Contrary to popular belief, inmates do not lose all of their rights once they enter jail or prison. Their rights are limited, but they do still fall under laws designed to treat them fairly and with some humanity in most societies. The issue of gender and gender alignment is one that is still not fully understood or appreciated in the free world. For inmates and those charged with their care, it adds another dimension to the medical, social and security needs of that group. Sex-change surgery is for many, an expense too far when it comes to the housing and control of prisoners. The cry of "the tax payer should not foot the bill" is an understandable one, yet it is often clouded by mis-information and emotion.
There have always been individuals who feel that they are living in the wrong body, or conforming to the wrong gender role in the society in which they live. It has very little to do with one's sexual orientation, and although psychological evaluation is carried out on the individuals, little real clinical research exists into whether there is truly a chemical imbalance present to cause the feelings of gender mis-identity. However, in those who decide to go through the gender reassignment process, there is no doubt in their mind that they were born in the "wrong" body.
The steps of the gender reassignment process are long and difficult. The decision to go forward usually comes after many years of inner turmoil for the individual, often well into adult life, having perhaps married and started a family in an attempt to conform. Before any surgery is approved, individuals usually spend a period (usually one to two years) living in the gender they wish to become. This involves dressing and socialising as that gender at first, then progressing to hormone treatment to physically change the body towards the preferred gender; this is usually known as "transition". Only after this has progressed to a certain point, and the individual has undergone lengthy counseling, does the question of sex-change surgery become a possibility.
Prisoners may have been going through transition before their life choices led them to prison. However, they would be assigned to a prison based on the gender on their birth certificate, and not the gender they display through dress or characteristics. Again, it is important to stress that transgender has little to do with sexual orientation. Placing a transgendered male who wishes to be female into a male prison, even though they have no sexual inclination towards other males, can create very real dangers for that inmate. In a perfect world, there would be specialist transgendered prison units able to deal with the specific psychological and medical needs of this group; but in a perfect world there would be no inmates.
Many transgendered individuals choose not to have sex-change surgery. Indeed there are many who do not go through the hormone treatment either and simply dress as their preference dictates. It is not a medical requirement to cure a disease or impediment, it is a cosmetic aid to further an individual's self-identity. For this reason, prisoners wishing to undergo sex-change surgery are unlikely to have their request approved. This is sensible on the part of the authorities up to a point; the surgery is costly, and the aftercare is very important. Prisoners are not afforded the luxury of long recuperative stays in hospital even when the surgery is life-saving, and prison staff are not trained or qualified to look after such complex needs. It also creates many security issues, between inmates and for the staff, as to where to house an inmate who was one gender when they arrived but then becomes another while they are incarcerated.
For the inmate, there would also be little psychological support available during the transition process. Even if the surgery was successful with no complications (infection and failure are very common for these procedures), the emotional needs of the individual are unlikely to be met by prison counseling staff, if they even exist. When the inmate is finally released, as the vast majority are, then returning to their home location is difficult enough without the added stress of doing so as a completely different person, outwardly and psychologically. Many inmate are released with no outside support, particularly after long periods of incarceration; it is not uncommon for them to re-offend within the first 12 months. This then places them back into the system, but possibly into a prison for the opposite gender.
While it is preferable for transgendered inmates to receive housing and adequate security while they are in prison, along with sympathetic counseling and perhaps a continuation of hormone treatment if they had begun it prior to their incarceration, there can be no good reason why sex-change surgery should be carried out while they are detained.