# How far should the prison system go to accommodate transpersons **URL:** \ **Category:** Great Debates\ **Created:** [August 23, 2013, 3:39am UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944 "2013-08-23T03:39:07Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![Cheesesteak](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cheesesteak/32/3694_2.png) [@Cheesesteak](https://boards.straightdope.com/u/Cheesesteak)\ **Post date:** [August 23, 2013, 11:22am UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/21 "2013-08-23T11:22:09Z")
When a dirt poor Transgender person can walk into a clinic and get treatment funded by the government, I’d be more than happy to provide the same level of service to a prisoner. Until then, I’m on the path that they should get whatever medical intervention is necessary to let them leave the prison system with the same level of health they came in with. If they’re on meds, they can continue them. Also, if they, or their family, want to pay for meds/surgery, to begin or advance the treatment, I have no problem with that, the prison doctor should administer/monitor them appropriately. ---
**Author:** ![Smapti](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/smapti/32/17938_2.png) [@Smapti](https://boards.straightdope.com/u/Smapti)\ **Post date:** [August 23, 2013, 11:51am UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/22 "2013-08-23T11:51:16Z")
> [@Der\_Trihs](#): > > Suicide or suicidal behavior brought on by the ongoing trauma. In tnat case, nobody is dying of transgenderism. They’re dying of suicide. > [@](#): > > And when they get out and kill you or someone else because they’ve been driven insane? Then clearly the prison system failed by letting an insane person out of custody. > [@](#): > > You are demonstrating what prison is _really_ about in the US: pure sadism. Of course it is. The point of prison is to punish people. I don’t want prisoners to be happy. ---
**Author:** ![Lord\_Feldon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lord_feldon/32/341_2.png) [@Lord\_Feldon](https://boards.straightdope.com/u/Lord_Feldon)\ **Post date:** [August 23, 2013, 11:54am UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/23 "2013-08-23T11:54:31Z")
> [@Cheesesteak](#): > > When a dirt poor Transgender person can walk into a clinic and get treatment funded by the government, I’d be more than happy to provide the same level of service to a prisoner. Do you apply the same standard to other treatment? ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [August 23, 2013, 12:22pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/24 "2013-08-23T12:22:59Z")
It is my understanding that post-transitioned transsexuals attempt or commit suicide at roughly the same rates as they attempted beforehand. They may report that they are happy afterwards, but it does not affect their behavior all that much. Therefore, it appears that the net effect of transitioning for an incarcerated transsexual is to make them happier. I don’t think the purpose of prison is to make the inmates happy. Regards, Shodan ---
**Author:** ![Czarcasm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/czarcasm/32/4050_2.png) [@Czarcasm](https://boards.straightdope.com/u/Czarcasm)\ **Post date:** [August 23, 2013, 12:48pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/25 "2013-08-23T12:48:57Z")
> [@Shodan](#): > > It is my understanding that post-transitioned transsexuals attempt or commit suicide at roughly the same rates as they attempted beforehand. From what source did you obtain this understanding? ---
**Author:** ![Ranchoth](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ranchoth/32/1066_2.png) [@Ranchoth](https://boards.straightdope.com/u/Ranchoth)\ **Post date:** [August 23, 2013, 12:49pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/26 "2013-08-23T12:49:43Z")
> [@Shodan](#): > > Therefore, it appears that the net effect of transitioning for an incarcerated transsexual is to make them happier. I don’t think the purpose of prison is to make the inmates happy. Indeed…if the prisoner was just blatantly [horribly deformed](http://4.bp.blogspot.com/-QfKh1ltDiPA/TdVpqKkEhvI/AAAAAAAABIQ/66Zu1luXpOM/s400/dp1983-phantom.jpg)—something you might sympathetically actually argue is the _case_ for transpersons—is it the state’s obligation to make them beautiful? Or if they feel spiritually unfulfilled, to let them out to go on a holy pilgrimage? 'Course, in this _particular_ prisoner’s case, I can’t help but feel this is more about grabbing attention than anything else. I’m putting bets on him converting to Islam or Wicca or hardcore Jainism within the next few years. Outside odds on him being an “Otherkin.” ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [August 23, 2013, 12:57pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/27 "2013-08-23T12:57:49Z")
