AUSTIN, Texas — A inmate currently housed in a North Texas prison could become the first transgender person to receive gender-affirming surgery while in federal custody.
Cristina Nichole Iglesias, 47, is a transgender woman serving a 20-year sentence for threatening to use a weapon of mass destruction against the British government. She was transferred to Federal Medical Center Carswell, a women’s prison in Fort Worth, in May 2021.
Iglesias has unsuccessfully requested the prisons bureau approve her for gender-affirming surgery since 2016. Late last month, a federal judge ordered the agency to meet to discuss her case before Jan. 24.
Iglesias’ lawyer said this was the first time a federal judge ordered the agency to evaluate such a request.
“We hope that the order directing (the Bureau of Prisons) to move forward will result in medically necessary and long overdue health care for Cristina — and, in time, for the many other transgender people in BOP’s custody who have also been denied surgery and other much-needed gender-affirming care,” John Knight, the LGBTQ Project Director at the ACLU of Illinois, said in a statement.
If approved, Iglesias could become the first transgender inmate to receive gender-affirming surgery while in federal custody.
In October, another federal prisoner became the first to be approved for gender-affirming surgery, according to court filings in Iglesias’ case. But it is unclear when that person will receive the surgery, and the bureau did not answer questions about the prisoner’s identity, medical status or housing location, citing “privacy, safety, and security reasons.”
“The BOP’s team of subject-matter-experts provide a wide range of gender-affirming accommodations based on comprehensive and individualized assessments. These accommodations can include gender affirming surgical referral when deemed appropriate,” Public Information Officer Scott Taylor said in a statement.
Iglesias’ case was filed in federal court in Illinois because she was previously housed in a facility there.
In her Dec. 27 order, Judge Nancy J. Rosenstengel urged the bureau to move quickly to schedule and complete the surgery, if Iglesias is approved, because she is scheduled to be released from prison at the end of 2022.
If Iglesias is not approved for surgery, Rosenstengel said the bureau must provide “all medical reasons” for its decision to the court within a week. The matter is also urgent, Rosenstengel noted, because Iglesias has indicated that her gender dysphoria may drive her to self-harm.
Gender dysphoria is the feeling of discomfort or distress that can occur in people who identify as a gender that is different from the gender or sex assigned at birth, according to the Mayo Clinic. Not all transgender people experience dysphoria, or feel it to the same degree.
“Iglesias has thought again about performing [surgery] on herself or committing suicide,” Rosenstengel wrote, “and has been told by staff that ‘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.’”
Barack Obama appointed Rosenstengel to the federal bench in 2014.
Dr. Randi Ettner, a clinical psychologist and past leader of a health care organization for transgender patients, said Iglesias was experiencing “the most severe form of gender dysphoria,” according to court records.
“For individuals with the most severe form of gender dysphoria, hormone treatment is insufficient,” Rosenstengel wrote, citing Ettner. “If left partially treated, Iglesias is on three trajectories: psychological decompensation, surgical self-treatment, or suicide.”
Through her lawyer, Iglesias said she was happy Rosenstengel intervened.
“Without that happening, I would continue to fall through the cracks and BOP would ignore my need for gender-affirming surgery which I’ve been fighting to get for decades. I am happy to have had the chance to tell my story and am hopeful that other transgender people will benefit from my case,” she said.
Iglesias was convicted in 2005 for sending death threats, including a white substance, to the Foreign and Commonwealth Office in the United Kingdom. She was already in federal custody at the time, after pleading guilty in 1994 to mailing threatening letters to a judge in Oklahoma.
Iglesias was in a Florida jail at the time she sent the 1994 threats. The then-19-year-old was had been indicted for sending similar threats to a federal judge and prosecutor the year before, and was jailed previously for stealing a car in Brooksville, where her mother said she briefly attended high school, according to a 1993 story in The St. Petersburg Times.
According to court filings, Iglesias knew her gender identity did not match her sex assigned at birth from a young age. Iglesias was diagnosed with “gender identity disorder,” now an outdated term, when she was first taken into federal custody in 1994. This diagnosis was later updated to gender dysphoria.
The prisons bureau first granted Iglesias’ requests for hormone therapy in 2015.
About 1,200 federal inmates self-identify as transgender, according to the U.S. Justice Department, or less than 1% of the total population.
In 2018, President Donald Trump rolled back several protections for transgender inmates established during the Obama administration. The new policies stated that transgender prisoners would be moved to prisons that correspond with their gender identity in rare cases only, and that “biological sex” would be the initial determinant of housing decisions.
The reversal was part of settlement negotiations after a group of non-transgender women incarcerated at FMC Carswell, backed by a conservative legal organization, sued the government to expel all transgender women from federal female prisons.
As of last fall, President Joe Biden’s administration had not updated the Trump-era policies for transgender inmates but was reviewing them.
Inmates housed in state-run jails and prisons are not subject to the same rules as federal inmates. While they too can receive hormone therapy while in custody, the state of Texas requires prisoners to be housed in facilities according to the “physical anatomy.” If the state prisons department determines a transgender inmate cannot be housed safely with other inmates, they may be housed individually, an agency spokesman said.
As of September 2021, there were 1,608 transgender inmates out of a population of about 120,000 people in all state-run jails and prisons.
