I think that there is a difference between patients in hospital wards and criminals. The criminally insane are maybe a separate category, but the nature of criminal insanity is that it pretty much always falls outwith usual parameters.
Hospital patients have full citizens' rights, and if they usually 'live as' the opposite sex, and if it would be traumatic for them to have to relinquish that, I think that every effort should be made to accommodate them and respect their choices. This should not be done in a way that compromises the well-being (mental or physical) of others on the ward, though, so in the current straightened circumstances of the NHS it is always going to be tricky.
Criminals, however, are a different matter. The purpose of jail is to deprive them of the freedoms they would have if they hadn't committed the crime for which they are imprisoned, and one of those freedoms is self-actualisation. People in jail can't necessarily 'be' a musician, or a husband, or a goth (or insert more up-to-date subculture of choice
) in jail, because they are being punished.
I'm not suggesting that trans people should attract extra penalties just for being trans (although I would argue that using trans status to commit a crime should attract an extra penalty, but that is different entirely). I do, however, think that just as most prisoners have to give up part of who they 'are', transpeople shouldn't expect to have special treatment either.
I think that governors of jails should be sensitive to their needs - as with all prisoners - so where possible, transpeople could share cells, for instance, or be housed on special wings if available. I don't think, however, that other prisoners should have to lose facilities because of the cost of building such wings, or should have to go to the back of the queue for premium cells - there needs to be fairness as well as compassion.
As it stands, it seems as though saying 'I am trans' is assumed to mean 'I am entitled to be treated as a special case whatever I do', and it shouldn't. Whatever 'living as' a member of the opposite sex is supposed to mean (and that is still very unclear to me) it doesn't mean that everyone around you should have to walk on eggshells and treat you differently from others? It smacks of self-indulgence to me.
I am a woman, and if I go into a woman's clothes shop and there is no space in the changing room, I am asked to wait, or to take the dress home to try on. Why should the same thing be seen as discriminatory when it happens to a non-binary person or a transwoman?