LeLe is a transgender federal prisoner who is currently housed at Federal Correctional Institution Petersburg, a medium-security federal prison in Petersburg, Virginia which houses male inmates. She is a male-to-female ("MTF") transgender person who is currently taking female hormones in an attempt to treat her gender dysphoria (which the Federal Bureau of Prisons calls "Gender Identity Disorder"). Because of internal conflicts amongst different departments within the Federal Bureau of Prisons, LeLe is not being provided an appropriate level of medical care. Thus, she is involved in the Administrative Remedy Program in an effort to resolve the matter and prepare for civil litigation in federal court. She simply wants to be treated in accordance with community standards for gender dysphoria. Nothing more, nothing less, she says.
CZ: Many Americans simply don't understand what transgender means. As such, their initial instinct is to recoil from such a topic. The American Psychological Association (APA), in a very informative document entitled "Answers to Your Questions About Transgender People, Gender Identity, and Gender Expression," define a transgender as a "person whose gender identity, gender expression, or behavior does not conform to that typically associated with the sex to which they were assigned at birth." Considering that you are a transgender person, do you have any thoughts you'd like to express concerning this?
LL: This is a very important issue since many persons confuse transgender -- which is sometimes referred to as transsexual -- with other gender or sexual categories [e.g., transvestite, hermaphrodite, etc.]. A transgender person is a person who feels as if they have been born into the wrong body. This is a gender matter, not a sexual one. The appropriate term is gender identity. This refers to the person's internal gender associations [whether they feel that they are male, female, or something different]. This could be where a man deeply feels that he should have been a woman or vice versa. This is not a choice or a lifestyle issue. It is a deep connection to a different gender.
CZ: I understand that you are a male-to-female transgender. Can you explain to me what this means?
LL: This means that I was born with male anatomy, but feel as though I should have been born a female. I believe that I was born as a female, but in a male body. Since I've felt this way for as long as I can remember, I like to think that I was only male on my birth certificate, nowhere else. This is something I believe I have in common with other transgender persons.
CZ: The APA also notes that "Transgender persons have been documented in many indigenous, Western, and Eastern cultures and societies from antiquity until the present day." Do you have any idea how many transgender persons there are? Wouldn't one think that if transgenderism has been around since antiquity that the average American would have come to understand and accept transgender individuals by now? After all, there are other cultures that recognize such persons beyond the male/female dichotomy.
LL: I think it would be difficult to place a number on how many transgender persons there are in the world, since so many of them hide this aspect of their lives. They do so by either by denying their deep-seated feelings and remaining in their "wrong" gender persona -- which can manifest itself in harmful ways -- or by living as the opposite sex, in "stealth" mode, where few would even know to question their presentation. Since so much of the world is uninformed as to transgender issues, many transgender persons hide this component of themselves since they are often viewed as being "abnormal." Unfortunately, the American people, while becoming more informed about transgender matters, are not yet at the stage of acceptance. This will one day become a reality.
CZ: Dr. Donald Lewis, the Chief Psychiatrist of the Federal Bureau of Prisons, in an April 2012 webinar entitled "Federal Bureau of Prisons Gender Identity Disorder," alerted his audience as to a number of famous transgender persons in history. He spoke about Jennie Hodgers, a civil war hero, Nong Toom, a champion boxer in Thailand, and even Christine Jorgensen, a famous transgender advocate. This is a remarkable list of transgender persons. Your comments?
LL: While most would like to ignore transgender people, we simply can't be ignored. There are many of us throughout the world and some, like the ones you noted, have done some remarkable feats. Sadly, many of us suffer because of badly developed misperceptions. Once transgender persons, as a group, are given a fair shot at acceptance, this issue will become a non-issue much as the gay and lesbian communities have seen with their evolution. Information first, then acceptance.
CZ: Does this mean that you desire to be a woman or is it more of a compulsion? Do you feel that this is a choice which you've settled upon or that it is something more? That you were born the wrong sex?
LL: I certainly don't think that this was a choice or a lifestyle. Why would somebody choose to deal with the controversy and problems? As far back as I can remember I've associated myself as a girl. I played with Barbie-dolls, wanted to be the girl in the video games, and grew my hair long. In fact, I was even a cheerleader in high school and middle school and would often wear makeup. These are not choices. They are a sense of being. They are who I am.