I have four observations: (1) Prisons should not pay for elective surgery. (2) In my view, transgender surgery, preceded by and consistent with a psychological evaluation and requisite counseling, should not be considered “elective.” (3) The comparison to a person on the street is inapposite. A trans-person living and supporting themselves should be responsible for their own health care costs; a person in prison clearly cannot be held to that standard. Prisons should therefore pay for transgender reassignment. (4) Der Trihs’ idea of debate appears to be to assert a fact and then repeat it, with no particular interest in supporting citation and no understanding of the burden of proof associated with the proponent of a proposition. ---
**Author:** ![Ravenman](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ravenman/32/2929_2.png) [@Ravenman](https://boards.straightdope.com/u/Ravenman)\ **Post date:** [August 23, 2013, 12:58pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/28 "2013-08-23T12:58:59Z")
Can someone provide evidence that hormone therapy or sexual reassignment surgery is an effective treatment and reduces the incidence of suicide? Are there other treatments (counseling, medication, etc.) that are shown to be effective? This is an honest question, I really don’t know one bit about the medical science here. ---
**Author:** ![lieu](https://avatars.discourse-cdn.com/v4/letter/l/c2a13f/32.png) [@lieu](https://boards.straightdope.com/u/lieu)\ **Post date:** [August 23, 2013, 1:06pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/29 "2013-08-23T13:06:12Z")
I don’t care what kind of surgery you’re talking about, whether it be for sexual reassignment, a deviated septum, gall bladder or whatever, you’re going to need some real post operative recovery time for the proper healing of tender flesh, muscle and organs. I think the last place on earth one could expect to receive guaranteed comfort and care is among a prison population. They’re hardly as understanding toward the reasons for reassignment as your average doper and in fact many of them are likely to be bigoted, homophobic, sadistic or whatever to the patients. The potential harm and chaos they might inflict has to be weighed into the equation too I would think. If reassignment is desired I hope it’s undertaken well before anyone enters a place that’s not really designed to be a hospital and where recuperative care will be an enormous challenge among a violent population. Done before or after if possible, they’ll certainly be in a better place to benefit from the procedure. I hope at some point the good doctor, QtM, see’s this thread and is compelled to weigh in. He has a unique perspective and understanding, would likely be directly affected if this were to become policy, etc. I’d value his opinion very much. ---
**Author:** ![John\_Mace](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/john_mace/32/185_2.png) [@John\_Mace](https://boards.straightdope.com/u/John_Mace)\ **Post date:** [August 23, 2013, 1:09pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/30 "2013-08-23T13:09:18Z")
> [@Der\_Trihs](#): > > A false equivalency. If you want to torment and kill transgendered people you might as well just admit it and go and do it honestly. Because let’s be clear, that’s the effect of untreated transgenderism; it tends to end in death, with a lot of suffering on the way. IN this context, what does “tends to” mean. My understanding would be that it happens at least 50% of the time. What is your understanding of that phrase. > [@Miller](#): > > …untreated ugly. Band name! As for the OP, this is a tough one for me. If we have some statistics that it is absolutely necessary for the health and well being of the individual, then I"m OK with it. But I have to wonder how squishy the medical diagnostic process is and how good our data is. ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [August 23, 2013, 2:34pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/31 "2013-08-23T14:34:58Z")
> [@John\_Mace](#): > > If we have some statistics that it is absolutely necessary for the health and well being of the individual, then I"m OK with it. But I have to wonder how squishy the medical diagnostic process is and how good our data is. Unfortunately, the data aren’t very good at all. However - > [@](#): > > There is no conclusive evidence that sex change operations improve the lives of transsexuals, with many people remaining severely distressed and even suicidal after the operation, according to a medical review conducted exclusively for Guardian Weekend tomorrow. > > The review of more than 100 international medical studies of post-operative transsexuals by the University of Birmingham’s aggressive research intelligence facility (Arif) found no robust scientific evidence that gender reassignment surgery is clinically effective. [Cite](http://www.theguardian.com/society/2004/jul/30/health.mentalhealth). It would seem to me that the burden of proof that sexual reassignment helps would remain on those advocating that prisoners be afforded it at public expense, but I would be surprised if we got much of that. I’m speaking of objective measurements, not surveys. Regards, Shodan ---
