Under the Dome

In NC prisons, gender identity evaluated individually

How to help transgender people fit in with daily life has only recently become a public conumdrum. But prisons have been faced with the question for a long time, if only recently taking action to protect those prisoners from the increased exposure to violence.

Last month, the U.S. Department of Justice issued new regulations intended to clarify guidelines it established in 2012. The regulations say any policy that determines where to place transgender inmates is based only on their external genitals is a violation of federal guidelines, although the guidelines are not legally binding.

Prisons should consider prisoners’ gender identity when deciding where to house them, according to the federal agency.

North Carolina prisons now make that decision on a case-by-case basis outlined in a formal review process that was established in a 2014 policy. What is clinically called gender dysphoria is defined in North Carolina prison policy as “a diverse group of individuals who identify their gender in ways that often do no correspond to their birth anatomy.”

Transgender is a broad term. Some but not all transgender people take hormones or undergo surgery. The term “transsexual” can apply but is sometimes considered outdated.

In North Carolina, when a prisoner claims to be a transgender person they are evaluated by medical and mental health staff. That includes a physical examination and an evaluation of their history before and during incarceration. That includes whether they have had or are currently in hormone therapy, have had surgical procedures, what their life experiences are and what their mental health history is.

With a diagnosis of gender dysphoria, each case is reviewed by a panel representing psychiatry, social work, primary care medicine, nursing, and prison administration. The state tries to place those prisoners in prisons with on-site psychiatrists during the evaluation.

The review panel then comes up with a plan that might include authorizing the use of items meant to be used for “masculinizing or feminizing effect,” hormone therapy and mental health services. A determination is made about whether to house them in male or female prisons, taking into consideration their health and safety and what management problems might arise.

Those who are already on hormone therapy when sent to prison are allowed to continue that treatment, once approved by an endocrinologist. Each case has to be approved by the top medical and mental health officials in the system.

Prior to the 2014 policy, North Carolina prisoners were placed based on their “genital identity” with staff supposedly taking steps to protect them, a prison official said in 2010.

According to the federal Bureau of Justice Statistics, an estimated 4 percent of state and federal prison inmates report being sexually assaulted. For transgender prisoners, that number rises to more than one-third.