Should taxpayers pay for gender realignment surgery for prisoners?

As far as I know, a person believing they are the wrong gender is not a recognized medical condition. So sexual reassignment surgery is considered an elective procedure. And the state does not pay for elective procedures for prisoners.

It is a recognized medical condition in the US. It’s just that there is no decent evidence that gender reassignment surgery works any better to improve the patient’s overall situation than support and counselling.

Lacking such evidence, the procedure will thus not be considered medically necessary by most medical professionals.

I’d have to disagree. A transgendered person is not transgendered of his own accord and can NEVER be held responsible for his situation. A person who’s in jail can feel guilt and remorse and often understands that he’s there of his own doing and deserves the punishment.

And we do treat other forms of mental disconnect in prison. To single this one out as off-limits is unfair.

Whuh? Am I the only one to consider this statement a huge bomb? All I’ve ever heard is that gender reassignment surgery is the only way to treat gender dysphoria and that patient satisfaction is close to 100%. What you’re saying is that support and counselling has as good a success rate as gender reassignment surgery, which must mean that counselling regularly makes the patient not desire gender reassignment any more.

If this is true (and considering the source I don’t doubt that it is) I’m going to have to completely change my views on transgenderism. Could you throw a few cites this way?

NOte my final phrase, “I dunno.” I’m pretty undecided on this issue, and was throwing out a bunch of different arguments either way.

That said, part of the punishment of being in prison is that you’re restricted as to the activities in which you may engage in the pursuit of happiness. A transgendered person might not be responsible for their condition–but neither is someone with chronic wanderlust. Prison inhibits both people from fulfilling their desires. The transgendered person isn’t responsible for being transgendered, but they ARE responsible for undertaking actions that land them in prison, where they’re unable to obtain treatment.

Qadcop’s distinction between “medically necessary” and “medically justifiable” is interesting, although I’m not sure I understand it.


I think that’s where the doctor making the decision comes in, or should come in. It might be that for Pat, counseling keeps his depression at bay, or at least low-level, and Pat’s doctor won’t consider gender reassignment surgery medically necessary (in which case the state shouldn’t pay for it), while Andy’s been in counseling for a decade and is still depressed and suicidal over having the wrong gender, and perhaps his doctor would consider surgery medically necessary in that case. In either case, gender realignment surgery could be medically justified, but only in one is it necessary.

No time to find my cites at the moment, but I recall from my last review of the literature that the patients who had the surgery still had similar rates of dysfunction to those that didn’t.

That means they measured various things like subjective life satisfaction, job stability, relationship stability, relapses into depression, suicide attempts, arrests, substance abuse rates, etc. And found that folks who had just counselling, support, and treatment for other conditions had the same rate of improved outcomes as the folks who had the surgery, conselling, support, and treatments… except the people in the former category didn’t have to undergo major surgery, with all its inherent risks.

Let’s compare it to another medical condition where treatment can be low-end or high end: dental care.

Let’s say I have a bad, bad tooth. On the outside, I get a root canal and a crown, or maybe I go for implants. Expensive, yes, but it means I’m not toothless. I would be very depressed if I were toothless. I don’t think I’d like dentures very much, either.

What would I get in jail? I’m pretty sure the prison system wouldn’t let me suffer the pain of a bad tooth, but I’m also pretty sure it wouldn’t spring for implants.

Another example, I would hope the prison system would make sure I can see by providing eyeglasses, or maybe even contact lenses. I don’t think they’d do Lasik.

Gender realignment surgery is the high-end option. People who can’t afford it, or aren’t insured, go with some other option until they can afford it.

Next thing you know prisoners will be suing for lumineers, breast implants, tummy tucks nose jobs, liposuction and weight loss programs. Prisoners need the necessities, not the extravagances.

Eyeglasses, yes. Contact lens, no. (And Lasik, no way.) The logic is pretty much the same. A prisoner has a medical need - he has poor vision - and eyeglasses or contact lenses will address that problem. So the state will choose which one to use and glasses are the default choice for a variety of reasons.

Our taxes may go up, but at least we’ll have the hottest, sexiest, most fabulous prisoners of any country on Earth!

If a female prisoner has breast cancer and has a mastectomy - does the state pay for reconstructive surgery or not?

I mean, you don’t need a breast to exist and have a healthy body, but the lack of that breast could be psychologically traumatizing.