CZ: To my understanding you are speaking about your gender expression. The APA defines gender expression as follows: "Gender expression refers to the way a person communicates gender identity to others through behavior, clothing, hairstyles, voice, or body characteristics." How do you quantify gender expression? Do your more classically masculine physical characteristics ever present internal conflicts?
LL: This is a huge issue for all persons, not simply transgender ones. Think about it. If a man was to be forced to wear a pink tutu to work, he would certainly be deeply troubled. The same is true, at times, when I look in the mirror and see my more male characteristics. They simply don't conform to my chosen gender, so my gender expression doesn't always conform to my gender identity. This is a very troublesome aspect of my life. It's as if when I look in the mirror I see a lie. I know that it is me, but I don't look as I think I should look. I should have makeup and eyeliner on, and not looking at the man staring back at me in the mirror.
CZ: Growing up, did you have troubles assimilating?
LL: Interestingly enough, I didn't since my peer group grew up together. Thus, we all knew one another very well, liked one another, and supported one another. To add to this, my parents were very supportive of my uniqueness. While many might consider me "abnormal," I do not. I consider myself valued and special.
CZ: The term Gender Identity Disorder (GID) has been in the news lately. It has also been a matter of serious litigation when inmates are involved. In particular, a Massachusetts state prisoner, Michelle Kosilek, recently won a case against the Massachusetts Department of Corrections and the DOC was ordered to treat her GID with sex reassignment surgery, if it is medically advisable. Can you explain to me what GID is and if you agree with the term?
LL: Gender Identity Disorder is a term used by the American Psychological Association -- and, subsequently, the Federal Bureau of Prisons -- to describe males who feel that they were meant to be females and vice versa. Again, this is not a choice or a preference, but a sense of self.
GID is a term which I, and many other transgender persons, disagree with. Personally, I prefer transgender or, if a clinical term must be used, gender dysphoria. Since GID is in the DSM-IV, it has to be a disorder to require treatment. I respect that. But I submit that schizophrenia, multiple personality disorder, and obsessive compulsive disorder are disorders. To me, transgenderism is not a disorder. It is a state of being.
CZ: So, you don't agree with the idea that transgenderism is a disorder. To my understanding, this is why transgender persons prefer for the diagnosis to be coined 'gender dysphoria.' What are your thoughts on what it should be termed? Does it really matter what it is called?
LL: Gender dysphoria, if they must call it something. Personally, I call it me. Others call me LeLe. I'm not a disorder nor do I represent a disorder or a problem. I'm a person and wish to be accorded as such. I simply wish to be comfortable in my own skin, congruent in my mind and heart.
It certainly does matter. I am not a problem. I am a person. So are my fellow transgender soldiers.
CZ: Has the Federal Bureau of Prisons been open with you concerning treating what they coin Gender Identity Disorder?
LL: Considering that this matter is a new one, much is being said, but little is being done. According to some sources, the Psychology Department and the Health Services Department are to be working together, but at Federal Correctional Institution Petersburg, Health Services is not cooperating. The Psychology Department is being very supportive. Health Services is actually being openly hostile toward the change in Federal Bureau of Prisons policy.
I find more and more that the administration is stonewalling. Transgender inmates are going through the Psychology Department, but being stonewalled by the administration. The policies are there, but not being abided by and those in the local administration are not requiring adherence to the policy. Thus, Health Services is not complying with the professional standards of care stipulated by the World Professional Association for Transgender Health, or WPATH Standards.
CZ: What types of treatments is the Federal Bureau of Prisons allowing?
LL: In terms of those who are actually receiving treatment right now, there are two of us here at FCI Petersburg (Medium) who were taking female hormones prior to incarceration. Both of us have had to provide detailed histories concerning our past lifestyles and any medications which we were taking within this arena. This was handled through an interview with the Psychology Department. After these interviews, diagnoses of GID were submitted to Dr. Lewis (the Federal Bureau of Prisons' Chief Psychiatrist). Dr. Lewis approved both of us for hormone replacement therapy (via estradiol valerate injections) back in December 2011. That part was not easy, but not extremely challenging to effect. Though, in order to receive androgen blockers (via spironolactone pills), we had to file administrative remedies with our unit teams and the warden's office. The androgen blockers aid in lowering testosterone levels so that estrogen can do its job better.
In terms of continued psychological treatment, we are not required to participate in therapy, but have the option of doing so. I have personally opted to engage in personal therapy with the LGBT Coordinator for FCI Petersburg who I see once a month. She has been instrumental in making this transition as smooth and uneventful as possible.
