New Hampshire State Prison for Men inmate Shaun Cook, who prefers to go by the name Selena Mariee, holds up a copy of the New Hampshire Department of Corrections' policy for transgender inmates. Elodie Reed—Monitor staff

Shaun Cook, who prefers the name Selena Mariee, looks through piles of yellow “grievance forms” during an interview at the men’s prison in Concord. The inmate, who identifies as a transgender woman, has sought out treatment and has asked for different housing. Elodie Reed / Monitor staff

Inmate Shaun Cook, who prefers to go by the name Selena Mariee, came out as a woman last year. Cook has asked the men’s state prison in Concord for special housing and medical treatment under a policy for transgender inmates. Elodie Reed / Monitor staff

On a crisp morning, an inmate was led, men on each side, into a small room. Sunshine coming through a barred window fell in stripes across the reddish-orange prison uniform.

A light layer of graying hair grew on the inmate’s balding head, which was usually shaved. The inmate’s eyebrows, thick in older social media photos, arched thin and plucked over brown eyes.

On the inmate’s cheeks, the previous day’s stubble was already visible.

The New Hampshire State Prison for Men refers to this inmate, Number 72855, as Shaun Michael Cook. But Cook, originally of Boscawen, prefers to go by the name Selena Mariee.

As a transgender person within the prison system, Cook’s case is complex. Cook wants to be treated as a woman in a facility that houses men. Cook is asking for medical treatment to become more feminine, but after an evaluation, doesn’t qualify for the publicly-funded care.

Cook also petitioned the court for special housing accommodations, which a judge denied.

Cook’s motives have been questioned, but some of the inmate’s requests have been granted. Cook has been allowed to have women’s undergarments, for instance, and wear them.

Cook is also referred to as “she” and “Ms. Cook” by some prison staff, though not all.

Accommodations like this are still fairly new for the New Hampshire Department of Corrections, which has had just a handful of inmates request treatment for the psychological condition of gender dysphoria.

The prison system is just starting to navigate the challenges of addressing gender identity in a highly-regulated environment: how to ensure safe and appropriate housing; how to make personal care accommodations; how to provide medical care; and how to educate prison staff along the way.

And then there’s the added element of working with inmates, who all have an individual, often complex, set of circumstances.

“The public barely knows really what goes on inside of these walls,” Cook wrote in a letter to the Monitor.

The evaluation

Cook, 40, came out as transgender about two years into a 4-to-10-year sentence for stealing a car in Boscawen and leading police on a chase in Franklin in April 2014.

Cook triggered the New Hampshire Department of Corrections’ policy for transgender inmates, which has been in place since 2014. The inmate met with a mental health social worker on Jan. 21, 2016 as part of a gender identity evaluation, prison records show.

Cook gave the Monitor permission to view the evaluation, conducted between July and September by Concord psychologist and gender specialist Dr. Anne Boedecker.

As one of the first gender specialists in New Hampshire to take a transgender client back in 1998, Boedecker has written the book on the topic. (Literally. She wrote and published The Transgender Guidebook: Keys to a Successful Transition in 2011).

Boedecker wrote prison officials on Sept. 27, 2016, and told them Cook didn’t meet the standards for a gender dysphoria diagnosis. That meant Cook wouldn’t have access to “medically necessary” treatment to pursue a transgender transition.

Within her report – in which she referred to Cook as “he” throughout – Boedecker noted that Cook cited many of the feelings of being transgender without much personal history behind them.

Boedecker said Cook grew up in an adoptive home before entering into the state juvenile system until age 18. Cook reported first thinking about transitioning to become a woman at age 19, and then took a more serious interest, beginning in January 2016.

“Since then he has made numerous requests regarding the ability to express a female gender presentation,” Boedecker wrote.

Boedecker also noted, however, that Cook has admitted to chronic lying, and has a history of multiple complaints and requests for special treatment while incarcerated.

“His statements are at times contradictory, and inconsistent with his behavior,” Boedecker wrote. “He asks officers to treat him as a woman, but does not want to be seen as transgender by inmates in the general population.”

Boedecker said that while Cook insists upon presenting as female, the inmate diplays little of the dysphoria associated with transgender identity.

“His behavior is more suggestive of the need to challenge authority, find excuses for his behavior, and seek a protected status as a woman,” she wrote.

Boedecker did recommend to prison officials that Cook continue to receive supportive counseling, have access to feminine undergarments, better fitting clothing and cosmetics, and came back for re-evaluation in six months.

In a recent email interview, Boedecker said someone who identifies as transgender doesn’t always manifest gender dysphoria, which is when a person feels their emotional and psychological identity differs from their biological sex, and suffers from dissatisfaction, anxiety or depression as a result.

“Most transgender people have some degree of gender dysphoria, but not everyone who identifies as such meets the criteria for the diagnostic category,” she said.

Boedecker explained that for each assessment, she reviews inmate mental health records, conducts interviews and talks with people associated with the individual. She then writes a report that summarizes the procedure and findings and offers treatment recommendations to the mental health team at the prison.

“I do not make decisions about hormone treatments, housing or any other ways the inmate is to be treated,” Boedecker said.

Who’s to judge

In a case like Cook’s where the inmate doesn’t have a formal diagnosis but still identifies as transgender, Deputy Director of Forensic Services Heidi Guinen said the NHDOC’s gender dysphoria team does what it can to make that person comfortable behind bars.

“If someone... comes to us and says this is going on, we’re going to talk about it,” she said. Currently, there are eight or so inmates identifying as transgender, all at men’s facilities.

“Our job isn’t to punish people once they’re here,” Guinen said. “It’s to treat people once they’re here.”

