Transgender inmates are over-represented in the correctional settings. 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.
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?
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
How Should Agencies Manage Transgender Inmates?
If you like this post, you will like:
The Correctional Nurses’ Guide to the Code of Ethics
Under the Influence: Impaired Nurses in Corrections
Caring for Criminals: Should We Be Glad Ariel Castro is Dead?
Manifesto Proposition Six: Responding to Degrading Treatment
Sexual Boundary Violations in Correctional Nursing: It Could Happen to You
Aria Blue says
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.
Lorry Schoenly says
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.
Aria Blue says
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! 🙂
Zoe Kala says
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.
Zoe Kala says
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.
Lorry Schoenly says
Zoe: This is well said! Thanks for adding good information to our dialog!
Lorry
Lorry Schoenly says
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
Lorry Schoenly says
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.
Lorry Schoenly says
Thanks for checking in!