Opinions
Why inmates need gender-affirming surgery
An insider’s perspective forged by years in prison

(Washington Blade file photo by Michael Key)
When it comes to genital reassignment surgery, a lot of the population questions its validity as a necessary medical procedure – especially for the incarcerated. But doctors worldwide now recognize gender dysphoria, a conflict between your physical gender and actual gender, as an actual medical condition. Treatment options vary from hormone therapy to surgery, but just like any other medical condition, doctors are the ones prescribing drugs and procedures.
What does this have to do with inmates? It wasn’t until I won my case against the state of California in April 2015 that incarcerated individuals were even eligible for this type of surgery. The decades-long struggle I faced with my identity, coming to terms with my gender dysphoria and then fighting for my rights – despite being behind bars – paved the way for other transgender men and women like me. It’s important to note that when you live behind bars in the United States, you’re still a human being with rights. You don’t give up those rights to being human because you’re serving time. If an inmate needed a medical procedure to be physically or emotionally healthier, once a doctor deemed it necessary it would be carried out. Because gender dysphoria is a medical condition, this type of procedure is no different. Yet it’s faced with incredible opposition.
My story is just one example of how challenging it is for a transgender individual to receive genital reassignment surgery, especially while incarcerated. I came out as transgender in 1994 after talking to a priest, various doctors and years of self-questioning. I began trying to express my true identity as I could with limited resources; I wore tighter clothes, grew my hair out and used makeshift makeup I was able to create. As I’m sure you can imagine, these changes didn’t make life with other inmates safe, either. While living as a trans woman behind bars I was a target for ongoing verbal and physical abuse, and was brutally gang-raped, left suffering from Hepatitis C, PTSD and Stage 4 Liver Fibrosis.
Once I was officially diagnosed with gender dysphoria in 2000, I began asking about surgery, requesting it over and over again. I wasn’t able to make any progress until a Department of Corrections doctor deemed it medically necessary. He submitted 13 pages about it, but was suddenly transferred to another prison. I filed an appeal as they were denying me a surgery their own doctor deemed necessary, citing Michelle Kosilek’s similar case in Massachusetts. The powers that be continued to deny appeals, refusing to take me seriously and sending people that didn’t have the authority to make the necessary decisions to the prison, so I sued the state of California. I won the case in April 2015 and the surgery was scheduled, but before it could take place I was suddenly paroled.
When I was released from prison, I approached the Transgender Law Center to help me navigate the path to receiving my surgery, but they refused to help me as their representation ended as soon as the case ended. I was left feeling completely alone in a world vastly different from the one I left 30 years prior, and needed to figure it out and advocate for myself yet again.
I started by calling the doctors scheduled to provide the surgery while I was in prison and they did a consult with me, explaining what type of insurance I needed. I made countless phone calls, went to the offices in person and ultimately navigated my way through so I could receive the insurance I needed for my surgery. I am looking forward to it finally taking place this February.
Along the way, I was very disappointed by the lack of support from advocacy groups that are supposed to be on my side; instead of giving me the help I needed, they just wanted to use me to advance their agenda. I’ve used this to fuel my mission, though. My dream is to open a home called Joan’s House, a safe place for other transgender men and women to become their true selves. I want to use my experience navigating through the confusing system to help others as they seek the medical care they need for their own gender dysphoria.
I’m truly grateful for a few organizations that are helping – specifically Bend Law Group, Three Girls Media and Healthright 360 – which have kept me off the streets, helped give me a voice and shown me the path to form a 501c3 non-profit.
Ultimately, the core of our identity is what’s truly at stake. My story is similar to so many other transgender men and women, and they’re why I continue to advocate.
Michelle-Lael Norsworthy is a trans rights advocate based in California.
The state of Tennessee has a long history of political discrimination against its 225,000 LGBTQ citizens. In 2019, a district attorney remarked that gay people should not receive domestic violence protections, and in 2023, for five months in Murfreesboro, homosexual acts in public were illegal, prompting a federal judge to have the ordinance removed.
In 2022, I briefly lived in Tennessee and played rugby with the LGBTQ-inclusive Nashville Grizzlies, who welcomed me with open arms as an ally, teaching me that rugby isn’t always about winning or losing – it’s about creating a safe, inclusive, and joyful space for people looking to feel welcome.
In Tennessee, where 87% of the LGBTQ community has experienced workplace discrimination, and where, each year, countless bills that target their identities are introduced, it can be difficult to feel welcome. The Nashville Grizzlies played rugby with the exuberance of newly liberated people who were finally able to be their authentic selves. I was inspired by their brotherhood.
When I read about the Charlie Kirk Act being passed last week, I felt a visceral need to write about it.
