# 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:** 3
**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, 4:00pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/41 "2013-08-23T16:00:52Z")
> [@Bricker](#): > > 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. I think BDD was an incorrect term. The correct term seems to be [BIID](http://en.wikipedia.org/wiki/Body_integrity_identity_disorder). Here, we are talking about, potentially, a wiring problem in the brain that, as far as I know, cannot be treated with something like antidepressants. Why is this considered a “disorder” yet transgenderism is not? I don’t know the answer to that question other than medical professionals think there is something “wrong” with people who want to chop off a perfectly good limb. I don’t personally think either should be accomodated at taxpayer expense. Note that I am not opposed to people with either condition being able to have surgery to accomodate their needs. I am opposed to having taxpayers pick up the tab for a surgery that makes them feel better about themselves while they are doing time for violating the law. ---
**Author:** ![Miller](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/miller/32/481_2.png) [@Miller](https://boards.straightdope.com/u/Miller)\ **Post date:** [August 23, 2013, 4:01pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/42 "2013-08-23T16:01:03Z")
> [@Simplicio](#): > > 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. > **[Sex reassignment: outcomes and predictors of treatment for adolescent and...](https://pubmed.ncbi.nlm.nih.gov/15842032/)** > > The results substantiate previous conclusions that sex reassignment is effective. Still, clinicians need to be alert for non-homosexual male-to-females with unfavourable psychological functioning and physical appearance and inconsistent gender... [http://www.shb-info.org/sitebuildercontent/sitebuilderfiles/articulogoorenkettenis99.pdf](http://www.shb-info.org/sitebuildercontent/sitebuilderfiles/articulogoorenkettenis99.pdf) [http://www.gendercentre.org.au/resources/fact-sheets/old/transsexualism-the-current-medical-viewpoint.htm](http://www.gendercentre.org.au/resources/fact-sheets/old/transsexualism-the-current-medical-viewpoint.htm) The ARIF study did show that there are problems with how the studies are constructed, but that’s different from saying that the studies conclusions were wrong - it’s worth noting that the ARIF study also looked at studies that said SRS was ineffective, and found the same methodology problems. It’s also worth noting that, while SRS might be effective in fixing someone’s dysphoria, that doesn’t automatically resolve all the accumulated trauma of their condition. 20+ years of being treated like shit because you dress and act different isn’t something that can be cured by surgery. It’s difficult to separate the effects of transexuality from the effects of transphobia. ---
**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, 4:04pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/43 "2013-08-23T16:04:38Z")
> [@Bricker](#): > > 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. Sorry if you got that impression but that is not what I think. I was merely drawing a parallel between our inability to properly treat a person who is depressed because they are in prison (can’t let you out for that!) and what should be our inability to provide extremely expensive elective surgery to alleviate the depression a person feels about being trapped in the wrong body. ---
**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, 4:11pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/44 "2013-08-23T16:11:23Z")
> [@yorick73](#): > > Sorry if you got that impression but that is not what I think. I was merely drawing a parallel between our inability to properly treat a person who is depressed because they are in prison (can’t let you out for that!) and what should be our inability to provide extremely expensive elective surgery to alleviate the depression a person feels about being trapped in the wrong body. The parallel does not stand up under scrutiny. A person suffers situational depression because they are in prison; prison is the intended punishment and the attendant depression an expected result. A person suffers depression as a symptom of gender dysphoria because of the gender dysphoria, and it’s not related to any expected result; it’s the lack of legitimate medical treatment for a legitimate medical condition. ---
**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, 4:21pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/45 "2013-08-23T16:21:41Z")
> [@Bricker](#): > > The parallel does not stand up under scrutiny. A person suffers situational depression because they are in prison; prison is the intended punishment and the attendant depression an expected result. A person suffers depression as a symptom of gender dysphoria because of the gender dysphoria, and it’s not related to any expected result; it’s the lack of legitimate medical treatment for a legitimate medical condition. My point was hypothetical but I’m was not referring to people who have the blues because they are in prison. If a person is severely depressed or suicidal due to a lengthy prison term we cannot “fix” that except by medicating to relieve the underlying depression. ---
