By the time he ended up in the custody of the Texas Department of Criminal Justice on insurance and theft charges, Tahj Graham was 33 and had been living as a man for nearly half his life. Born in 1985 as the youngest of three kids, Graham soon realized he was not like other children who had been assigned female at birth.
“As early as 5 years old, I knew that something was different,” Graham, 36, said in a phone call from his home in Mansfield, a suburb between Dallas and Fort Worth.
He came out as a teenager, started taking hormones at 17 and had his breasts removed when he was 20 in a procedure known as “top surgery.” Once he had undergone a medical transition, Graham said, he passed completely as a man.
“Unless it was someone that I was dating, I never disclosed being trans,” he said.
As he was transitioning, Graham’s life also moved forward in other ways. He started working toward a college degree, taking classes at other schools before enrolling in the University of Texas at Austin in 2006. After he tried out a couple of other majors, he finally settled on religion. “I was given a Bible at age 7,” he said, and faith was “just something I always felt.”
He had dreams of starting his own ministry and distributing Bibles around the world. However, in 2016, Graham was arrested for insurance fraud and was also under investigation for wiring himself about $90,000 from an ex-girlfriend’s bank account without her permission. In 2018, he pleaded guilty to both charges and was sentenced to three years in prison.
First, he was sent to a men’s prison — until, he alleges, guards started to perform invasive strip and cavity searches and he raised the alarm.
“I was then transferred to a women’s unit, where the big nightmares occurred,” he wrote in an email. Over the next few months, he endured “voyeuristic strip searches by female staff,” was forced to grow out his hair and was sexually harassed by other prisoners, he said. “So many incidents occurred at the female unit I nearly lost count.”
Currently and formerly incarcerated transgender people, like Graham, are increasingly coming forward to discuss their difficult experiences behind bars, and over the past few years, news outlets have devoted considerably more space to their stories. The reporting, however, has focused primarily on trans women, who are incarcerated at a higher rate than any other segment of the LGBTQ community. Transgender men are also incarcerated at disproportionate rates: According to the 2011 National Transgender Discrimination Survey by the National Center for Transgender Equality and the National Gay and Lesbian Task Force, about 10 percent of trans men have spent time in jail or prison — approximately twice the rate of U.S. adults overall.
Incarcerated transgender men encounter many of the same issues as their transfeminine peers — including high rates of solitary confinement and sexual assault and denial of gender-affirming care and gender-appropriate clothing. But they also face “unique issues that are separate from what trans women experience,” said Aaron El Sabrout, the advocacy manager of Black and Pink, a nonprofit group based in Nebraska that supports LGBTQ people in prison.
“Trans women have hypervisibility,” he said, whereas “trans men, most people think we don’t exist.”
Trans men’s experiences, however, are not uniform. Every city, county and state, as well as the federal government, has broad authority to establish its own policies about the treatment of trans prisoners. For that reason, the conditions experienced by these men vary significantly across the country. Individual prison environments and leadership also affect what someone may experience behind bars.
Verbal and physical harassment
In March 2018, Graham turned himself in to the Texas Department of Criminal Justice to begin serving his sentence. Although he had transitioned medically years before and “passed” as a man in his daily life, Graham did not fit neatly into the binary categories of “male” or “female,” and for that, he said, he paid. On his first day in custody at the men’s prison where he was first sent, two correctional officers began to strip search him inappropriately, he said.
“The officer asked me to lie down on a table, then told me to spread my legs and hold them open,” Graham said, adding that he was then instructed to pull his genitalia back so the officer could “get a better look.” He said he could see that the officer was getting an erection. When the search was over, Graham said, he told a counselor at the facility what had happened.
After an invasive exam at the nurse’s office, “they moved as fast as they could to get me out of there,” he said. Graham also filed a sexual abuse complaint about the incident, which, he said, was never pursued by the Texas Department of Criminal Justice. (With Graham’s permission, NBC News requested a copy of Graham’s medical file and complaint history. The department denied the request; Graham was able to provide copies of several records he had.)
After having spent several weeks at an Austin jail, Graham was transferred to a women’s prison run by the Texas Department of Criminal Justice. But rather than offer him greater safety and security, the women’s prison “was a million times worse,” he said. Upon his arrival, Graham said, he underwent a strip search in view of a large group of incarcerated women.
“They forced me to bend over and open up my legs to make sure I didn’t have a hidden penis,” he said.
