Inside Gender Identity

A report into the health and social care needs of transgender offenders 

"No matter why someone is in this system, or who they are, our job as a responsible society is to treat all offenders with respect and dignity, to keep them sane and well, to prevent self-harm or worse, death and at the same time to help them to rehabilitate and join the rest of us in making this a world we all want to, and can, live in."

Professor Lord Patel of Bradford OBE


CIE have just launched their report into the health and social care needs of transgender offenders - Inside Gender Identity .
The report, is based on a review of the national and international literature and 55 interviews with a cross range of stakeholders from the health and criminal justice system, Lesbian, Gay, Bisexual and Transgender agencies and transgender offenders.
The full report, Executive Summary and the Literature Review can be downloaded from the buttons on the right.
Since November 2015 the Prison and Probation Ombudsman (PPO) has investigated four deaths by hanging  of transgender prisoners. These deaths were all trans women, and at the time of their death three were held in the male estate (PPO, 2017).

Trans health


In assessing the health and social care needs of the trans population it is important to recognise the limitations of the available research base and the relative lack of inclusion of trans people in population based health and social care needs assessments. This is largely a result of research and surveys failing to include identification of trans people in data collection and analysis. Lack of clarity and consistency in the use of terms to describe transgender also adds to the challenge of interpreting data. Nevertheless, there is a large and growing body of evidence that trans people experience a wide range of significant health and social care needs that are directly associated with being a trans person. These include:

Mental health problems are known to be higher amongst trans individuals. This may be part of gender incongruence experienced as a result of being trans and/or in response to the high levels of stress and anxiety that can be caused by the experience of stigma and discrimination associated with being trans.


  • 56% of transgender people had been diagnosed with depression at some point in their lives, four times the rate for the general population (Hyde, et al. 2014).


  • Trans women on average are more likely than trans men to report paranoid ideation, interpersonal distrust, anxiety, depression, and obsessive-compulsive complaints (Claes, et al. 2015).


  • More than half of trans people have self-harmed at some point and more than a third have considered suicide (McNeil, et al. 2012).


  • Three quarters of trans young people have self-harmed and over a quarter (27%) are currently purposely self- harming (METRO, 2014).

Poor Mental Health

Engagement with health services may be a factor that impacts on the health and wellbeing of trans people. For example:

  • Trans people are known to experience negative attitudes and discrimination from health professionals that may result in avoidance of health services and neglect of health problems (LGBT Foundation, 2017)


  • Gender specific health needs such as for age related cancer screening programmes, might be masked or neglected due to trans peoples’ poor experience of healthcare and subsequent lack of engagement with health services (Williams, et al. 2016).

Poor Healthcare

Trans individuals are more likely to report their health as being poor, this is in comparison not only to general population self reported health but also with respect to Lesbian, Gay and Bisexual populations (Williams et al.



  • For trans people taking regular, long term hormonal therapies there are particular risks with respect to morbidity and mortality, for example, cardiovascular disease, cancer and osteoporosis (Streed et al., 2017; Ashbee and Goldberg, 2006; Guasp, A. 2011)


  • 62% of trans people may be dependent on alcohol or engaging in alcohol abuse (McNeil, et al. 2012).


  • Trans people are up to four times more likely to be HIV positive than those in the general population and are thought to be less likely to be tested for HIV (Grant, 2010).

Poor Physical Health
High Social Risks
  • 1 in 4 trans young people experienced physical abuse at school (Whittle, et al, 2007).


  • 22% of trans people were not permitted to use the appropriate toilet after coming out at work (Ibid).


  • 58% of trans people were reported to have a disability or chronic health condition, including 8.5% who were deaf and 5% who were visually impaired (McNeil, et al.

  • 2012).


  • Transgender people may be more likely than the general population to have an autistic spectrum disorder (Pasterski, et al. 2014).


  • 57% of transgender adults have experienced family rejection (Haas, et al. 2014).


  • 1 in 5 transgender people reported having experienced homelessness at some time in their lives because of discrimination and family rejection (Ibid).

Trans Justice


Trans individuals are much more likely to be victims of crime, rather than offenders. For example, trans people frequently experience verbal abuse and harassment in public and young trans people in particular report high levels of bullying at school.

  • 73% of trans people experienced some form of harassment in public and 21% stated that they avoided going out because of fear of harassment (Whittle, et al. 2007).


  • 64% of young trans men and 44% of young trans women experienced harassment or bullying at school, not just from their fellow pupils but also from school staff including teachers (Ibid).


  • 28% of trans people stated that they had moved to a different neighbourhood because of their transition (Ibid).


  • 19% of trans people reported experiencing domestic violence by a family member because they were transgender or gender non-conforming (Grant, et al. 2011).


  • 12% become victims of sexual violence (Ibid).


  • 80% of trans people have experienced emotional, physical or sexual abuse from a current or former partner based on the rejection of their trans identity (Roche et al., 2010).