**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, 4:27pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/46 "2013-08-23T16:27:39Z")
> [@Bricker](#): > > The parallel does not stand up under scrutiny. A person suffers situational depression because they are in prison; prison is the intended punishment and the attendant depression an expected result. A person suffers depression as a symptom of gender dysphoria because of the gender dysphoria, and it’s not related to any expected result; it’s the lack of legitimate medical treatment for a legitimate medical condition. On further thought, the depression here could be (now) classified as situational and an expected result. Prisons don’t do SRS. I wonder how many other conditions of being in prison could result in depression (lack of sex, lack of an intimate relationship, etc). The point is that he would have been able to pursue SRS as a free man but, now, he is a convicted felon. ---
**Author:** ![EverwonderWhy](https://avatars.discourse-cdn.com/v4/letter/e/ee59a6/32.png) [@EverwonderWhy](https://boards.straightdope.com/u/EverwonderWhy)\ **Post date:** [August 23, 2013, 4:54pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/47 "2013-08-23T16:54:33Z")
> [@Lowdown](#): > > 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. What seems to be coming out is that Manning was being treated for gender dysmorphia prior to committing her crimes. I believe her psychologist and/or psychiatrist testified of this during Manning’s trial - even stating that Manning joined the military in hopes it would force her to overcome her gender identity crisis. After her arrest, information about hormone replacement therapy and digital evidence that Manning was going by the name “Breanna” was found in her room in Baghdad. It was not something that could be treated outside of counseling while on deployment or while active military. Either way, there is evidence of Manning’s gender dysmorphia in her medical records prior to her arrest. I believe Master Sergeant Paul Adkins, was even demoted for failing to act or report the issue to a more senior officer after he received an email from Manning (where she came out and attached a picture of dressed as girl) and discussed the situation with Manning’s therapists. ---
**Author:** ![EverwonderWhy](https://avatars.discourse-cdn.com/v4/letter/e/ee59a6/32.png) [@EverwonderWhy](https://boards.straightdope.com/u/EverwonderWhy)\ **Post date:** [August 23, 2013, 5:12pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/48 "2013-08-23T17:12:14Z")
> [@yorick73](#): > > On further thought, the depression here could be (now) classified as situational and an expected result. Prisons don’t do SRS. I wonder how many other conditions of being in prison could result in depression (lack of sex, lack of an intimate relationship, etc). Those circumstances are caused by confinement, gender dysmorphia is not caused by confinement, it is a present condition prior to confinement and should be treated as such. Attempting to reclassify it as ‘situational depression’ upon confinement in order to avoid treating it is an obvious attempt to deny it as legitimate medical condition. ---
**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, 5:15pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/49 "2013-08-23T17:15:07Z")
> [@EverwonderWhy](#): > > What seems to be coming out is that Manning was being treated for gender dysmorphia prior to committing her crimes. I believe her psychologist and/or psychiatrist testified of this during Manning’s trial - even stating that Manning joined the military in hopes it would force her to overcome her gender identity crisis. After her arrest, information about hormone replacement therapy and digital evidence that Manning was going by the name “Breanna” was found in her room in Baghdad. > > It was not something that could be treated outside of counseling while on deployment or while active military. > > Either way, there is evidence of Manning’s gender dysmorphia in her medical records prior to her arrest. I believe Master Sergeant Paul Adkins, was even demoted for failing to act or report the issue to a more senior officer after he received an email from Manning (where she came out and attached a picture of dressed as girl) and discussed the situation with Manning’s therapists. This I did not know. Thanks. ---
**Author:** ![Clothahump](https://avatars.discourse-cdn.com/v4/letter/c/51bf81/32.png) [@Clothahump](https://boards.straightdope.com/u/Clothahump)\ **Post date:** [August 23, 2013, 5:17pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/50 "2013-08-23T17:17:20Z")
> [@psychobunny](#): > > Another Bradley Manning debate but I’d like to concentrate on this issue rather than others such as the length of the sentence. > > Specifically, what should the taxpayers pay for? My opinion: Nothing. If they want hormone therapy, let them pay for it. Same for sex-change operations, etc. ---
**Author:** ![even\_sven](https://avatars.discourse-cdn.com/v4/letter/e/dfb087/32.png) [@even\_sven](https://boards.straightdope.com/u/even_sven)\ **Post date:** [August 23, 2013, 5:32pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/51 "2013-08-23T17:32:20Z")
Why would it be treated differently than any other condition? You get diagnosed, you get treated according to standard treatment guidelines. ---