**Author:** ![Garula](https://avatars.discourse-cdn.com/v4/letter/g/ea666f/32.png) [@Garula](https://boards.straightdope.com/u/Garula)\ **Post date:** [August 23, 2013, 2:39pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/32 "2013-08-23T14:39:43Z")
Untreated transgenderism is something people kill themselves over. When the state incarcerates someone, they assume the responsibility for that person’s care. I’m deeply uncomfortable with the idea of putting people in a position where they don’t have the means to deal with something so potentially serious. That seems to condemn them to a significantly worse punishment than the typical inmate, and that comes much to close to cruel and unusual punishment for my tastes. I’d rather err on the side of compassion and just provide doctor recommended treatment. I hope a medical professional will weigh in on the matter. I fear the population at large greatly underestimates how severe a mental health issue this can be for individuals. I mean, would we be okay with denying inmates medication for clinical depression or other mental health problems? ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [August 23, 2013, 2:52pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/33 "2013-08-23T14:52:53Z")
> [@Ravenman](#): > > Can someone provide evidence that hormone therapy or sexual reassignment surgery is an effective treatment and reduces the incidence of suicide? Are there other treatments (counseling, medication, etc.) that are shown to be effective? > > This is an honest question, I really don’t know one bit about the medical science here. Here is a [column](http://www.straightdope.com/columns/read/3066/are-transsexuals-mentally-ill)from a very reliable source that says there is very little good evidence that surgery is effective. ---
**Author:** ![Simplicio](https://avatars.discourse-cdn.com/v4/letter/s/c37758/32.png) [@Simplicio](https://boards.straightdope.com/u/Simplicio)\ **Post date:** [August 23, 2013, 2:56pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/34 "2013-08-23T14:56:59Z")
> [@Garula](#): > > Untreated transgenderism is something people kill themselves over. If transgendered kill themselves at a much higher rate then the general population, and reassignment surgery is effective at preventing that, I’d tend to agree. But several people have presented evidence that’s not the case, while people arguing the other way haven’t given much in the way of evidence beyond repeated assertions. ---
**Author:** ![yorick73](https://avatars.discourse-cdn.com/v4/letter/y/b5a626/32.png) [@yorick73](https://boards.straightdope.com/u/yorick73)\ **Post date:** [August 23, 2013, 3:18pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/35 "2013-08-23T15:18:27Z")
> [@Bricker](#): > > (2) In my view, transgender surgery, preceded by and consistent with a psychological evaluation and requisite counseling, should not be considered “elective.” Why do you think it should not be considered “elective”? There are many people out there with BDD who want to have a limb removed and are willing to go to great lenghts to take it off themselves but I don’t think prisons are willing to allow inmates that suffer from this condition to do this. What about female prisoners with mastectomies? Are they given implants to feel whole again? I don’t know the answer to the second question but the taxpayers shouldn’t have to pay for any surgery that increases an inmate’s sense of well-being. What purpose would it serve anyway? He’s in prison for the next thirty-something years. It’s not like he will be missing out on finding a good man or having satisfying sexual experiences with his new equipment since he is a prisoner. He just has to pee standing up like the rest of us. ---
**Author:** ![Cheesesteak](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cheesesteak/32/3694_2.png) [@Cheesesteak](https://boards.straightdope.com/u/Cheesesteak)\ **Post date:** [August 23, 2013, 3:22pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/36 "2013-08-23T15:22:13Z")
I’m going to go ahead and change my opinion on this. It isn’t something I thought much about, previously. Seems to me, one can draw an analogy to mental illness\*. A person is not going to die directly from a mental illness. It’s a pre-existing condition that may or may not have been treated prior to incarceration. Inmates who require it, are routinely given psychotropic medication. It’s also often the case that inmates get better treatment in prison than they do on the street, which is sad, but there’s no reason to apply a higher standard to transgender treatments. \*Note, I am not equating the condition with a mental illness, merely the physical effects on the person and the methodology of non-surgical treatment. ---