If we justify reconstructive breast surgery - a cosmetic procedure at base - for a woman with breast cancer, how do we justify denying the transgendered inmate sex reassignment surgery?

(which is not to say I’m stating my personal view on this, which is pretty much undecided. I’m just trying to work through the ethical problem here)

Reconstructive surgery is decided on a case by case basis, at least in my state. Gross disfigurements, or those cases where the lost part significantly impairs the ability to function, are pretty much automatically approved. A mastectomy procedure which included some restorative work at the time of mastectomy would also likely be acceptable. Extensive procedures to make the reconstruction appear as much like a breast as possible, not so likely.

Even so, there is quite a bit of difference between surgery to restore what was lost or damaged due to a disease process (a breast) and surgery to alter a perfectly healthy body part because it doesn’t conform with the person’s desires (breast augmentation, gender reassignment, nose job).

But according to the last thread on transgenderism we had the sexual modification was medically necessary. In this thread it seems the majority is coming out in favor of it being a cosmetic enhancement.

What about the psyche of the person? Shouldn’t we be concerned with that? What if it was a deciding factor in their becoming a criminal? Not that I am saying transgendered people are more likely to be criminals, but for some the trauma might be more than they can bear, and as such they cannot operate in normal society.

Also, if we did allow this, what prison should they be put in?

This is exactly why the inmate should have sessions with a therapist of some sort; to help them cope with this - potentially temporary - circumstance. If I wanted to change something about myself so badly that it drove me to commit some kind of crime, then I need some kind of psychological treatment.

People suffering from depression share these type of feelings, which is why many attempt to commit suicide. All the more reason for them to seek psychological assistance, to help them cope with these unbearable circumstances and resume activity in society.

Tough one.

I’d say, doctor’s discretion for people facing life in prison. Being transgendered is a very serious problem. It has around a 30% death rate via suicide. There is a treatment for it. That treatment is not decided by what offends moral the least or what is cheapest. It is decided by what works, and that is something that doctors know a lot more about than we do. In many cases, that treatment is gender reassignment.

Would we deny treatement for depression if it was expensive? What if you have a non-threatening brain tumor that gives you blinding headaches every day? Or a bad case of tinnitus that needs and expensive operation? I’m pretty sure we’d treat those prisoners. The only reason we treat this different is the widespread misconception that transgenderism is some kind of kinky perversion. It’s time for us to stop acting like fifth graders (OMG it has to do with gonads!) and treat it like any other disorder by providing proper proven treatment.

No, not every treatment for depression should necessarily be made available, even if it’s considered effective. I don’t have access to every available treatment either. Becoming a ward of the state by virtue of your criminal activity should not by definition mean you now get to demand whatever medical treatment you’d like.

If some prestigious institution has a unique and promising program for treating depression, one that seems to accommodate our criminal’s needs but with an enormous price tag–does he get this treatment?


You have people in this very thread saying they think this is a valid medical treatment, but don’t agree that it should be available to prisoners. So methinks your “only reason” conclusion is just a bit broad.

I’m guessing that if a prisoner lost all his teeth the state would pay for dentures but not titanium tooth implants. The state will pay for root canals, but not cosmetic veneers. Treating dental problems is medically necessary, but not all dental treatments are covered.

I think there’s an argument here for some concession to transgender status, such as clothing (not that there’s much difference between male and female orange jumpsuits), segregation from hostile elements in the general population and so forth.

Many non-incarcerated transsexuals wear female clothes, take hormones, and so forth but don’t have that final surgery. Frequently, it’s a matter of finances but sometimes a transsexual stops just short of genital alteration but in all other ways is their preferred gender. Frequently, for female to male transsexuals it has to do with inadequancies in current surgical techniques for their needs. Even for male to female, though, being able to pass as female even while retaining a penis often relieves much of their distress.

So, I think an argument can be made here that while it may be medically necessary to treat transgender prisoners, that treament doesn’t necessarially include surgery in all, or even most cases.

We’ve got a winner!

Thanks for that nice summation.

Forgive me if this is on the dumb end of the spectrum, but can a prisoner pay for elective (or medically justifiable) surgery on his or her own? Are they completely restricted to receiving only the medical care provided by the state, or could the hypothetical prisoner spring for the high-end implant if she wanted to have it done? Could she pay out of pocket for a different surgeon or PCP?