Federal Bureau of Prisons could allow first gender-affirming surgery ever

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Cristina Nichole Iglesias is seeking gender-affirming surgery after waiting for years.

A transgender woman could receive the first ever gender-affirming surgery provided by the Federal Bureau of Prisons if her court case, currently pending in the U.S. District Court for the Southern District of Illinois, is successful.

On Tuesday, the court heard Cristina Nichole Iglesias' testimony in favor of a preliminary injunction, which would allow health care professionals with expertise in gender dysphoria to evaluate her and provide transition-related care, including gender-affirming surgery, and would keep her in a facility aligned with her gender.

Iglesias has requested gender-affirming surgery on multiple occasions since 2016, according to the American Civil Liberties Union of Illinois, which is representing her. She appealed a denial in 2018, saying she was depressed and had thoughts of self-mutilation.

According to the ACLU, during her time in prison Iglesias also suffered sexual violence and other incidents of physical violence before being transferred to a Texas women's facility.

John Knight, director of the LGBTQ and HIV Project at the ACLU of Illinois, said he expected a relatively quick ruling on Iglesias' latest emergency motion.

It's not unusual for transgender women to be housed with men or to suffer violent consequences as a result.

In 2020, a NBC News investigation found that nearly all transgender inmates in state prisons across the country had been placed in facilities that didn't correspond to their gender. At the California Institution for Men, a state prison in Chino, one of the facilities investigated in the NBC News report, nine out of the facility's 10 transgender women housed there said they had experienced sexual assault in detention.

A 2015 Justice Department report cited by the outlet noted that at least 35% of transgender individuals who had spent time in state or federal prison had reported being sexually assaulted the year prior by either a fellow inmate or a facility staffer; 34% of transgender individuals who had spent time in local jail facilities said the same.

The ACLU first filed a complaint on behalf of Iglesias against the Federal Bureau of Prisons in September 2020. A year earlier, when Iglesias was being held in a Bureau of Prisons health facility in Lexington, Kentucky, a health care professional had recommended surgery for her but said that there was no one in Kentucky qualified to perform it.

In March of 2020, Ian Connors, the national inmate appeals administrator for the Office of the General Counsel for the Bureau of Prisons, denied Iglesias' surgery request, arguing that she did "not meet the qualifications to be transferred to a female facility" and claiming her hormone levels "have not been maximized or stabilized," according to the ACLU complaint.

"They say the reason they want hormones to be at the maximum level or their optimum level is because of concerns about the transgender woman fitting in or safety on the part of cisgender women, and this whole notion that transgender women are going to have sex with cisgender women," the ACLU's Knight told the American Independent Foundation. "That seems to be their speculation, which I don't understand."

Still, Iglesias stands a chance at victory: In April the ACLU was successful in winning a motion to get her transferred to her current facility in Texas, the first step toward ensuring her health care needs are met.

Change has been a long time coming.

During the Trump administration, the Bureau of Prisons rolled back an Obama-era policy on the treatment of transgender prisoners, changing its Transgender Offender Manual in 2018 to remove references to considering a prisoner's gender identity when deciding where to house them, NBC News reported at the time. The manual afterward instructed people working for the agency to think about "biological sex" for an "initial determination," effectively gutting Obama administration policies, including 2012 regulations that had set standards for implementing the 2003 federal Prison Rape Elimination Act.

Since taking office in January, President Joe Biden and his administration have worked to roll back numerous anti-LGBTQ policies implemented by the Trump administration, including the transgender military ban that went into effect in 2019. Biden also withdrew a rule that that would have allowed shelters to exclude transgender women.

But on the issue of transgender prisoners' access to health care and assigned housing, the administration hasn't rolled out any official plans. In September, the Associated Press reported that the Justice Department was reviewing those policies, with a spokesperson telling the outlet that officials were "committed" to the safety of all inmates.

The Biden administration has signaled support for changes to current policy, with Justice Department lawyers writing in an April brief that it was unconstitutional to continue to place transgender people in facilities where they'd experience "cruel and unusual punishments" or to deny them care to treat their gender dysphoria.

"Blanket bans on categories of treatment are at odds with the Eighth Amendment because they do not account for the individual medical needs of prisoners," the lawyers wrote.

Knight is optimistic moving forward, noting there have been some transfers of transgender people already to facilities aligned with their gender in the past few months.

"[That] at least suggests ... that the policy will change in the future," he said.

In the meantime, Iglesias continues to fight for her safety. "Ms. Iglesias lives in constant fear of further physical or sexual violence as a result of being a transgender woman in a male prison," the ACLU complaint noted in September. "Ms. Iglesias should not have to await the next act of violence to be placed in a women's facility."

Published with permission of The American Independent Foundation.