The purpose of this study was to survey the current assessment, housing, and mental health treatment needs of transsexual inmates within state correctional facilities. The literature reviewed epidemiology, prevalence, multiple uses of terms, assessment, and current standards of care. Along with the rise of the multicultural movement, growing interest in transgender treatment has spread through the mental health and criminal justice community. Individuals with transgender needs (assessment, housing, and treatment) have been largely ignored despite the fact that they remain a key minority population at risk to experience suicide, depression, and hate crimes. Criminal justice administrators and mental health providers are faced with the challenges that arise when dealing with individuals with transgender concerns. To address these concerns a survey was mailed to 50 mental health directors of each state's correctional department. Of the 21 responses received, 18 were fully completed questionnaires. The other 3 responses indicated that the states were not able to respond due to ongoing litigation concerning transgender issues. The majority of the mental health directors were psychologists, however, in some states the psychology department is a division of general health services and the surveys were completed by physicians. The 16-item survey was developed to obtain information about current methods of treatment and policies used by correctional facilities. The survey was comprised of 12 binary response (yes or no) questions with follow-ups for further explanation depending on the question, in addition to three free form questions. All text responses were coded and categorized. The binary and categorized responses were then analyzed descriptively to find trends by examining every binary data point and free form question for quantitative association between addressing special needs against lower risk factors. The results of the survey indicated not only a lack of psychological and physiological treatment, but also a consistent acknowledgement of discomfort with the lack of understanding about transgender specific issues. Implications for correctional administrators and mental health providers as well as recommendations for future research are provided.