Last August, the Army private now known as Chelsea Manning was sentenced to 35 years in military prison. A day after the trial, Manning announced plans to undergo hormone therapy and begin public life as a woman. Her coming-out shone a light on a population that media rarely discusses: transgender women in prison.

I have a fat, accordion-style file folder—each section stuffed with mangled envelopes from across the country—full of heavy-hearted, handwritten letters from women I’ve never met. Shaylanna, Venus, Prada, and Eva: every letter flaunts the industrial, pre-stamped return address of a state prison, and every signature is a transgender woman living in a male facility.

With the help online networks that connect people to pen pals in prison, I wrote to all four women last fall, shortly after Chelsea Manning was convicted of leaking troves of classified documents to WikiLeaks and, a day later, came out as transgender. Ostracized by fellow prisoners and tarred by a system that refuses to acknowledge basic human rights, their letters spin a compelling—and woefully unsurprising—narrative.

All four women gave me permission to tell their stories. The names listed here reflect their chosen names; some self-applied during their incarceration, others chosen decades before.

Let’s start with Venus. Incarcerated in San Quentin State Prison, the maximum-security facility notorious for housing true-crime superstars Richard Ramirez, Charles Manson, and Scott Peterson, she writes of a lonely, dejected routine where she endeavors, above all, to just stay out of everyone else’s way. “I eat by myself most of the time,” she told me in one letter. “I don’t like being hated by many inmates and cops, but at least I’m not hiding behind my eyes like most people seem to do.” Incarcerated since 1981, Venus is celibate and “very burnt out on mean men,” as she writes. She craves the creature comforts of the outside world—“real makeup, real nylons, real high heels, real dresses, real panties”—and longs for a loving, meaningful relationship.

In 1986, while living in a different prison, Venus was nearly beaten to death by a group of “redneck speed freaks,” as she recalls, for being transgender. Frightened for her life, she forced herself to identify as male for the next 18 years, and was transferred to San Quentin as a male prisoner. With the help of a prison doctor, Venus “came out” again in 2003, and in 2005 began a regimen of estrogen and anti-androgen medication. Last year, after “many attempts, many letters, and many prayers,” San Quentin finally agreed to issue Venus her first “personal property” bra. A small victory.

“Playtex—I love it,” she wrote.

Finding solace in something as simple as an undergarment is a common thread in these letters from prison. For Prada, it’s eyeliner. For Eva, it’s conversations with her best friend, Natalie, another transgender woman in prison. For Shaylanna, who spends her days sketching caricatures of guards and friends as well as self-portraits, pencil and paper bring the most comfort.

“I’ve been drawing since I was seven years old,” she told me. “My first drawing ever was a flower, and I drew it on my mother’s leather sofa. Oh, she was pissed.”

Today, Shaylanna lives at Marcy Correctional Facility in New York. It’s a “hellhole” where “everybody sticks with their own kind,” she wrote in one letter. Self-expression provides a necessary escape. She wrote in another letter:

“Being a trans inmate is scary. No one really likes us…. You got the Bloods that stick with their kind, the Crips that stick with their kind, the Latin Kings that stick with their kind, [and] no gang members are ‘allowed’ to talk to us.”

Eva shared a similar experience. In a diary-like essay buried in one letter, she described her life in two California prisons—Corcoran and Kern Valley—and the social hierarchy that ensures trans people are always on the bottom rung of the ladder:

“Seal off a one-block radius in society. Take a sample of the most socially and economically depressed people, about 1,200, and house them within the radius—a sample of races, religions, gangs, the disabled, mental-health patients, every temperament, some who can never get out, have no money, no hope, biological males with no one of another gender except 10 to 20 transgender women. Impose a maximum-security status throughout, with strictly controlled movement and boundaries. This kind of setting would equate [to] just one yard of a multi-yard state-jurisdiction prison in California. As soon as the cell door opens for breakfast, the static begins: nervous, anxious, expectant; it will crackle all day, until the door locks for [the] night at 9 p.m…. [Other prisoners] hate too much or are trying to be the next John Dillinger and can’t afford to appear so weak as to respect a fag on a prison yard…. It is an ideology, attitude, and yard policy of hate pure and simple, without pretext.”

