Incarcerated Trans Woman Could Receive Gender-Affirming Surgery

Accessibility to trans healthcare is a topic increasingly on the lips of legislators and LGBTQ folks, and those serving prison sentences hold no exception, as folks often denied access to the same care as others. Now, a trans woman incarcerated in a Texas prison could become the first person held in federal custody to receive gender-affirming surgery, setting a precedent for the treatment of incarcerated trans folks, according to reporting from them.

Christina Nichole Iglesias submitted a request for surgery, which the Transgender Executive Council (TEC) within the Bureau of Prisons (BOP) must evaluate by January 24, according to a ruling issued by Chief Judge Nancy J. Rosenstengel. The 61-page decision was issued December 27 in the U.S. District Court for the Southern District of Illinois, additionally mandating timelines for the BOP based on the ultimate approval or rejection for the surgery on behalf of the TEC.

Should Iglesias receive approval, the defendants are required to file a notice within two days of approval with a detailed plan, including a list of surgeons and timeline for surgery preparation and recovery. Additionally, the defendants would be required to file notices regarding the process of finding a surgeon each week until they secure a surgeon and to send weekly notices confirming the scheduling of the surgery until it happens.

According to the ACLU of Illinois, who represents Iglesias, this is the first time a federal judge has ordered the BOP to evaluate a surgery request. ACLU of Illinois LGBTQ Project Director John Knight told Dallas Morning News the organization hopes Iglesias can receive “medically necessary and long overdue healthcare,” adding that he hopes the order will pave the way for other trans people in BOP custody who have been denied surgery requests and other gender-affirming care.

The ruling says Iglesias is “running out of time” to receive the surgery. She has been in custody since 1994, denied hormone replacement therapy until 2015, and was only transferred to a women’s facility last year after filing a separate court case against the BOP in 2016. The ruling notes Iglesias’ testimony, saying that having gender dysphoria “is a living hell,” noting that she has suffered “anxiety every single moment and panic attacks as well.” While she has had access to bras, panties, and makeup, the report notes her dysphoria is not completely alleviated.

The ruling quotes Iglesias saying “self-castration or suicide is always there,” that she was allegedly told by staff “the BOP was just trying to run the clock out on (her) lawsuit, and that they were not trying to give (her) any kind of treatment,” even though she was recommended for surgery by multiple doctors.

Even if Iglesias’ surgery isn’t approved, this first-of-its-kind order will still provide more leverage to trans people in prison in the future. It builds on the case of Ashley Diamond, a Black trans women incarcerated in Georgia who sued the state for denying her access to hormones and placed her in a men’s facility.