CZ: What types of treatments have they banned you from receiving?
LL: Receiving the proper dosage of approved medications has been challenging. We've had to file administrative remedies, up to the Federal Bureau of Prison's Mid-Atlantic Regional Office, in an effort to gain the proper dosage of spironolactone. Currently the two of us who are taking hormones are being restricted to 50 mg a day. Considering how long we've been on the drug, we should be in the 200 mg to 300 mg range. The administrative remedy is still pending concerning this matter, but we might have to take it further, maybe to federal court.
A very troubling part of this whole issue is that the Health Services Department of FCI Petersburg has created roadblocks to treatment every step of the way. Dr. Vasquez, the BOP physician whom I've been assigned to, has declined further treatment in lieu of repetitive blood tests. When the tests come back good, he creates other excuses. For example, Dr. Vasquez likes to state that he is a general practitioner, not a Gender Identity Disorder specialist. Thus, he appears to feel as though he should not treat this condition since he didn't learn about GID treatment while in school. This is an absurd proposition considering that he is the ONLY physician that can treat me for any ailment which I might possess.
Dr. Vasquez has even used an unrelated medical condition of mine -- epilepsy -- as a reason to deny treatment for my gender dysphoria. He had the gall to suggest that I could witness a fight which could result in me forgetting to take my medication which could result in a seizure. He concluded by stating that he'd then "be questioned in court" and that it's his "medical degree on the line." Well Dr. Vasquez, it's my quality of life we're talking about here. This I believe to be important enough for you to study up on considering that you missed this topic while fulfilling your continuing education requirements.
To make matters even worse, Dr. Vasquez actually referred to the LGBT Coordinator, a woman with a professional doctorate in psychology, as "young lady." He won't even refer to her as "Doctor," as her PhD education demands. In fact, he's made comments about psychologists not being real doctors! With ideas like this pervasive within the FCI Petersburg Health Services Department, it is no wonder that myself and the other GID-diagnosed inmates are not receiving the treatment we need.
CZ: The World Professional Association for Transgender Health (WPATH) calls itself "an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, advocacy, public policy, and respect for transgender health." They present several viable psychological and medical treatments for those with gender dysphoria in their Standards of Care. These include test periods of gender expression and role, "real life experience," (where the transgender tries out the role of their gender identity, either full time or part time), hormone therapy, surgery to change sexual characteristics (whether primary or secondary), and psychotherapy. They even speak about access to care for institutionalized persons, like prisoners. Their view is that access to meaningful care should be available to all transsexual, transgender, and gender nonconforming people. This regardless of their living situation. What kinds of treatment should the Federal Bureau of Prisons provide to incarcerated transgenders?
LL: WPATH standards should be utilized. In fact, until other standards of care are developed by other professional bodies, they must be followed since they are the only standards currently available. On a top level, this means counseling, the real world experience of living as the preferred sex, within the prison context, hormone therapy, if applicable, and sexual reassignment surgery if it is required.
On a more practical note, this means a competent and willing Health Services Department which is willing to prescribe medications as needed, such as hormone therapy at the proper levels. This means hair growth medications for those with male pattern baldness, and electrolysis or laser therapy to assist in the removal of facial hair. And once a transgender prisoner has gone through the applicable hormone replacement therapies and has been fully evaluated by medical professionals, sex reassignment surgery, whether primary or secondary, if the inmate requires such treatment.
But most of all, we want to be treated in an individualized manner. My name is LeLe. My best friend here is named Ashley. We are different people who happen to suffer from the same diagnosis: gender dysphoria. As unique individuals with unique treatment needs, we require individualized treatment.
CZ: I understand that you are interested in being able to utilize makeup and feminine undergarments. Who should pay for these? What kinds of product are we talking about here?
LL: One common misperception is that we are asking for handouts. This is simply not the case. We are willing to purchase our own makeup, if this must be done. We are not agitating for Victoria Secret undergarments, but simply those that are issued to female inmates. We don't see ourselves as requiring specialized treatment, or some improvement in our conditions of confinement, we just want access to the same products and services which female inmates have access to. This would fulfill our needs.
And on a side note, since there are so few transgender prisoners within America's prisons -- an estimated 80 are incarcerated within the Federal Bureau of Prisons, as per Dr. Lewis's remarks in the April webinar -- creative funding solutions are available for such non-medical products. I have no doubt that certain advocacy organizations [such as GLADD, WPATH, etc.] and sympathetic citizens would cover any applicable costs, if so required.