Graham recalled experiencing near-constant verbal abuse from staff members from then on. In a grievance form he filed while he was incarcerated, Graham described an incident in which an officer became enraged at him, screaming, “You were born a f------ girl, you’re at a woman unit.”
“I do not expect an officer to berate me and argue with me and declare as if they’re God in front of other offenders,” Graham wrote in the May 2019 complaint, according to a copy provided by Graham and reviewed by NBC News.
In its response, the Texas Department of Criminal Justice said there was “no evidence to support” Graham’s allegations and concluded, “No further action is warranted.”
The department said it is unable to comment on Graham’s grievances because they are not public.
Robert Hurst, a spokesman for the department, also declined to comment on Graham’s account of the strip search and directed NBC News to the department’s written policy regarding the Health Appraisal of Incoming Inmates. According to additional policy documents provided by Hurst, Texas Department of Criminal Justice officers are not required to refer to transgender people by their preferred pronouns.
Giovanni Gonzales, 31, is incarcerated at the Central California Women’s Facility in Chowchilla, just north of Fresno. He said in a phone interview that he has dealt with transphobic harassment from prison staff members. In spring 2021, when Gonzales was working at the prison’s clothing exchange, his supervisor on the site — an employee of the facility — consistently made discriminatory remarks, he said.
“He makes comments to me that are inappropriate. He always refers to me as a she. He refuses not to,” he said. In July, Gonzales said by email that he had been barred from going to work. He filed an official complaint, but his boss denied Gonzales’ account, and prison officials ultimately determined that his complaint was unsubstantiated, he said.
“The cameras have no audio — how convenient for them — so all he had to say was no he didn’t disrespect me,” Gonzales wrote in an email.
Terry Thornton, the deputy press secretary for the California Department of Corrections and Rehabilitation, said that the department has a policy mandating respectful communication and that it has developed training specifically to help staff members better engage with incarcerated people who are transgender or nonbinary.
“Repeatedly or intentionally using inappropriate pronouns or any other type of derogatory comments about a person’s gender is a violation under PREA, constitutes staff-on-offender sexual harassment, and subjects the staff member to discipline,” she said in an email, using the acronym for the federal Prison Rape Elimination Act.
Gonzales, who grew up in San Jose, California, said his childhood was not easy. He knew he was different but did not have the language or the framework to pinpoint why.
“I didn’t understand. I didn’t know about gender dysphoria,” he said.
It was only once he was in prison that he started taking testosterone.
“I had to wait a whole year to get on the shots, because I got in trouble a lot,” he said. “I wanted this so bad I got [myself] together.”
Gonzales has now been on testosterone, also known simply as “T,” for five years.
'Forced to be someone we are not'
In addition to what he said was routine verbal and physical harassment from prison staff members, Graham also said he was prevented from dressing and grooming himself in a way that aligns with his gender. Correctional officers told Graham he would get written up unless he grew out his hair, and they forced him to shave his beard, which he had permission to maintain on religious grounds, he said. He also alleged that they told him he was required to wear women’s underwear and a bra, even though he had had his breasts removed.
Several other trans men incarcerated in Texas and contacted by NBC News said they had encountered officers who required them to wear sports bras and women’s underwear, as well as to grow out their hair to longer than 2½ inches or risk “catching a case” — getting written up for breaking the rules. According to advocates and currently and formerly incarcerated people, trans men in the state have no routine access to boxer shorts and are unable to buy chest binders, which are used by those who have not yet had top surgery to flatten their breasts.
“I’ve tried to request boxers and chest binders and was denied, which made my depression worse,” Angel Ochoa, 49, another incarcerated trans man in the state, said in a letter. Asked to clarify the state’s position on clothing for transgender people, Hurst, the Texas Department of Criminal Justice spokesperson, said, “Inmates are to dress according to the sex assigned to them at birth.”
Ochoa said he was a tomboy growing up and started dressing as a boy when he was 12. His family supported his transition from the start, he said. “I was loved by my mom and grandmother and accepted as a boy.”
Ochoa, who has been incarcerated since the 1990s, said he has faced humiliating and degrading treatment in the prison system.
“The most pressing issue is us being forced to be someone we are not,” he said, adding that he was made to grow out his hair, which was shaved bald when he entered prison. “They say it’s a ‘security precaution.’ ... It’s just a way to hurt us.”
According to data recently obtained through a public information request, 980 transgender women and 113 transgender men were in Texas Department of Criminal Justice custody in 2019. A policy document provided by the department states that “inmates are housed according to their genital status.”
