California Prisons Struggle to Process Inmates' Gender-Affirming Surgery

Prisons across California are struggling to process an increasing number of requests by inmates to undergo gender-affirming care.

CalMatters, a nonpartisan newsroom committed to explaining California politics and policy, reported on Monday that the California Department of Corrections and Rehabilitation (CDCR) is seeing double the amount of prisoners requesting gender-affirming surgeries since last year. In its report, CalMatters added that the estimated increase in gender-affirming surgery requests is based on new budget documents.

As defined by the World Health Organization (WHO), gender-affirming care encompasses any social, psychological, behavioral and medical interventions "designed to support and affirm an individual's gender identity" when it conflicts with the gender they were born with.

CalMatters' report comes over a year after California Governor Gavin Newsom signed "The Transgender Respect, Agency and Dignity Act" in 2020, which allowed "incarcerated transgender, non-binary and intersex people to be housed and searched in a manner consistent with their gender identity." The legislation went into effect on January 1, 2021.

California Gender Affirming in Prisons 01
A wall outside a California prison is seen. Prisons across the state are currently struggling to process an increasing number of requests by inmates to undergo gender-affirming care. Tim Gray/Getty

"CDCR has already proactively implemented several policies, practices and procedures for the screening, housing, searching and treatment of incarcerated transgender, intersex, non-binary and gender non-conforming people," Newsom's office said in a statement after he signed the legislation. "This includes allowing access to clothing and personal care items consistent with their gender identity and setting clear expectations that staff address them consistent with their gender identity, to include the use of correct pronouns and honorifics."

Since 2017, only 20 inmates in California have undergone gender-affirming care, according to CalMatters. However, Monday's report notes that in the 2021-2022 calendar budget year, the number of gender-affirming surgery requests among inmates increased by 99 to 270.

CalMatters reported that the new budget documents estimate that 348 gender-affirming surgeries will be carried out this year, and at least 462 will be performed next year. The report also notes that the CDCR is only able to evaluate three gender-affirming surgery requests per week.

In a statement, a CDCR spokesperson told Newsweek that "the California Department of Corrections and Rehabilitation/California Correctional Health Care Services are requesting $2.2 million from the General Fund and 7.5 positions in 2023-2024 and ongoing for the Integrated Gender Affirming Health Care Program."

The statement continued: "This will support implementation and deliver gender-affirming care to the incarcerated population for transgender and gender diverse patients that is consistent with Departmental policy and Penal Code Sections 2605 and 2606."

California prisons are also facing a backlog of housing transfer requests, as there has only been 35 of 364 requests completed since 2021, CalMatters reported.

Meanwhile, in 2021 the feminist advocacy group Women's Liberation Front filed a lawsuit against the state criticizing it for allowing transgender women to be transferred to a female prison facility in Chowchilla.

"The reality that men and women are factually, materially, immutably different, in ways that disadvantage women and necessitate attention to women's unique needs, supports protection of incarcerated women by providing women-only correctional facilities," the group's lawsuit said, according to CalMatters. The lawsuit is currently ongoing in the U.S. Eastern District Court of California.

On the other hand, the American Civil Liberties Union (ACLU) and the Transgender Law Center, which filed a brief challenging the suit, said that transgender women should be transferred to female prison facilities, supporting the legislation that was signed by Newsom in 2020.

Update 6/27/23, 9:30 a.m. ET: This story has been updated to include a statement from the California Department of Corrections and Rehabilitation.

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