Correctional Nurse . Net

Lorry Schoenly, PhD, RN, CCHP

Transgender Inmates: He Said, She Said

THE SITUATION: You’re working medical screening for new detainees at a large urban jail. Your next case arrives for assessment with make-up and bright female clothing, although you also see male-pattern facial hair and muscle structure. What do you do?

Transgender individuals are over-represented in the inmate population. If you work in corrections, you are likely to come face-to-face with your attitudes and emotions about these individuals. Nursing ethical principles require those of us in the profession to provide nursing care with concern and respect for human dignity, no matter the life choices the individual has made.

Transgenders (also called trans or cross-genders) are individuals with an incongruity between their felt gender and their anatomic gender. The majority are male and can have a DSMIV diagnosis of gender identity disorder (GID). Your inmate-patient may be in the midst of hormonal therapy or have partial or complete sex reassignment surgery (SRS).

Conversation

Your first concern is how to address the person. Do you use the term ‘He’ or ‘She’? Though it may seem trivial, your sensitivity in this area will establish needed repoire. Often you can avoid using gender terms or you can clearly see which term to use. For example, the individual above is likely to desire to be referred to as ‘she’, especially if the clothing involves a dress or skirt. When in doubt, your best option is to ask the individual how they would like to be addressed. Let them be in control of this small issue – control of so much else is gone. Attempt to be as matter-of-fact and non-judgmental as possible in all interactions.

Destination

Unless your system has special facilities for the transgender inmate, such as the new 30-bed transgender Italian prison, administration will need policies in place to determine housing designation. This is a vulnerable population requiring some type of protective housing.  The nature of the condition predisposes the inmate to a higher potential of assault or in-custody violence. In addition, those with GID are more likely to be depressed, suicidal or self-injurers. Keep this in mind when assessing these inmates for any health conditions.

Change Management

What if the person is in the midst of hormonal therapy or SRS? What responsibilities are there for maintaining or continuing escalation of therapy? Policies regarding transgender treatment differ among state and county systems. Investigate the policy at your facility before you need to use it. Discuss the situation with your manager and medical director.

In  a recent survey of correction system policies about transgender treatment, the majority of responding facilities had policies for the continuation of hormonal therapy, at least at the current level. Abrupt discontinuation of hormonal therapy can lead to physical and psychological side effects and should be avoided. Many facilities will use a ‘freeze-frame’ approach which continues the current therapy but does not escalate or advance the gender-change process.

Autocastration – Medical Emergency

Be aware that disturbed individuals may resort to autocastration or autopenectomy to reduce testosterone levels. The elasticity of the testicular arteries allows them to retract into the perineum making it very difficult to staunch the flow. Emergency transport, critical care and blood transfusion may be necessary.

More Resources on Transgender Treatment

Lock Up Doc on KevinMD

Transgender Guidelines from NCCHC

Trans People in Criminal Justice by Justice Institute of BC

How Should Agencies Manage Transgender Inmates?

June 22, 2010 - Posted by | Ethical Issues, Medical Conditions | , , , , , , , , , , , , , , ,

11 Comments »

  1. Out of curiosity, is there any effort made to differentiate between people who are playing a role (aka transgender”queens”, bottoms in jail “marriages”, etc.) and those who are actually transsexual?

    Also, I find it curious that transgender would be overrepresented in prison. Why do you suppose that is? In the general public the incidence of full-time crossdressers, who comprise the bulk of the “transgender” and are what most people think of when they hear the word, are a distinct minority rarely encountered outside of certain large cities and gay districts. It’s strange that transgender would spread in prisons, unless it was an adaptive behavior.

    Comment by Aria Blue | June 22, 2010 | Reply

    • Thanks for the read and your comment, Area: The research isn’t clear on why trans is over represented in correctional settings, however, it is suggested that the population is marginalized in society and more likely to rely on the sex trade for livlihood. There is no indication that transgender ‘spreads’ in prison, but that there is a higher representation in prisons than in the general population. Even with that, it is still quite a small percentage.

      Comment by Lorry Schoenly | June 22, 2010 | Reply

  2. That’s possible I suppose. But if you are talking about “transsexual” I think that it’s a bit of a myth that they tend to be in the sex trades moreso than the general public. “Transgender” sex workers on the other hand are rather common. The nature of transsexualism seems to preclude sexual contact of that random nature due to the revulsion of the body that accompanies the syndrome.

    “Transgender” prostitutes generally are gay men who affect women’s behavior to cater to a specific clientele. “Transsexual” is coming to be understood as a kind of birth condition, and there is mounting evidence in neurology to support this hypothesis. There has been a lot of political confusion on this topic lately as people have tried to push everything together for one reason or another. I’d be very curious to see a study done after some real diagnostics are developed.

    Anyway, thanks for the reply. Great blog! :)

    Comment by Aria Blue | June 25, 2010 | Reply

  3. This over-represented trans population in prison are primarily trans people of color. They typically come from communities with fewer social supports for their unconventional needs. Securing a job is extremely rare. Homelessness is common, and the sex trade may be the only way to find shelter.

    Many do resort to sex work for survival, but not all. Resorting to drugs and the drug trade is also not uncommon. Because sex work is the stereotypical profile, these transwomen of color are frequently picked up for prostitution simply when walking down the street at night. Transgender profiling by police leads to a proportionate increase in catching them involved in other survival crimes.

