Spring 2026 Issue

Forensic Social Work: The Realities of Being Transgender in Prison
By Sue Coyle, MSW
Social Work Today
Vol. 26 No. 2 P. 8

Transgender individuals often experience violence and isolation when incarcerated.

On February 19, 2026, the Federal Bureau of Prisons released a new policy in which it stated that individuals in prisons will no longer have access to gender-affirming medical care. Describing gender identity as “disconnected from reality,” the policy states that “In instances when an inmate is diagnosed with GD [gender dysphoria] but is not currently receiving hormones to address GD, the Bureau will not provide hormones to address GD and the inmate will not receive hormones to address GD. Such inmates will continue to have an individualized treatment plan to meet the inmate’s needs. The individualized treatment plan may include psychotherapy, group counseling, psychiatric services, and psychotropic medications.”1

Those currently in a federal prison receiving hormone therapy will be tapered off of the treatment, ending in discontinuation. The Bureau of Prisons will also not provide access to surgery or even clothing and toiletries that align with an individual’s gender identity.

It is a change in policy that is “just devastating,” says Megan E. Gandy, PhD, LICSW, an associate professor and BSW program director at the School of Social Work at West Virginia University in Morgantown, West Virginia. “The biggest problem here is we’re treating this particular medical condition differently than we treat any other medical condition that people who are incarcerated face. Take for example diabetes. If we were to say, ‘Sorry! No more diabetes treatment for people who are incarcerated,’ that would be a violation of people’s right to life-saving medical care while they are incarcerated.

“Gender-affirming care is not different. Gender-affirming care is lifesaving,” Gandy emphasizes.

Access to gender-affirming care or the lack thereof is just one of the many, often life-altering, challenges that transgender individuals who are incarcerated contend with. These experiences in prison impact the well-being of transgender people while there and once released. For social workers to best support and advocate for the rights of transgender individuals who are incarcerated, they must understand what those challenges are.

Housing
At present, the vast majority of individuals in both state and federal prisons are housed in accordance with the sex they are assigned at birth, meaning a transgender woman would be placed in a men’s prison and a transgender man would be placed in a women’s prison. Some, though not many, states have policies that differ. For example, in California, The Transgender Respect, Agency and Dignity Act, which was signed into law in 2020, allows for transgender, nonbinary, and intersex individuals who are incarcerated to be housed based on gender identity.

“They have certain safety exceptions, so it’s not just a really broad umbrella of ‘You just get to choose,’” Gandy explains. “There’s a mandated guidance around [the placement] with the transgender person at the helm of that decision making.”

California and the few additional states with similar policies are, however, the exception, and these policies only apply to state prisons and jails. Federal prisons and jails rarely deviate from genital-based placement. In fact, it is estimated that 99% of transgender women in federal custody are in men’s facilities. NPR reported that, “as of Feb. 20 [2025], the BOP [Bureau of Prisons] has 2,198 transgender inmates within the federal prison system. Of those people, 22 trans women are currently housed in women’s facilities and one trans man is living in a men’s facility.”2

Violence and Isolation
While incarcerated, “People who identify as LGBTQIA+ and TGNCNB [transgender, gender nonconforming, and nonbinary] face the same challenges all incarcerated people face—isolation, cultures of violences and punishment—and more,” says Ali Kamerman, program coordinator of Osborne Association’s LGBTQIA+ Case Management Program in New York. The Osborne Association serves individuals and families impacted by the criminal justice system, offering services such as the LGBTQIA+ case management program which offers support to LGBTQIA+ and TGNCNB individuals during reentry or while at risk for justice involvement.

“The biggest struggles I see are discrimination within jails and prisons, from other incarcerated people and from correction officers,” Kamerman describes.

Although some of the issues that arise may be universal, the transgender population is disproportionately affected. For example, Gandy notes that while only about 4% of the overall prison population report sexual victimization, 40% of transgender people report the same while incarcerated. Transgender individuals are also more at risk for physical nonsexual assault/violence, as well as verbal assault and harassment when in prison.

“That really is the headline,” says Gandy of the prevalence of sexual assault. “Everything else comes from that: PTSD, mental health concerns, all the health risks that come with sexual violence like STDs. It really becomes an avalanche of problems when you just look at that one singular risk factor.”

It is important to note that the perpetrators of the violence experienced—sexual, physical, and verbal—are not just other incarcerated individuals. Staff have been alleged to be a part of or party to the assaults, as well.