This could mean access to undergarments and cosmetics, like what was recommended for Cook, who now has sports bras. It could also result in changing the prison environment itself.

“We’re looking at more of a gender neutral canteen,” Guinen said. In the men’s prison, she added, there are now full-length, versus bottom-only, shower curtains.

“We changed out our shower curtains so they were more appropriate,” she said.

Even if they aren’t technically stipulated under policy, ignoring those needs, Guinen said, can lead to bigger problems.

Transgender individuals are statistically far more likely to commit suicide. A 2014 survey by the Williams Institute showed that 41 percent of transgender and gender non-conforming individuals reported a lifetime suicide attempt, compared to just 4.6 percent of the general population.

For this reason, and with the hope of rehabilitating inmates so they are more successful when they reenter society, Guinen said NHDOC tries to support inmates with the needs they’re expressing and not judge who they are.

“Only they know if they’re transgender. We don’t determine that,” Guinen said. “You really have to believe that people are the true storytellers of themselves.”

There are complications, however. Guinen said some inmates try to take advantage of various inmate policies for the perks. She said, for example, that she doesn’t want to feed a male inmate’s sexual fetish by giving him women’s underwear.

“Unfortunately, we have some very sick people who try to use that as a bargaining tool and who truly don’t have any gender dysphoria,” she said. “You do just want to help the people you need to help.”

What’s possible

With or without a gender dysphoria diagnosis, there are some things that inmates just can’t change within the NHDOC system.

If a transgender inmate wants a name change, for instance, he or she can accomplish that by filing a request through probate court. But the inmate remains in the system under the original name.

“Whatever their name was when they first came to prison is the one we will continue to identify them as in the data management system for as long as they are incarcerated,” spokesman Jeff Lyons said this week. “However, if they successfully change their name – we will list it as an alias in our data management system.”

Cook’s name remains the same. Despite mentioning the desire for a name change in numerous letters to the Monitor and during Boedecker’s evaluation, no name change petition is on file with the probate division of the Concord District Court.

Prison records do show, however, that some staff have begun using Cook’s preferred feminine pronouns. Guinen said she has been working with prison staff in implementing the prison’s transgender policy more fully.

“We want to make sure all of our staff are educated and that takes time,” she said. “Not everybody in our community understands it.”

As for housing accommodations for transgender inmates, this is done on a case-by-case basis.

This may mean moving an inmate to a different housing unit for safety’s sake. Thus far, no transgender inmate, Guinen said, has been transferred between men’s and women’s facilities.

“To date we haven’t found that would be appropriate,” she said.

For Cook, housing has been a troublesome topic. Prison health records show the inmate was raped once last spring, and Cook has lived mostly in isolation for this and other safety reasons.

Cook has a stack of yellow inmate request slips, many of which ask to be sent to certain out-of-state institutions that might be safer and more appropriate for transgender inmates.

Cook then took it one step further. Self-characterized as “litigious” – Cook currently has 72 records on file within the New Hampshire court system – the inmate filed a habeas corpus petition in August against the warden of the prison, Michael Zenk. Cook requested placement in a correctional institution of the inmate’s choosing that provided treatment for transgender identity.

Court documents show that in response to the habeas corpus petition, Warden Michael Zenk said the prison was capable of providing for gender dysphoria, and that Cook had rejected out-of-state suggestions.

In addition, Zenk noted that other in-state facilities will not take Cook due to past conduct there, or for safety reasons.

In his December order, Judge David Ruoff – who referred to Cook with feminine pronouns – denied and dismissed the inmate’s petition. Ruoff noted that Cook is provided with gender dysphoria treatment already at New Hampshire State Prison for Men.

In addition, Ruoff explained that, as an inmate, Cook isn’t privileged to access any treatment the inmate wants. In his order, he quoted Warden Michael Zenk on how New Hampshire’s Department of Corrections decides on how care is provided.

“As correctly noted by the warden, ‘the fact that an inmate is entitled to adequate medical care does not mean that (she) is entitled to ideal care or the care of (her) choice,’ ” Ruoff wrote.

Health care, like other inmate needs, is completely funded by state tax dollars. NHDOC spokesman Jeff Lyons said in 2016, the total NHDOC medical and dental budget was $11.6 million. If an inmate were to undergo a full transgender transition, the typical cost for hormone treatment, counseling and sex reassignment surgery amounts to about $20,000.

Though some have started hormone therapy, Guinen said no inmates have undergone sex reassignment surgery, yet.

Cook’s goal

What Cook really wants is to start hormone therapy. The inmate said a formal diagnosis shouldn’t be necessary to proceed with a transition.

But that doesn’t look likely, at least for now. The inmate wrote in several letters about post-prison plans for transitioning, including looking for a primary care provider to start hormone therapy upon release.

“I’m a more brave woman today because I refuse to allow my fears (to) get in the way any longer,” Cook wrote in a letter to the Monitor. “I’m going to pull through this nightmare one day at a time.”

Boedecker said the transgender transition process is always going to be more difficult in a prison setting.

“It’s not easy to transition in a highly regulated environment with limited access to the trappings of feminine or masculine presentation,” she said.

From what she’s seen so far, Boedecker said the state’s corrections department seems to have made good first steps.

“I do know the mental health team is sincere about helping transgender inmates, and the staff is appropriately concerned about their safety,” she said.

Editor’s note: A correction has been made to reflect that Dr. Anne Boedecker was not the first, but one of the first, gender specialists in New Hampshire.

(Elodie Reed can be reached at 369-3306, ereed@cmonitor.com or on Twitter @elodie_reed.)