Derogatory behavior by other people in prison creates a breeding ground for abuse, Eva went on. But the people behind bars aren’t the only offenders. “Prison guards do not help us [or] are part of the problem,” she wrote. “We rely on ourselves alone.” Their experiences reflect what many transgender people go through in prison, studies show:

Chart from Injustice at Every Turn: A Report of the National Transgender Discrimination Survey.

It’s a sentiment that echoes throughout the letters. From Shaylanna:

“What seems to be a constant issue is the staff and officers of all ranks,” she wrote. “They make jokes, sarcastic remarks, and biased statements about us, usually to other prisoners or in front of other prisoners…. There used to be this one CO [correctional officer] who would always harass me and threaten me. One of his main statements was, ‘This ain’t a female’s prison, you’re in the wrong place, bitch-boy.’ It’s extremely unprofessional in an environment that can become violent in seconds.”

On some level, the political world seems to be paying attention. In high-profile recognition of the widespread harassment and assault in prisons, George W. Bush signed the national Prison Rape Elimination Act (PREA) into law in 2003. It finally started to take effect late last year. The law requires facilities to employ specially trained staff to provide “professional and respectful” pat-down searches of transgender individuals, as well as accommodations for their safe housing, assessed on a case-by-case basis. On a smaller scale, the Harris County Sheriff’s office in Houston, Texas made national headlines last November when it modified its own anti-discrimination policies. Among the changes, spokesperson Alan Bernstein told me, is a greater emphasis on the housing needs of trans people and language specifically banning their mistreatment.

Still, access to hormone therapy is missing from both the PREA and Harris County policies. To anyone following trans rights issues, this shouldn’t come as a surprise: though the American Medical Association, American Psychological Association, and National Commission on Correctional Health Care have all published statements emphasizing the medical necessity of hormone therapy (with the latter two specifically calling for reform in correctional facilities), most prisons offer zero guidelines on who should receive it.

Chart from Injustice at Every Turn: A Report of the National Transgender Discrimination Survey.

Dean Spade, founder of the Sylvia Rivera Law Project, a legal collective that provides free services to low-income transgender people and transgender people of color, worries that the lack of any clear policy dictating who should receive hormones can lead to serious and deliberate inequalities. Spade notes that transgender people are among the most severely impacted by racist systems of criminalization, and points to reports indicating that trans individuals, especially those of color, suffer shockingly high rates of arrest and imprisonment compared to other demographics. About 47 percent of black transgender people have been incarcerated at some point in their lives, according to the National Center for Transgender Equality.

“Prisons are, in reality, full of poor people [who] violate minor drug laws,” Spade says. Regardless of the crime committed, “the idea that people in prison in general don’t deserve medical care is a biased and frightening notion.”

Until the summer of 2013, this was a controversy few people outside the penal system paid attention to. Chelsea Manning’s “I am a female” announcement, amplified by the revelation that she planned to begin hormone therapy as soon as possible, changed that, bringing the issue to national media attention. A month prior, pop culture introduced it to the masses: In an episode of Netflix insta-hit Orange is the New Black, Laverne Cox’s Sophia Burset, an imprisoned transgender woman, is swiftly taken off hormone therapy without explanation. It’s a poignant, deftly political episode, but by the end of the season she’s allowed to resume treatment.

Sophie gets little help from the Litchfield prison doctor on Orange is the New Black.

For Shaylanna, Venus, Prada, and Eva, the tug of war for hormone therapy is far more tenuous. Prada started hormones eight years before her sentence, so persuading officials to continue the treatment was a comparatively easy victory. For others at her facility, the process is a relentless undertaking: when we first connected, Prada shared a cell with another transgender prisoner who was repeatedly denied hormones. “I get injections… every other week,” Prada writes. “I am lucky. My ex-cellie isn’t on hormones because she wasn’t on them before she came to prison.”

The disparity became a source of constant bickering between the two, Prada went on, and on more than one occasion it led to physical altercations. Eventually, they had to be separated. “It sucked living with her, she was miserable and hated me because I’m fem,” Prada wrote.

