for Transgender Health.

Transgender Health Care in Correctional Settings, Page 3 of 3

that transgender people are common targets for violence. Accordingly, appropriate
safety measures should be taken, regardless of whether the individual is placed in
male or female housing areas.
Discharge Planning

Transgender inmates receiving hormone therapy should receive a sufficient supply
upon release to last until a community provider assumes care. Referrals should be
made to community-based organizations with sensitive and inclusive services for
transgender people.


Correctional policies for management of transgender inmates should be developed
and implemented in partnership with local transgender communities, particularly
current and former inmates, and transgender service providers, whenever possible.

Adopted by the NCCHC Board of Directors October 18, 2009, Orlando, Florida.



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