Reflections on the Legal Battles Over Prisoners with Gender Dysphoria

Momentum has shifted in the legal battles over the provision of sex reassignment surgery (SRS) for male prisoners. In 2015, two court decisions granted the operation and were not appealed by the California Department of Corrections and Rehabilitation. The author, who has participated in some of these battles as an expert, analyzes the strengths and limitations of the medical illness, developmental, and minority rights paradigms for Gender Dysphoria that are used to reach psychiatric opinions about medical necessity. Courts are influenced by the recommendation of the World Professional Association for Transgender Health (WPATH) that inmates should be treated as are individuals in the community. This is a compassionate assertion, but one not fully informed by practical experience with SRS among prisoners. Most inmates requesting SRS through litigation are serving very long or life sentences. Their backgrounds are quite unlike most transgendered individuals encountered in the community. If long-term prisoners are provided with SRS, the study of their adaptations may enable future decisions to be based on adaptation data rather than the competing opinions of experts. Gathering such data may be challenged as an experiment, however, and viewed as unethical.