**Author:** ![Honesty](https://avatars.discourse-cdn.com/v4/letter/h/f04885/32.png) [@Honesty](https://boards.straightdope.com/u/Honesty)\ **Post date:** [August 23, 2013, 5:34pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/52 "2013-08-23T17:34:38Z")
> [@Der\_Trihs](#): > > In my opinion, hormones and surgery should be provided for transgender people both in and out of prison. Of course, I’m one of those evil filthy socialists who thinks we should have single payer UHC because its cheaper and works better. I wish there was a like button. This. - Honesty ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [August 23, 2013, 5:40pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/53 "2013-08-23T17:40:41Z")
Hormone therapy is a recognized standard of care for gender dysphoric patients. It has been reasonablly well-shown that it improves mental health and other outcomes. So I as a physician, support the practice. The meds are cheap, anyway. Caring for suicide attempts or severely depressed patients in prison is much more expensive. Surgical outcomes are not so clear cut, so I’m not ready to advocate for surgical reassignment. And at present I’m providing care for 3 gender dysphoric inmates, all on hormones. ---
**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, 5:44pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/54 "2013-08-23T17:44:47Z")
> [@Miller](#): > > [Sex reassignment: outcomes and predictors of treatment for adolescent and adult transsexuals - PubMed](http://www.ncbi.nlm.nih.gov/pubmed/15842032) > > [http://www.shb-info.org/sitebuildercontent/sitebuilderfiles/articulogoorenkettenis99.pdf](http://www.shb-info.org/sitebuildercontent/sitebuilderfiles/articulogoorenkettenis99.pdf) > > [http://www.gendercentre.org.au/resources/fact-sheets/old/transsexualism-the-current-medical-viewpoint.htm](http://www.gendercentre.org.au/resources/fact-sheets/old/transsexualism-the-current-medical-viewpoint.htm) I looked thru your cites rather quickly, but I didn’t see any reference to how much, if any, SRS reduced suicide rates. That’s what we are talking about - do you have cites about that? > [@](#): > > The ARIF study did show that there are problems with how the studies are constructed, but that’s different from saying that the studies conclusions were wrong - it’s worth noting that the ARIF study also looked at studies that said SRS was ineffective, and found the same methodology problems. Well, if the studies were concluding that SRS was working, and the studies were flawed, then you are incorrect - the conclusions are wrong. And as I said, if people are saying that SRS is effective in reducing suicide or otherwise benefitting transsexuals in objectively measurable ways, then the burden of proof lies with those who make the claim. It’s no different than any other medical treatment or drug - if you say it treats such-and-such a disorder, then let’s see the valid studies showing it does better than placebo. If the idea is to go ahead without evidence because nobody can prove it _doesn’t_ work, well, that’s quackery. > [@](#): > > It’s also worth noting that, while SRS might be effective in fixing someone’s dysphoria, that doesn’t automatically resolve all the accumulated trauma of their condition. 20+ years of being treated like shit because you dress and act different isn’t something that can be cured by surgery. It’s difficult to separate the effects of transexuality from the effects of transphobia. Isn’t this the same thing as saying that “treating transphobia+SRS” has no more effect than “treating transphobia alone”? If the idea is to treat “all the accumulated trauma of their condition”, then we need evidence for each of the elements of treatment. If you want to treat pneumonia with antibiotics and witchcraft, we need to know both that the antibiotics work, and that the witchcraft works. Regards, Shodan ---
**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, 5:45pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/55 "2013-08-23T17:45:17Z")
> [@Qadgop\_the\_Mercotan](#): > > Hormone therapy is a recognized standard of care for gender dysphoric patients. It has been reasonablly well-shown that it improves mental health and other outcomes. So I as a physician, support the practice. The meds are cheap, anyway. Caring for suicide attempts or severely depressed patients in prison is much more expensive. > > Surgical outcomes are not so clear cut, so I’m not ready to advocate for surgical reassignment. > > And at present I’m providing care for 3 gender dysphoric inmates, all on hormones. I consider it cheating when a person with medical training participates in a thread about medical treatment. Shame on you! ---
**Author:** ![aruvqan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/aruvqan/32/2891_2.png) [@aruvqan](https://boards.straightdope.com/u/aruvqan)\ **Post date:** [August 23, 2013, 6:00pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/56 "2013-08-23T18:00:16Z")
> [@Der\_Trihs](#): > > What’s the point of counseling when you’ve forbidden them the recommended course of treatment? > > In other words, you want to make sure that they don’t get the proper treatment and become more and more traumatized and irrational over time. Why not just kill them if you hate them that much, instead of essentially torturing them then releasing them into near-certain disaster? Your way is pointless sadism that will get more people hurt, considering the mental state they’ll likely be when released. Counseling because that is what they were already undegoing - there is NO transgender program on this planet that will just take someone walking in off the street and lop off body parts as needed, and add body parts as needed - everybody has to undergo counseling and drug therapy first. And it would not be torturing them to ship them off to the tranny specific prison, it would be better off than isolating them in solitary in wherever they were. This way they could be in a general population of people with the same issues they have. They could actually interact with others that might be able to help them with suggestions - even just knowing there are others around you with the same problems is good mentally. And they would be better off because they were not forced to _stop_ the counseling and hormone therapy and go into a general population that has nothing in common with them and might actually mutilate, rape or kill them. ---
