Several other trans men incarcerated in Texas and contacted by NBC News said they had encountered officers who required them to wear sports bras and women’s underwear, as well as to grow out their hair to longer than 2½ inches or risk “catching a case” — getting written up for breaking the rules. According to advocates and currently and formerly incarcerated people, trans men in the state have no routine access to boxer shorts and are unable to buy chest binders, which are used by those who have not yet had top surgery to flatten their breasts.
“I’ve tried to request boxers and chest binders and was denied, which made my depression worse,” Angel Ochoa, 49, another incarcerated trans man in the state, said in a letter. Asked to clarify the state’s position on clothing for transgender people, Hurst, the Texas Department of Criminal Justice spokesperson, said, “Inmates are to dress according to the sex assigned to them at birth.”
Ochoa said he was a tomboy growing up and started dressing as a boy when he was 12. His family supported his transition from the start, he said. “I was loved by my mom and grandmother and accepted as a boy.”
Ochoa, who has been incarcerated since the 1990s, said he has faced humiliating and degrading treatment in the prison system.
“The most pressing issue is us being forced to be someone we are not,” he said, adding that he was made to grow out his hair, which was shaved bald when he entered prison. “They say it’s a ‘security precaution.’ … It’s just a way to hurt us.”
According to data recently obtained through a public information request, 980 transgender women and 113 transgender men were in Texas Department of Criminal Justice custody in 2019. A policy document provided by the department states that “inmates are housed according to their genital status.”
Nell Gaither is the president of the Trans Pride Initiative, a Texas-based nonprofit group founded in 2011 that has communicated with over a thousand transgender people incarcerated in the state. Gaither said it is her impression that in recent years the Texas Department of Criminal Justice has been less aggressive in forcing trans men to wear sports bras or grow out their hair but that it reflects a shift in priorities and culture rather than a change in policy. Facial hair continues to be a problem, she said, because trans men “can’t get enough razors to keep cleanshaven, then ‘get cases’ for having beards.” She also said that one significant impact of Covid-19 on trans prisoners has been the delay or lack of access to gender-affirming hormones.
But the situation can vary significantly from state to state and even city to city. In California state prisons, for example, trans men in women’s prisons can buy the same hygiene items available to people in men’s prisons and are provided with male clothing. They can also purchase chest binders, though the $40 or $50 price tag puts the option out of reach for many individuals. In Georgia state prisons, trans men in women’s facilities can shave their heads and grow out their beards, but, except for boxers, they are only able to obtain clothing from the female order form.
Ronnie Fuller, 42, is incarcerated at Georgia’s Arrendale State Prison in Alto, about an hour northeast of Atlanta. He said he has identified as male since he was a kid but did not always know what those feelings meant.
“I didn’t know what ‘transgender’ was until I came to prison, and that was years within my sentence,” he said.
Fuller has been incarcerated since 2004, and for his first decade behind bars, the state refused to provide hormones to trans people who had not been prescribed them before they entered the prison system. In 2015, the policy changed.
“When the option became available here in the prison, I jumped on the opportunity,” Fuller said of obtaining hormones.
Since then, the prison administration has made other small concessions, including allowing trans men to buy boxers, he said. However, he and others are still unable to get chest binders, and he said the prison turned down an offer from a volunteer who was willing to donate them.
Prison staff members “give us male hormones, boxers and believe that is enough,” he said, adding that being unable to obtain a chest binder and get gender-affirming surgery has affected him “emotionally, mentally and physically.”
Fuller said that with so many barriers to obtaining gender-affirming care, he believes prison is the worst place to begin a medical transition.
“I have experienced more judgment and discrimination behind these walls than I have ever experienced on the outside,” he said in a letter.
The Georgia Corrections Department did not respond to requests for comment made by phone and email.
‘It should not be so hard to get normal treatment’
As a result of lawsuits successfully litigated across the country, most transgender prisoners in the U.S. now have the right to obtain gender-affirming hormones, regardless of whether they had been prescribed them before they were incarcerated. However, according to advocates, prisoners rights attorneys and currently and formerly incarcerated people, while the policies may exist on paper, hormones are often difficult to obtain in practice. Trans people behind bars said it can take months or even years for them to obtain gender dysphoria diagnoses and be evaluated by endocrinologists or other specialists, resulting in delays in treatment that are distressing and perplexing to those seeking care.