Nell Gaither is the president of the Trans Pride Initiative, a Texas-based nonprofit group founded in 2011 that has communicated with over a thousand transgender people incarcerated in the state. Gaither said it is her impression that in recent years the Texas Department of Criminal Justice has been less aggressive in forcing trans men to wear sports bras or grow out their hair but that it reflects a shift in priorities and culture rather than a change in policy. Facial hair continues to be a problem, she said, because trans men “can’t get enough razors to keep cleanshaven, then ‘get cases’ for having beards.” She also said that one significant impact of Covid-19 on trans prisoners has been the delay or lack of access to gender-affirming hormones.
But the situation can vary significantly from state to state and even city to city. In California state prisons, for example, trans men in women’s prisons can buy the same hygiene items available to people in men’s prisons and are provided with male clothing. They can also purchase chest binders, though the $40 or $50 price tag puts the option out of reach for many individuals. In Georgia state prisons, trans men in women’s facilities can shave their heads and grow out their beards, but, except for boxers, they are only able to obtain clothing from the female order form.
Ronnie Fuller, 42, is incarcerated at Georgia’s Arrendale State Prison in Alto, about an hour northeast of Atlanta. He said he has identified as male since he was a kid but did not always know what those feelings meant.
“I didn’t know what ‘transgender’ was until I came to prison, and that was years within my sentence,” he said.
Fuller has been incarcerated since 2004, and for his first decade behind bars, the state refused to provide hormones to trans people who had not been prescribed them before they entered the prison system. In 2015, the policy changed.
“When the option became available here in the prison, I jumped on the opportunity,” Fuller said of obtaining hormones.
Since then, the prison administration has made other small concessions, including allowing trans men to buy boxers, he said. However, he and others are still unable to get chest binders, and he said the prison turned down an offer from a volunteer who was willing to donate them.
Prison staff members “give us male hormones, boxers and believe that is enough,” he said, adding that being unable to obtain a chest binder and get gender-affirming surgery has affected him “emotionally, mentally and physically.”
Fuller said that with so many barriers to obtaining gender-affirming care, he believes prison is the worst place to begin a medical transition.
“I have experienced more judgment and discrimination behind these walls than I have ever experienced on the outside,” he said in a letter.
The Georgia Corrections Department did not respond to requests for comment made by phone and email.
'It should not be so hard to get normal treatment'
As a result of lawsuits successfully litigated across the country, most transgender prisoners in the U.S. now have the right to obtain gender-affirming hormones, regardless of whether they had been prescribed them before they were incarcerated. However, according to advocates, prisoners rights attorneys and currently and formerly incarcerated people, while the policies may exist on paper, hormones are often difficult to obtain in practice. Trans people behind bars said it can take months or even years for them to obtain gender dysphoria diagnoses and be evaluated by endocrinologists or other specialists, resulting in delays in treatment that are distressing and perplexing to those seeking care.
Graham was in custody of the Texas Department of Criminal Justice for about six months before he was given access to the gender-affirming hormone treatments he had been receiving before his incarceration, according to Graham and prison records he provided. Fuller similarly said that while he was approved to be evaluated for hormone treatment in April 2017, it took well over a year for him to get his first endocrinologist appointment.
“It should not be so hard to get normal treatment, whatever that may be,” Fuller wrote in a letter.
Furthermore, while the U.S. has taken steps to ensure that trans prisoners have access to gender-affirming hormones, the vast majority of jurisdictions still do not allow incarcerated people meaningful access to gender-affirming surgery, said Danny Waxwing, an attorney at Disability Rights Washington, who has represented many trans prisoners in the state. For trans men, that means not being able to undergo top surgery for the duration of their sentences.
In August, the LGBTQ civil rights group Lambda Legal sued the Virginia Corrections Department on behalf of an incarcerated transgender man, Jason Yoakam. The organization said the suit is among the first filed on behalf of an incarcerated trans man for the denial of treatment for gender dysphoria.
“Under the Eighth Amendment, prison systems are required to provide adequate medical care,” said Richard Saenz, a senior attorney and criminal justice and police misconduct strategist at Lambda Legal. “This lawsuit is necessary because for a number of trans people behind bars, even those who are provided some care, [they] are often not provided adequate medical and mental health care.”
“All medically necessary treatment is available,” a Corrections Department spokesperson told the Washington Post in August. “Treatment decisions are made on a case-by-case basis. In addition to medical treatment, individual and group therapy is also available. We follow the community standard of care.” The case is currently scheduled for mediation.
