The prevalence of incarcerated individuals with gender dysphoria (formerly known as gender identity disorder), intersex conditions, and who are transgendered remains unknown. Correctional systems face increased scrutiny, litigation risks, and other challenges in the treatment of individuals with gender dysphoria. This presentation is designed to provide an overview of the phenomenology, clinical presentation and challenges of this unique patient population within corrections. We will review examples of “real world” issues with resulting access to care, medical and specialist staffing, medico-legal, and fiscal implications. We will describe the implementation of a university medical school based gender dysphoria diagnostic clinic into our existing correctional medical and mental health care system statewide and how this has improved timeliness and efficiency of referrals, treatment services, and quality of care.