The policy addresses the process for diagnosing such inmates and developing treatment plans, which are to be based on medical necessity. It says hormone therapy may be medically necessary, but it is silent about sex reassignment surgery.

Scaletta said that issue has not been decided yet, although the department has ruled out cosmetic surgery.

The Iowa policy also spells out that staff should use an inmate’s preferred gender pronoun and preferred first name and that transgender inmates should be asked which gender of staff they prefer doing strip searches.

In addition, transgender inmates are to be allowed to buy clothing and cosmetic items for their preferred gender from the canteen.

The policy says that housing of transgender prisoners, whether in a male or female institution, is to be made on a case-by-case basis.

Dawn-Renee Smith, a Nebraska corrections spokeswoman, said she “had no information” about any Nebraska policies or regulations regarding transgender inmates. She did not respond to questions about the number of transgender inmates in the state prison system.