Graham was in custody of the Texas Department of Criminal Justice for about six months before he was given access to the gender-affirming hormone treatments he had been receiving before his incarceration, according to Graham and prison records he provided. Fuller similarly said that while he was approved to be evaluated for hormone treatment in April 2017, it took well over a year for him to get his first endocrinologist appointment.
“It should not be so hard to get normal treatment, whatever that may be,” Fuller wrote in a letter.
Furthermore, while the U.S. has taken steps to ensure that trans prisoners have access to gender-affirming hormones, the vast majority of jurisdictions still do not allow incarcerated people meaningful access to gender-affirming surgery, said Danny Waxwing, an attorney at Disability Rights Washington, who has represented many trans prisoners in the state. For trans men, that means not being able to undergo top surgery for the duration of their sentences.
In August, the LGBTQ civil rights group Lambda Legal sued the Virginia Corrections Department on behalf of an incarcerated transgender man, Jason Yoakam. The organization said the suit is among the first filed on behalf of an incarcerated trans man for the denial of treatment for gender dysphoria.
“Under the Eighth Amendment, prison systems are required to provide adequate medical care,” said Richard Saenz, a senior attorney and criminal justice and police misconduct strategist at Lambda Legal. “This lawsuit is necessary because for a number of trans people behind bars, even those who are provided some care, [they] are often not provided adequate medical and mental health care.”
“All medically necessary treatment is available,” a Corrections Department spokesperson told the Washington Post in August. “Treatment decisions are made on a case-by-case basis. In addition to medical treatment, individual and group therapy is also available. We follow the community standard of care.” The case is currently scheduled for mediation.
A handful of states, including California and Washington, have policies that make it possible for trans people to obtain gender-affirming surgery while incarcerated. However, according to prisoners interviewed by NBC News, the process for evaluating who qualifies for the procedure is flawed and inadequate.
Giovanni Gonzales, the California prisoner, said neither he nor his doctor has played a key role in determining whether he qualifies for top surgery on the grounds that it is medically necessary. Instead, the decision is made by a committee responsible for evaluating trans prisoners across the state, he said. Under Corrections Department policy, primary care providers on the institutional level are tasked with passing along requests for surgery to a statewide body known as the Gender Affirming Surgery Review Committee. The committee, which is made up of medical and mental health experts who have not treated the prisoner, then votes on whether to approve or deny the request.
Gonzales and others interviewed by NBC News expressed frustration that the committee exists at all, since no parallel committee exists for individuals seeking to obtain treatment deemed medically necessary by their physicians — for example, people who need to have their breasts removed due to a cancer diagnosis.
“My doctors don’t have a say in my surgery. It’s these doctors that go on this committee that don’t have nothing to do with me,” Gonzales said.
With the support of his psychologist, Gonzales initially made a request to obtain surgery in November 2018. He was issued a denial several months later and filed a lawsuit afterwards alleging that the California Department of Corrections and Rehabilitation was violating his constitutional rights. In February, more than two years after he filed suit, his request for surgery was finally approved.
No ‘simple’ housing solution
In addition to facing barriers in obtaining their preferred clothing, as well as gender-affirming health care, incarcerated trans men also say they struggle when it comes to housing. As NBC News documented in an investigation last year, the vast majority of trans people in the U.S. are incarcerated in prisons that match their birth sexes or genitalia, rather than their gender identities, even though doing so without considering safety concerns or prisoners’ preferences is illegal under the Prison Rape Elimination Act. That reality has put many trans women in danger of sexual assault, violence and harassment.
El Sabrout of Black and Pink said that transgender men would not necessarily be safer if they were housed in men’s facilities, as opposed to being housed according to their sex assigned at birth. However, he added, that does not mean they do not experience physical or sexual violence in women’s prisons.
Graham said women on his unit would undress and climb into his bed at night saying they were going to have sex with him or would try to look at his body while he was showering, even though he was supposed to be permitted to shower alone.
Prison staff members did not take steps to keep him safe, he said. After staff members were alerted to one particular incident, he spent about 10 days in “safekeeping,” a form of isolation also known as protective custody. Incarcerated trans people often end up in protective custody for their purported protection, because they are uniquely vulnerable to sexual and physical assault when they are in the general population. But the conditions in protective custody generally mirror the conditions faced by those in disciplinary isolation. When he was in safekeeping, Graham said, he was fed through a door and had very limited access to showers or his property. After a third time in safekeeping, Graham said, he was fed up and vowed never to end up there again.