    Once arrested, they find themselves more easily convicted with frequently harsher sentences. Surviving sexual exploitation while in a men’s prison can lead to frequent disciplinary write-ups and loss of goodtime. They may also be denied parole because they have no place to go. Currently there are no halfway houses specific to the needs of transgender ex-prisoners.

    This all reinforces their belief that the public sector is not there for them and that they must fend for themselves by any means necessary. Pushed to the fringes of society they find less motivation to play by the rules we take for granted. Consequently, they may spend more time in prison than on the streets.

    Comment by Zoe Kala | June 27, 2010 | Reply

    • Zoe: This is well said! Thanks for adding good information to our dialog!

      Lorry

      Comment by Lorry Schoenly | June 28, 2010 | Reply

  4. BTW, referring to transgender expression as a “life choice” tends to minimize the complexity of the transgender experience, potentially implying that an alternate more socially acceptable choice is available. Choosing anything but to be their authentic gender self correlates with health issues. It’s arguably why my transsexual sister died in prison.

    While forced to live outwardly as a male and repress her felt need for gender balance, she became numb to her body’s homeostatic signals. She drank less water and more coffee, and also smoked more than she ever did before. She learned too late that her smoker’s cough had developed into full blown lung cancer, and had metastasized to her brain.

    While attempting to respect the individual with appropriate pronouns is laudable, such intent can be negated if the incarcerated transwoman picks up this notion that she is merely “choosing this lifestyle”. Indeed, she has lost a lot of control and has become naturally self-protective. So I applaud any effort to remain open to learning about transgenderism and to humbly check one’s own presumptions about gender. It can be a subtle way of encouraging the transwoman’s health.

    Comment by Zoe Kala | June 27, 2010 | Reply

  5. Zoe: I am sorry to hear of your loss. There is much insensitivity in the corrections system. I’m sure I still have much to learn about how best to provide authentic and compassionate nursing care to the transgender community. I appreciate the time you have taken to clarify some points.

    Lorry

    Comment by Lorry Schoenly | June 28, 2010 | Reply

  6. Hi Lorry…

    This is a really good starting article. We don’t groove too much on the use of the word “transgenders” as a noun overall though. It can modify things like saying, “Hi, my name is Lincoln and I’m a transgender man.” But it’s not great as a noun. It’s basically along the same lines as “homos”.

    One thing you may want to link together for clarity is something that may need a bit of checking up, as my only sources are anecdotal (however that word is spelled). Most of the time I’ve ever read/heard about trans women attempting to self castrate while incarcerated, it’s been a direct result of denial of hormones. Even if an institution has a policy of continuing hormones once started on the outside, guards and other staff can work hard to make sure it doesn’t happen. We have found that often medical staff will have to go above and beyond to make sure that trans inamtes get their dosages.

    There’s a lot to learn about our population. The first thing I would recommend doing is discounting out of hand everything AriaBlue said. I was going to be much more upset about it, but then I visited her blog and realized she’s part of that Harry Benjamin Syndrome subculture. I can’t really explain it much here, except to say that they believe that they are the only true transsexuals on the planet. In order to affirm that, they talk trash and prepetuate myths about the rest of the trans communities. But some people just have to do stuff I guess.

    A website you might want to check out is Just Detention International. They have a lot of stuff about trans incarceration and the things that go on. I think it’s really important for medical professionals in the corrections realm to unterstand what’s going on when folks aren’t in the medical wing. It seems like you do also.

    There’s a movie I haven’t seen yet called Cruel and Unusual. It’s interviews with trans women who have been incarcerated. It’s supposed to be very good.

    Here is a link to a newer development. The DOC at Washing DC jail has a policy for trans inmates.

    http://doc.dc.gov/doc/frames.asp?doc=/doc/lib/doc/program_statements/4000/PS_4020_3A_GenderClassificationandHousing041210.pdf

    Anyway, I could talk about this stuff all day. I worked out here in Seattle with some friends to write a policy that the King County Jail accepted. Now my pastor has given the go-ahead for us to start up Raised Voices. Raised Voices is a penpal program for trans inmates in Washington State.

    I guess you could email me if you want to talk more.

    Lincoln

    Comment by Lincoln | July 10, 2010 | Reply

    • Thanks for taking the time to add this good information to the post. I appreciate the DC policy link! This can be a volatile issue. I am glad for your even-handed input.

      Comment by Lorry Schoenly | July 11, 2010 | Reply

      • Hi Lorry,

        I saw Cruel and Unusual today. It’s a documentary chronicaling the lives of some trans women who were incarcerated. I recommend seeing it. My girlfriend and I felt there were some moments of cisgender voyuerism (cisgender=technical term for non-trans people). By voyeuristic shots, we mean things like totally unnecessary close ups on faces where there’s still hair patterns, chest shots, and so on. It was a putting them on display that distracted from the overall storyline.

        I would recommend watching it. If you do rent it, go ahead and watch the extra commentary from “the experts”. (As if the women aren’t the experts on their own lives). There’s some really good explanatory stuff in there that for reasons I can’t figure, was left out of the movie. It really should have been included because it would have shifted the burden of doing “trans 101″ education from the incarcerated women to the professionals who serve them.

        Just thought I’d drop that in here. Not sure why. Just trying to be helpful I guess. :-)

        Comment by Lincoln Rose | August 1, 2010

      • Thanks for checking in!

        Comment by Lorry Schoenly | August 1, 2010


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