**Author:** ![yorick73](https://avatars.discourse-cdn.com/v4/letter/y/b5a626/32.png) [@yorick73](https://boards.straightdope.com/u/yorick73)\ **Post date:** [August 23, 2013, 3:32pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/37 "2013-08-23T15:32:59Z")
> [@Cheesesteak](#): > > I’m going to go ahead and change my opinion on this. It isn’t something I thought much about, previously. > > Seems to me, one can draw an analogy to mental illness\*. A person is not going to die directly from a mental illness. It’s a pre-existing condition that may or may not have been treated prior to incarceration. Inmates who require it, are routinely given psychotropic medication. It’s also often the case that inmates get better treatment in prison than they do on the street, which is sad, but there’s no reason to apply a higher standard to transgender treatments. > \*Note, I am not equating the condition with a mental illness, merely the physical effects on the person and the methodology of non-surgical treatment. Why not just treat the depression. I wonder how many people are suicidal or very depressed because they are in prison. One could argue that the cure is to set them free. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [August 23, 2013, 3:45pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/38 "2013-08-23T15:45:51Z")
> [@yorick73](#): > > Why do you think it should not be considered “elective”? There are many people out there with BDD who want to have a limb removed and are willing to go to great lenghts to take it off themselves but I don’t think prisons are willing to allow inmates that suffer from this condition to do this. What about female prisoners with mastectomies? Are they given implants to feel whole again? I don’t know the answer to the second question but the taxpayers shouldn’t have to pay for any surgery that increases an inmate’s sense of well-being. > > What purpose would it serve anyway? He’s in prison for the next thirty-something years. It’s not like he will be missing out on finding a good man or having satisfying sexual experiences with his new equipment since he is a prisoner. He just has to pee standing up like the rest of us. From my understanding of gender dysphoria (as defined in the upcoming DSM-V) the current approach is not to classify this as a disorder – as we would, in your example, classify body dysmorphic disorder. Instead, there is a recognition that assessment has already eliminated causes such as depression or psychosis as the reason for the desire for sexual reassignment surgery. And that same assessment process has validated the persistent desire to be the opposite sex, physically, as one that arises from an unshakeable conviction that the patient is, inside, _already_ the opposite sex. This is markedly different from implants intended to address the cosmetic effects of a mastectomy – not to denigrate that desire either, but it’s clearly separate from what’s under discussion here. This is something that, as a society, we understand as a condition, not a disorder, and one that we foreclose a prisoner from acting upon by virtue of that prisoner’s confinement. Simple logic compels us to assume responsibility for it. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [August 23, 2013, 3:52pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/39 "2013-08-23T15:52:35Z")
> [@yorick73](#): > > Why not just treat the depression. I wonder how many people are suicidal or very depressed because they are in prison. One could argue that the cure is to set them free. Your answer suggests that you view all depression as a symptom that’s susceptible to treatment in and of itself. It’s not. A person who experiences depression as an indicator of gender dysphoria won’t be cured by release from prison, because the depression in that case does not arise from imprisonment. Situational, or reactive, depression is different in cause and recommended treatment from, say, bipolar disorder. A person is imprisoned for both punitive and rehabilitative goals. Depression as a result of that imprisonment is certainly possible, and indeed not particularly remarkable. Depression arising from gender dysphoria is a different animal, and not analyzed the same way. ---
**Author:** ![Lowdown](https://avatars.discourse-cdn.com/v4/letter/l/c57346/32.png) [@Lowdown](https://boards.straightdope.com/u/Lowdown)\ **Post date:** [August 23, 2013, 3:58pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/40 "2013-08-23T15:58:48Z")
My opinion is that taxpayers should be on the hook for counseling, and healthcare for illness or injury. Body modification should absolutely not be covered. If you want to swap parts, I’m on board and support you 100%, but you need to get that done before you decide to break bad. If you are/were transgendered (regardless of what set of equipment you have) at the time you committed your crime, you should be treated as such by the justice system. If you proclaim you’re the opposite gender after the fact (Manning), no dice. [Previous page](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944.md?page=1) [Next page](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944.md?page=3)