CZ: How have Federal Bureau of Prisons staff members treated you? Have you been subject to harassment or antagonism because of your status as a transgender person?
LL: Surprisingly, the majority of the staff has been respectful and open to learning about transgender issues. But prison staff are human. Some have their own ignorant views, and their personal opinions do come into play. Regardless of this, most have been cordial. The Captain has been particularly respectful of our unique circumstances. In fact, she has done a remarkable job by helping to support transgender inmates. One remarkable aspect of this has to do with post-visitation body searches. She has ensured that transgender inmates are searched privately, instead of in the usual group fashion generally used after visits. She advised me that she specifically instructed visiting room staff to be especially respectful of our needs. I was very impressed by that.
CZ: It is well documented in court cases and other literature that transgender inmates housed in male prisons are often subject to rape, exploitation and other abuses, both from staff and inmates alike; have you experienced sexual harassment or other more severe forms of harassment? Antagonism?
LL: The transgender prisoners at FCI Petersburg have always been treated fairly well, at least for the past several years that I've been here. In some part this is due to the fact that most of us have been openly transgender for the entirety of our incarceration. As such, there are no interpersonal issues amongst old acquaintances. One of the transgender individuals, though, has experienced some trouble since she has largely gone through the process since being incarcerated. This certainly can't be an easy issue to deal with. As a group, we try to protect each other when protection is needed. I, personally, feel as though someone would be hard pressed to pick a fight with any of us since it would mean that they would have to fight with all of us. And our friends who support us.
CZ: I understand that you're currently pursuing the administrative remedy program concerning transgender issues. How far are you willing to take this? To federal court?
LL: I plan on Federal Correctional Institution Petersburg becoming the focus of supportive case law to help other similarly situated persons. It is absurd that persons in this country must fight the government to receive adequate medical care. It is absurd that Federal Bureau of Prisons physicians have access to necessary medications, but are allowed to refuse to prescribe them. It is absurd that doctors, Dr. Vasquez in this circumstance, are allowed to deny medical treatment because they have a moral objection to transgenderism (Gender Identity Disorder according to the DSM-IV), a diagnosable medical condition. So, yes. I am more than willing to do whatever it takes so that I, and those who come after me, might receive the medical treatment which we so desperately need.
CZ: At what point should a male-to-female transgender person go to a female prison? What about a female-to-male transgender person?
LL: I think the point would be once sex reassignment surgery (SRS) has been completed. There should be no option of staying in the current facility after SRS has been fulfilled. The same should be true for female-to-male transgenders. Outside of this, I think there should be no hard-and-fast rules. Inmates suffering from gender dysphoria are not a formless grouping, we are individuals. Thus, our treatment should be of an individual nature.
CZ: Do you think the transgender community will become normalized as the gay and lesbian communities have? Will Middle America one day accept transgender persons as they now accept lesbian and gay persons?
LL: I believe that once the American people understand the issue and get to know transgender persons -- either in their community or in popular culture -- people will be more understanding and accepting. But I do believe that the process will be more challenging than the traditional gay and lesbian communities experienced since there are so few of us transgender persons. This is why it is so important for all of us transgender persons to stand together, work to explain our position, connect with those in our communities who are open and accessible, and to eventually legitimize our plight. Then we can be on even footing and be seen as equals amongst men and women, as we strive to be.
CZ: Are you willing to speak with newspapers or be interviewed regarding this matter?
LL: Of course. I'll do whatever I can to bring this vital issue to light.
CZ: What can those outside of prison do to help the transgender cause within prison walls?
LL: Attention. This is what is required. As Supreme Court Justice O'Connor once said, "Prison walls do not form a barrier separating prison inmates from the protections of the Constitution." In order for these protections to be enforced, those outside of prison must pay attention to what transpires within the prison walls. When a transgender person is in need of help, those outside of prison need to heed the call. And when issues of policy are at hand, as they are in my case and the cases of several other inmates who are engaged in litigation, they need to be shared amongst neighbors and advocacy networks alike. If the American people would open their eyes as to what is going on in this nation's prisons -- regardless of whether the issue is a transgender one or not -- much change could be effected. Many lives could be saved.
CZ: Thank you very much.
LL: My pleasure.