**Author:** ![Merneith](https://avatars.discourse-cdn.com/v4/letter/m/57b2e6/32.png) [@Merneith](https://boards.straightdope.com/u/Merneith)\ **Post date:** [August 23, 2013, 7:09pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/57 "2013-08-23T19:09:47Z")
> [@Qadgop\_the\_Mercotan](#): > > Hormone therapy is a recognized standard of care for gender dysphoric patients. It has been reasonablly well-shown that it improves mental health and other outcomes. So I as a physician, support the practice. The meds are cheap, anyway. Caring for suicide attempts or severely depressed patients in prison is much more expensive. > > Surgical outcomes are not so clear cut, so I’m not ready to advocate for surgical reassignment. > > And at present I’m providing care for 3 gender dysphoric inmates, all on hormones. If I may ask - have you ever treated a patient who started on hormone therapy and then who decided it was the wrong track after all, and went off them again? Are the prisoners who are being treated with hormone therapy held in original quarters or in their reassigned quarters? Thanks - just curious about whatever you can share. As for the topic - I think it’s a personal decision between a patient and a doctor and not something with which the state should not interfere. Transgender patients - all patients - should receive the care their doctors deem necessary and the burden is on the state to keep them safe and healthy while they are in custody. ---
**Author:** ![Little\_Nemo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/little_nemo/32/3120_2.png) [@Little\_Nemo](https://boards.straightdope.com/u/Little_Nemo)\ **Post date:** [August 23, 2013, 7:13pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/58 "2013-08-23T19:13:52Z")
> [@Clothahump](#): > > My opinion: Nothing. > > If they want hormone therapy, let them pay for it. Same for sex-change operations, etc. We don’t allow that. Prisoners get the medical services the state provides them and they cannot pay for their own medical procedures. ---
**Author:** ![Miller](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/miller/32/481_2.png) [@Miller](https://boards.straightdope.com/u/Miller)\ **Post date:** [August 23, 2013, 7:18pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/59 "2013-08-23T19:18:09Z")
> [@Shodan](#): > > I looked thru your cites rather quickly, but I didn’t see any reference to how much, if any, SRS reduced suicide rates. That’s what we are talking about - do you have cites about that? Sorry, my bad. I didn’t realize the question was about SRS specifically, and not general treatment of gender dysphoria. FTR, I’m not strongly in favor of giving SRS to inmates. Ultimately, it should be up to a doctor to make the call if its necessary or not, but I suspect in most cases, hormones and counseling would be sufficient. > [@](#): > > Well, if the studies were concluding that SRS was working, and the studies were flawed, then you are incorrect - the conclusions are wrong. Not at all. A flawed process doesn’t necessarily result in an incorrect conclusion, merely an unreliable conclusion. Again, the ARIF report also looked at studies that were unfavorable to SRS, and also found the same flaws. The conclusions for both pro- and anti- can’t both be wrong, any more than they can both be right. So one set of studies got the right conclusion. The question is, which set? > [@](#): > > Isn’t this the same thing as saying that “treating transphobia+SRS” has no more effect than “treating transphobia alone”? If the idea is to treat “all the accumulated trauma of their condition”, then we need evidence for each of the elements of treatment. I agree. However, a failure to treat the results of transphobia shouldn’t be confused as a failure to treat the results of being transexual. ---
**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, 8:52pm UTC](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944/60 "2013-08-23T20:52:55Z")
> [@Miller](#): > > Again, the ARIF report also looked at studies that were unfavorable to SRS, and also found the same flaws. The conclusions for both pro- and anti- can’t both be wrong, any more than they can both be right. So one set of studies got the right conclusion. The question is, which set? That can’t be determined without valid studies. But the default assumption ought to be that we do not do something with known risks without real evidence of some kind of offsetting benefit. As I said, the burden of proof remains on those suggesting that it should be made available to prisoners. Regards, Shodan [Previous page](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944.md?page=2) [Next page](https://boards.straightdope.com/t/how-far-should-the-prison-system-go-to-accommodate-transpersons/666944.md?page=4)