A trans woman in Texas may become the first inmate to get gender-affirming surgery in prison

• Cristina Nichole Iglesias may become the first person to receive gender-affirming surgery while in federal custody.
• Iglesias, who has been in custody for 27 years, unsuccessfully petitioned the Federal Bureau of Prisons (BOP) to approve her gender-affirming surgery in 2016.

Cristina Nichole Iglesias, a prisoner at Federal Medical Center Carswell, may be the first inmate to receive gender-affirming surgery in federal prison.

Iglesias, who is serving a 20-year sentence at the North Texas facility for sending death threats to the British government when she was 19, unsuccessfully petitioned the Federal Bureau of Prisons (BOP) to approve her gender-affirming surgery in 2016.

The Dallas Morning News reported federal judge Nancy J. Rosenstengel reopened Iglesias' case on December 27, ordering the BOP to revisit the matter again before January 24.

"Iglesias's mental health has severely deteriorated because of the trauma she has experienced from being denied necessary treatment for her gender dysphoria and harassment at male facilities," Rosenstengel wrote in her order.

In her order, Rosenstengel said that the BOP should approve and schedule Iglesias' surgery as soon as possible in order for it to be performed before her release date in December 2022.

The ACLU stated Iglesias was diagnosed with "gender-identity disorder" – now known as gender dysphoria – in 1994. While the BOP is aware of Iglesias' diagnosis, the ACLU stated Iglesias has not been able to receive medical treatment to help manage her dysphoria during the 27 years she's been in federal custody.

According to the BOP, gender-affirming care is offered in federal facilities based on "comprehensive and individualized assessments."

"These accommodations can include gender-affirming surgical referral when deemed appropriate," BOP Public Information Officer Scott Taylor said in a statement.

The BOP did not consider "gender confirmation surgery (GCS)" medically necessary for trans inmates until October 2021, according to the order filed December 27, 2021.

According to the ACLU, there are currently 1,200 transgender prisoners in federal custody, none of whom have received gender-affirming surgeries during their sentences. If approved for the procedure, Iglesias will become the first federal prisoner to receive gender-affirming surgery.

"Cristina has fought for years to get the treatment the Constitution requires," John Knight, Iglesias' attorney and representative of the ACLU of Illinois, said in a statement. "The Court's order removes the unnecessary hurdles and delays BOP has repeatedly constructed to prevent her from getting the care that she urgently needs."