The Experience of Transgender Women Prisoners Serving a Sentence in a Male Prison: A Systematic Review and Meta-Synthesis

AuthorJoanne M. Brooke,Karolina Biernat,Nina Shamaris,Victoria Skerrett
Published date01 November 2022
Date01 November 2022
Subject MatterArticles
The Experience of
Transgender Women
Prisoners Serving a
Sentence in a Male
Prison: A Systematic
Review and Meta-
Joanne M. Brooke
Karolina Biernat
Nina Shamaris
and Victoria Skerrett
Due to social exclusion and direct and indirect discrimination, there is a
disproportionate representation of transgender individuals in prison. The
aim of this article is to report the ndings of a syste matic review and
meta-thematic synthesis to understand the experience of transgender
women who have served a sentence in a male prison. The review identied
14 papers, and the thematic synthesis identied ve themes. The themes
are discussed within a contemporary socio-ecological model, developed
by White Hughto and co lleagues to support transgender heal thcare in pri-
son, and to explore if th is model is applicabl e for the wider prison
Birmingham City University, Birmingham, UK
Corresponding Author:
Joanne M. Brooke, Birmingham City University Centre of Social Care, Health, & Related
Research, 117 Ravensbury House, City South Campus, Westbourne Rd., Birmingham B15 3TN,
The Prison Journal
2022, Vol. 102(5) 542564
© 2022 SAGE Publications
Article reuse guidelines:
DOI: 10.1177/00328855221121097
transgender, prison, gender dysphoria, systematic review
Transgender is a widely used term for people whose gender identity, expres-
sion, and behavior are different from their biological sex assigned at birth
(Drescher & Pula, 2020).
The medical diagnostic label is gender dysphoria (American Psychiatric
Association, 2013), which identies being transgender as a recognizable con-
dition with treatable symptoms. Treatments for gender dysphoria may include
psychological counseling, psychotherapy, and medical interventions to
promote physical changes such as hormonal therapy, permanent hair
removal, chest/breast surgery, and genital removal, or reconstructive surgeries
(National Health Service, 2020).
Due to the uid nature of gender identity and the sensitivity and stigma
associated with identifying as transgender, the available estimates of transgender
populations are often tentative and from data which are unreliable (Zucker,
2017). The World Health Organisation/Europe (WHO, 2020) estimated 0.3 to
0.5% of the global population identify as transgender, which is approximately
25 million people. A contemporary report from the United States (US)
has estimated1.6 million people aged 13 and older identify as transgender,
an estimation of almost 0.5% of the population (Herman et al., 2022), although
previously prevalence has been estimated to be between 0.39% and 2.7%
of the total US population (Nolan et al., 2019; Zucker, 2017). In the UK,
there are currently no ofcial gures, but it has been estimated by the
Government Equality Ofce (2018) that between 200,000 to 500,000
people identify as transgender. Globally, there are two key trends observed in
relation to transgender prevalence: an increase in the prevalence of people self-
identifying as transgender and a higher prevalence of self-identication among
younger generations (Nolan et al., 2019). These trends are not due to an increase
in prevalence of transgenderper se but rather a result of an increase in condence
to express gender identity or to seek support, and improved reporting
(Zucker, 2017).
Transgender individuals have reported experiencing social exclusion
throughout their childhood and adult lives, resulting in inequalities in access to
further education, housing, health care, and employment (Cruz, 2014; Grant
et al., 2011; Jaffee et al., 2016). Social exclusion, stigma, and inequalities increase
a transgender individuals risk of developing severe mental health conditions
(Grant et al., 2011; Greene et al., 2014; McDermott et al., 2017). For example,
Brooke et al. 543

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