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Transgender prisoners and healthcare

Some transgender prisoners are allowed to take social, legal, and medical transition steps while in custody. The rules vary widely and cannot be generalized.

Because the costs of gender transition are often funded with taxes, these decisions are subject to debate by experts, politicians, the media, and the lay public.

Social transition


Facilities usually require that prisoners use only those items of clothing and linen issued to them. This example is from the California Department of Corrections and Rehabilitation (CDCR):

  • Men
    • Work shoes (one pair)
    • Jeans (three)
    • Shirts (three)
    • Undershirts (four)
    • Socks (six pair)
    • Undershorts (four pair)
    • Jacket (one)
    • Belt (one)
  • Women
    • Work shoes (one pair)
    • Blouses/shirts (three)
    • Slacks (three pair)
    • Bras (three)
    • Dress, muumuu, robe, or duster (one)
    • Coat (one)
    • Panties (five)
    • Nightgown (0ne)
    • Socks (six pair)

CDCR has relatively progressive rules for qualified trans and gender diverse people:

Transgender inmates and inmates having symptoms of gender dysphoria as identified and documented in SOMS [the Strategic Offender Management System] by medical or mental health personnel within a CDCR institution shall be allowed to possess the state-issued clothing that corresponds to their gender identities in place of the state-issued clothing that corresponds to their assigned sex at birth at designated institutions.


Most facilities also have grooming standards which may include sex-specific rules about hair length and style as well as use of approved hair holding devices. For instance, prisoners with braids may be required to undo them on demand to check for contraband.

Legal transition

Changing your legal name and gender while incarcerated is possible in some systems, but each one is different. Some do not allow it.

Prior to 2018, California state prisoners needed permission from the Secretary of the California Department of Corrections and Rehabilitation (CDCR) to change name or gender. Thanks to activists within the prison system, an incarcerated person can directly file a petition with the court through the same process used by a person who is not incarcerated. California has one of the most progressive rules in the world, however.

In most jurisdictions, a prison official must approve any legal name or gender change, if it is even allowed.

Medical transition

Incarcerated transgender people have a right to healthcare while in custody. Every facility has different rules about what constitutes necessary or accepted medical care.

Historically denied

Healthcare is often denied for trans prisoners, or it is very difficult to get.

  • In 2023 Florida executed Duane Owen without providing requested trans healthcare. Owen was convicted for the 1984 rape and stabbing of a 14-year-old girl, the rape and murder of a 38-year-old woman, and was a suspect in other attacks.


Hormones are generally much easier to get than surgery.

  • Convicted murderer Michelle Kosilek successfully sued to get hormones in 2002, then unsuccessfully sued to get electrolysis in 2009. Kosilek is serving a life term for murdering her wife in 1990.


Many trans prisoners unsuccessfully sought surgery via the courts.

  • Career criminal Donna Dawn Konitzer’s attempts to get state-funded trans healthcare led to passage of Wisconsin’s 2005 Sex Change Prevention Act, ruled unconstitutional in 2011. Konnitzer’s most recent period of incarceration began December 20, 1994, following a conviction on multiple counts of armed robbery and possession of a firearm by a felon.
  • Convicted murderer Michelle Kosilek unsuccessfully sued to get surgery while in prison from 2006 to 2015. In 2019, Kosilek was transferred from men’s facility MCI-Norfolk to women’s facility MCI-Framingham. In 2021, providers performed her gender-affirming surgery. In 1990 Kosilek murdered her wife.
  • Convicted murderer Michelle-Lael Norsworthy was granted permission for bottom surgery in 2014, but was paroled before the state could pay. In 1984 Norsworthy shot and killed a man she knew from a previous drug deal.
  • Convicted murderer Shiloh Quine was the first in the state to get state-funded surgery, in 2017. Quine and an accomplice were convicted in 1980 of robbery, kidnapping, and murder.
  • Convicted rapist Jessica Winfield received surgery while being held at men’s facility HM Prison Whitemoor. Winfield was convicted of raping two women in 1995.

In 2017, there were 475 transgender prisoners is the California system.

As of 2023, there were about 1200 trans inmates in the US federal system, about 1% of the total.

  • In 2023, Cristina Nichole Iglesias was the second US federal prisoner to receive gender affirming surgery. Her legal team said she got bottom surgery and facial feminization. The ruling in her 2022 case made it possible for the first recipient in 2022. Iglesias was convicted of mailing threats to British government officials while in prison for mailing threats to US government officials.

Disclaimer: this is legal and medical talk, not advice. Some of this may not apply to you. It is presented without warranty. It may contain errors or omissions. You must do your own research.


Cal. Code Regs. tit. 15 § 3030

Transgender Law Center (2020). Guide to Legally Changing Your Name & Gender While Incarcerated.

Ramirez, Marc (April 6, 2023). Transgender prisoner who fought for gender-affirming care for all inmates undergoes surgery. USA Today

Phillips, Kristine (January 10, 201). A convicted killer became the first U.S. inmate to get state-funded gender-reassignment surgery. Washington Post

See also

Transgender prisoner resources