Of all my pen pals, it’s important to note, Prada seems the least bothered by life behind bars. Housed in Arizona, she writes of a love affair with the best-looking man in her facility, and says two of her biggest grievances are having to tailor her uniform with a “ghetto sewing needle” and “pretending to like everybody.” Fair access to hormone therapy certainly influences Prada’s mood, but she also has a habit of looking on the bright side. Separated from her family at age eight, Prada spent 10 years in foster care and group homes. Prada “knew [her] whole life” she was a woman, she told me, but she wasn’t able to start transitioning until age 15, when she ran away from home. Three years later, she tracked down some relatives to tell them she was trans.

“My aunts called me a freak and said some hateful things,” she wrote. “I told them off, too. I told them I didn’t care what they though about me, they were never in my life anyway so it [was] nothing new.” She was hurt by their rejection, she wrote, but she's accepted that her biological family will never be there for her in the way she wants.

Like Prada, Shaylanna was also on hormones before she was sentenced to prison, but because she bought the medicine illegally, it took two-and-a-half years and a “kickass” lawyer to get them back, she recalls. She restarted the therapy last fall, though the fight isn’t over. Rev. Jason Lydon, a Boston, Mass.-based Unitarian Universalist minister whose nonprofit Black and Pink links LGBTQ prisoners with pen pals on the outside, notes that even when a prisoner does secure hormone therapy, they’re often punished for acting “too feminine”—growing their hair long, for instance, or for making a dress out of their uniform.

And then there’s the transition itself. As Eva writes:

“Discrimination. It’s going to happen; it’s just a matter of when, from who, and how. Even good-natured shit from cats can bug us. ‘They’re getting big.’ ‘Love them cakes.’ Some girls eat it up…. I don’t.”

For Shaylanna, it’s worth the risk. “Kill me and I rebirth,” she writes. “I have that tattooed on my collarbone.”

It’s worthwhile to pause here and note that, outside of prison walls, human rights groups are having a tough time selling state-subsidized “rebirths” to the public. When a 2012 district court ruled that Michelle Kosilek, a Massachusetts prisoner who twice attempted suicide and self-castration, had a constitutional right to sex-reassignment surgery, even the most liberal of politicians responded with dogged objection. Among the loudest opponents: former congressman Barney Frank and current Senator Elizabeth Warren, both Democrats who have long supported pro-LGBTQ initiatives. “I have to say, I don’t think it’s a good use of taxpayer dollars,” Warren told the radio station WTKK-FM in September 2012.

In January 2014, a federal appeals court upheld the decision, ruling that “even if [it] strikes some as odd or unorthodox,” transgender prisoners have a right to medical treatment. The decision could be an agent of change throughout the country, though the Massachusetts Department of Corrections has yet to find an in-state doctor willing to perform the surgery, so Kosilek’s transition is on an indefinite hiatus, according to The Boston Globe.

Rallying political pressure for access to healthcare for Americans outside of prison is an arduous process, at best. Still, activists note, hormone therapy is as medically necessary to a transgender person as insulin is to someone who is diabetic. Lauren McNamara, a transgender woman who testified at Chelsea Manning’s trial, spelled it out for me: “Incarceration is the sentence, not medical negligence,” she says. “From a scientific and medical perspective, there isn’t a debate here.”

Ten months into a 35-year sentence at Ft. Leavenworth prison in Kansas, Manning is still fighting for access to hormone therapy. Transgender people are not allowed to serve in the military, the logic goes, so Ft. Leavenworth, a military facility, cannot legally administer the treatment.

On May 14, the Associated Press offered a glimmer of hope: In April, a report revealed, the Pentagon approved initial efforts to transfer Manning to a facility that does provide the treatment. If Manning clears that hurdle, her life will improve dramatically, her supporters contend. But if letters from Shaylanna, Venus, Prada, and Eva are a litmus test of life behind bars for transgender prisoners, she’ll encounter plenty of others.

Prada has some advice. “We all have different struggles,” she wrote. “Do the best with what you got.”

Related Reading: It's Time to End the Long History of Feminism Failing Transgender Women.

Kristen Bahler is a Brooklyn-based, Midwestern-bred human rights journalist. She is a vegan when it’s convenient, and tweets at @ChristianBale_R.