A handful of states, including California and Washington, have policies that make it possible for trans people to obtain gender-affirming surgery while incarcerated. However, according to prisoners interviewed by NBC News, the process for evaluating who qualifies for the procedure is flawed and inadequate.
Giovanni Gonzales, the California prisoner, said neither he nor his doctor has played a key role in determining whether he qualifies for top surgery on the grounds that it is medically necessary. Instead, the decision is made by a committee responsible for evaluating trans prisoners across the state, he said. Under Corrections Department policy, primary care providers on the institutional level are tasked with passing along requests for surgery to a statewide body known as the Gender Affirming Surgery Review Committee. The committee, which is made up of medical and mental health experts who have not treated the prisoner, then votes on whether to approve or deny the request.
Gonzales and others interviewed by NBC News expressed frustration that the committee exists at all, since no parallel committee exists for individuals seeking to obtain treatment deemed medically necessary by their physicians — for example, people who need to have their breasts removed due to a cancer diagnosis.
“My doctors don’t have a say in my surgery. It’s these doctors that go on this committee that don’t have nothing to do with me,” Gonzales said.
With the support of his psychologist, Gonzales initially made a request to obtain surgery in November 2018. He was issued a denial several months later and filed a lawsuit afterwards alleging that the California Department of Corrections and Rehabilitation was violating his constitutional rights. In February, more than two years after he filed suit, his request for surgery was finally approved.
No 'simple' housing solution
In addition to facing barriers in obtaining their preferred clothing, as well as gender-affirming health care, incarcerated trans men also say they struggle when it comes to housing. As NBC News documented in an investigation last year, the vast majority of trans people in the U.S. are incarcerated in prisons that match their birth sexes or genitalia, rather than their gender identities, even though doing so without considering safety concerns or prisoners’ preferences is illegal under the Prison Rape Elimination Act. That reality has put many trans women in danger of sexual assault, violence and harassment.
El Sabrout of Black and Pink said that transgender men would not necessarily be safer if they were housed in men’s facilities, as opposed to being housed according to their sex assigned at birth. However, he added, that does not mean they do not experience physical or sexual violence in women’s prisons.
Graham said women on his unit would undress and climb into his bed at night saying they were going to have sex with him or would try to look at his body while he was showering, even though he was supposed to be permitted to shower alone.
Prison staff members did not take steps to keep him safe, he said. After staff members were alerted to one particular incident, he spent about 10 days in “safekeeping,” a form of isolation also known as protective custody. Incarcerated trans people often end up in protective custody for their purported protection, because they are uniquely vulnerable to sexual and physical assault when they are in the general population. But the conditions in protective custody generally mirror the conditions faced by those in disciplinary isolation. When he was in safekeeping, Graham said, he was fed through a door and had very limited access to showers or his property. After a third time in safekeeping, Graham said, he was fed up and vowed never to end up there again.
Trans men may also be unfairly identified as threats to other inmates and punished, said El Sabrout, who said others “perceive them as threatening” and “dangerously sexual,” particularly when they begin taking testosterone.
Ochoa said he was once placed in solitary confinement after he was accused of having a sexual relationship with a correctional officer.
“Anyone can say anything about you and it’s believed, especially if you’re a trans guy,” said Ochoa, whose prison records were not independently reviewed by NBC News.
When they were interviewed, most incarcerated trans men said they would not want to be transferred to a men’s prison. Some, including Graham, said they would prefer to be placed in transgender-specific housing units, an approach that was previously used by Immigration and Customs Enforcement and some city jails to house trans women, while others said they would not feel comfortable in those environments.
“Special units can cause you to feel isolated,” Ronnie Fuller, the trans man incarcerated in Georgia, wrote in a letter, adding that he “would feel like I am not being treated as a human but as an outcast.”
El Sabrout said trans women and trans men may end up behind bars at disproportionate rates for broadly the same reasons — including discrimination, a heightened risk of interpersonal violence, homelessness and reliance on the survival economy. Yet because the issues they face on the inside are somewhat different, the solutions to improve their conditions may be different, too.