There is not enough data to determine if rates of violence are or would be lesser when transgender people are housed according to gender identity. This is due at least in part to the fact that so few individuals are placed as such.

Attempts to protect transgender individuals from assault in prison can be further detrimental. “Broadly speaking, prison policies are punitive in nature, and they are ‘cookie cutter,’” Kamerman says, “meaning there is a lack of individualized approaches to challenges inside. Trauma-informed approaches do not exist. Discipline for infractions, the use of protective custody—which can feel like solitary confinement—and the approach to ‘suicide watch’ if someone expresses harm to self or others are all traumatizing.”

Many prisons resort to placing the victimized person in solitary confinement to shield them from the perpetrators. However, solitary confinement is typically a form of punishment—one that has proven harmful to mental health. For example, researchers in New York state found that people who were put into solitary confinement between 2015 and 2019 were five times more likely to die by suicide than the general prison population.

Thus, it can be assumed that solitary confinement for transgender individuals who have been assaulted would contribute more harm than help.

“If we have solitary confinement as a punishment, then the folks that need safety and protection are put into a place of punishment. Then, they not only face all the negative psychological impacts of solitary confinement, they also take on the burden of having needed protection and gotten punishment instead,” Gandy says.

In addition to the violence and isolation, it is also often challenging for trans people to access gender-affirming physical and mental health care in prison. This was true even before the Bureau of Prison’s February policy update. Several states, such as Kentucky and Idaho for example, have passed legislation that would prohibit taxpayer funding from being used for gender-affirming care in state prisons and jails. These laws are currently being challenged legally.

Reentry and Recidivism
The impact of the prison experience is long-lasting, extending beyond a person’s time served. “There are two different profiles—one person who has had gender-affirming care and therefore isn’t subject to all the trauma and the impacts of it. They can be released into the community with a much lighter load basically than a person who has been facing that discrimination or hasn’t had consistent gender-affirming care,” Gandy describes. “There are a lot more barriers to overcome.”

Kamerman has witnessed these barriers through the case management program and reports frequently seeing individuals with PTSD and complex PTSD when they are released.

“People are used to being extremely isolated and rigidly controlled and can struggle to survive without structure. They are not used to being in community with other LGBTQIA+ people and can be unsure how to make connections because of how long many of them had to fear homophobic and transphobic violence in prison or jail. As a result, many are closeted. They are likely to keep their identities a secret even when they are released because of the homophobia and transphobia in the shelter system,” she says.

Access to gender-affirming services outside of prison can also be challenging, particularly when there are delays or disruptions in Medicaid coverage, for instance. An inability to then receive gender-affirming medical care outside of prison further compounds the physical and mental health ramifications of limited or no care in prison. Difficulties in finding adequate housing and more can impact the reentry process, as well.

While there is no exact data on how these barriers may contribute to recidivism rates for the transgender population, it is known that transgender individuals are incarcerated at nearly twice the rate of the general population.

Advocacy and Support
Improving the realities of incarceration for transgender people requires support on both clinical and macro levels from social workers. Right now, as policies stack up against gender-affirming care, that can seem daunting, but it is possible.

Gandy recommends looking to policies already in place that offer protection. They do exist. The Prison Rape Elimination Act of 2003, for instance, has protections written into it specifically for the LGBTQIA+ population in prison. It requires that facilities screen individuals for risk of experiencing sexual violence and abuse, and that housing, work, and educational decisions not be based solely on the person’s gender assigned at birth. It also allows for accommodations, such as separate showering, for transgender and intersex people regardless of what gender-specific facility they are placed in.

Social workers should look for opportunities to learn, as well, so that they can offer quality gender-affirming care and/or advocate effectively. Organizations such as Glisten, the Human Rights Campaign, WPATH, and Advocates for Trans Equality offer such opportunities, as well as resources for the individuals served.

— Sue Coyle, MSW, is a freelance writer and social worker in the Philadelphia suburbs.

References
1. U.S. Department of Justice, Federal Bureau of Prisons. Management of inmates with gender dysphoria. https://www.documentcloud.org/documents/27279642-526001-management-of-inmates-with-gender-dysphoria/. Published February 19, 2026.

2. Diaz J. Federal prisons prep to move trans inmates as early as this week. NPR website. https://www.npr.org/2025/02/21/nx-s1-5305282/trans-inmates-federal-prison-policytransfers#:~:text=The%20BOP%20revealed%20in%20recent,to%20make%20
such%20a%20move. Updated February 25, 2025.