In recent years, some advocates and legislators across the country have focused on passing legislation or changing prison rules to allow trans people to be housed according to their gender identities or in the facilities where they feel safest. Battles to enact such policies have been won in some states, including California and New Jersey, enabling trans women in all stages of transition to be transferred from men’s to women’s prisons. According to data provided by the California Corrections Department, 315 people housed in male institutions have requested to be housed in female institutions since the state began implementing its new policy, and 10 people housed in female institutions have requested to be housed in male institutions. None of the requests to transfer to men’s facilities has thus far been approved.
“Some trans women have been successful at getting transferred to women’s prisons, and that improves their health outcomes,” said El Sabrout. “But there’s not quite so simple a solution for transmasculine people.”
Minimizing harm, maximizing safety
While research on transgender men in prison is limited, currently and formerly incarcerated trans men and their advocates cite many of the same potential solutions to improve the experience of transmasculine people behind bars — whether they are in men’s or women’s prisons. The solutions include access to the same clothing, hygiene products and grooming standards as cisgender men; the availability of gender-affirming items, including chest binders; expanded access to gender-affirming health care, including hormones, surgery and mental health services. Relatively simple interventions, such as allowing trans people to participate in peer support groups, can also make a significant difference in their wellbeing, sources said.
Waxwing, the attorney who works for Disability Rights Washington, said prison systems must ensure access to mental health and medical providers who are experienced and competent in caring for transgender people. If the expertise is not in-house, he said, prison administrators need to bring in providers from the community.
“Oftentimes working with community-based providers can be an important transitional step for agencies and minimize harm to trans patients as policy changes and training are implemented over time,” he said.
Waxwing also said not enough is being done to understand and implement changes that would enable trans men to be housed in men’s facilities.
“At the present moment, many trans men will be safer, and would prefer to remain, in facilities designated for women,” he said in an email. “What systems rarely, if ever, ask of trans individuals, though, is what they could be doing differently to address their safety and other needs such that being housed according to their gender identity could be a viable option.”
Another important step, El Sabrout said, would be to make the Prison Rape Elimination Act substantively enforceable. Currently, states that fail to comply with the law risk forfeiting 5 percent of prison-related federal grants, a sum so small that its impact on corrections budgets is negligible. In addition to provisions regarding how to house trans people, the law also requires facilities to allow trans prisoners to shower privately and to limit when cavity and strip searches can be conducted and by whom.
“Actually making PREA regulations and standards meaningful is really important,” he said.
For Richard Saenz, the Lambda Legal attorney, keeping trans prisoners safe is not just about where they are housed but how they are housed. Prisons “have a constitutional duty to keep everyone in their custody safe and should implement policies that actually do that,” he said. “They shouldn’t rely on the use of ‘protective housing,’ where those restrictions are the same as solitary confinement and could cause additional harm to the person seeking help.”
In addition, simply enacting official policies mandating that corrections staff members use transgender inmates’ preferred pronouns would improve their lives, he added. That is what he said his client, Jason Yoakam, is being denied at Virginia’s Fluvanna Correctional Center.
“Departmental staff, with the exception of mental health staff providing treatment, are trained to refrain from using pronouns altogether,” Benjamin Jarvela, the Virginia Corrections Department’s deputy director of communications, said in an email.
Asked about the Yoakam lawsuit, he said, “All inmates are provided access to the community standards of medical and mental health care, in keeping with the constitutional mandate to provide the necessary care.”
'I won’t give up'
For many incarcerated trans men, the battle to improve their conditions of confinement is ongoing.
“I won’t give up and encourage others not to either,” Ochoa wrote in a letter.
Other trans men have taken the fight for justice to a national stage. In the last national election cycle, Ronnie Fuller, who is serving a life sentence, launched a campaign to run for president.
“I never thought about politics as a kid and nor did I ever hear my family talk about it,” he said. “It was not until I was in prison that I witnessed and experienced injustices and saw the turmoil in society that I started to speak out.”
Since he was released in late 2019, Graham has been rebuilding his life. He is back in school, working toward completing his college degree, and he was recently promoted in his customer service role at a high-end retail company. But he said the 19 months he spent in prison is not quite behind him. Hearing the sound of keys jangling, he said, drives him into a panic.
“I went into that prison sentence knowing I’d done something wrong,” he said. “My punishment was that sentence, and they inflicted a whole other level of trauma that wasn’t ordered.”
Graham is also not as optimistic as some of the other currently and formerly incarcerated trans men about the possibility of change in the prison system — at least not in Texas.
“It’s going to take time and attention and somebody giving a damn for the transgender population to be properly handled,” he said. “And that’s nobody” at the Texas Department of Criminal Justice.