While the bill is presented as legislation that strengthens free speech and encourages greater public discourse on campuses, it would effectively allow a school to expel a student who felt compelled to walk out on a speaker with hateful views, forcing marginalized groups to sit through existentially harmful rhetoric.
And ironically, it doesn’t seem like free speech goes both ways — a Tennessee University administrator lost their job last year for sharing negative views on Charlie Kirk, and countless LGBTQ books have been banned not only in schools, but even in adult libraries.
We like to think that as time moves forward, progress is inevitable, but this isn’t always the case. In a 2023 study, 27% of LGBTQ Tennesseans and 43% of transgender people in the state have considered relocating, forcing them to reckon with leaving home in pursuit of a better life. Nashville Grizzlies Captain Ethan Thatcher told me, “I’ve thought about leaving Tennessee. Hard not to when the government does not want you here. What has kept me here is the Grizzlies community, and the thought that existence is resistance.”
Everybody in our country deserves to feel safe. I thought that was a core value of the American ethos, but apparently, in some states, certain groups are welcome while others are ostracized.
Tennessee Gov. Bill Lee should reject the Charlie Kirk Act.
Tyler Kania is a 2025 IAN Book of the Year nominated author and civil rights activist from Columbia, Conn.
Opinions
The latest Supreme Court case erasing LGBTQ identity
Chiles v. Salazar a major setback for movement
In its recent decision in Chiles v. Salazar, the U.S. Supreme Court invalidated Colorado’s law prohibiting licensed counselors from engaging in efforts to change the sexual orientation or gender identity of minors. The decision, which puts into question similar laws in 22 other states, relied on the First Amendment to hold that the law violates counselors’ free speech rights. But the decision also strikes a blow against LGBTQ dignity, a point the court’s opinion does not even address.
The eight-member majority, which included Justices Elena Kagan and Sonia Sotomayor, who usually side with LGBTQ groups, justified its reasoning by suggesting that the law was one-sided: it permitted treatment that affirms LGBTQ identity but forbade treatment that seeks to change it. But the law is one-sided, as Justice Ketanji Brown Jackson’s lone dissent pointed out, because the medical evidence only supports one side: reams of research show that “survivors of conversion therapy continue to suffer from PTSD, anxiety, and suicidal ideation.” And major medical associations all agree, no evidence demonstrates the efficacy of conversion efforts. This isn’t surprising. Medicine often take sides — some treatments work, and some don’t.
But particularly concerning is the vision of LGBTQ identity that undergirds the majority opinion when compared to the dissent. Justice Jackson’s dissent explains that LGBTQ identity is simply “a part of the normal spectrum of human diversity” — not something to be “cured.” By contrast, for the majority, how best to help LGBTQ minors is “a subject of fierce public debate.” That can hardly be the case if LGBTQ identity stands on equal ground with straight, cisgender identity, or if LGBTQ people are as deserving of safety, rights, and dignity.
Indeed, the LGBTQ rights movement only began in earnest when advocates in the 1960s decided to end the “debate” over gay identity. Until then, community leaders would routinely cooperate with psychiatrists who were interested in researching homosexuality as a medical condition. A new generation of activists, led by Frank Kameny, a key movement founder, began arguing that this got the issue upside down: Rather than wondering if they could be “cured,” LGBTQ people had to assert a right to their identity. As Kameny put it—“we have been defined into sickness.” Only once the case was made that it was society that had to change, and not LGBTQ people, could LGBTQ consciousness, LGBTQ pride and LGBTQ rights develop. Their activism led to the first Pride parade in New York, and the official declassification of homosexuality as a disease in 1973.
The Supreme Court’s conservatives don’t just want to reignite this half-century old medical “debate”; they also treat medical claims that undermine LGBTQ identity very differently from those who support it. Last year, in an opinion backingTennessee’s law that banned gender affirming care for minors, the court sympathetically marched through the reasons Tennessee offered for “why States may rightly be skeptical” of such care, and cited three times, in some detail, to “health authorities in a number of European countries” (that is, some Nordic countries and the UK) that had curbed pediatric care. It failed to mention that most of Western Europe and every major American medical association provides access to this care.
In Chiles, by contrast, the court cites none of the evidence that Colorado amassed that conversion therapy harms LGBTQ children. None of the countries that the court had invoked to justify anti-trans policies allow conversion therapy in their health care systems (indeed, one of them criminalizes such practices). So rather than cite medical evidence, the court simply asked — why trust medical evidence at all? “What if,” asks the court, “reflexive deference to currently prevailing professional views [does] not always end well?” and cites an infamous 1927 Supreme Court case, Buck v. Bell.
In Buck, the Supreme Court embraced eugenic reasoning, backing a eugenic state law that allowed the sterilization of individuals with mental disabilities, on the grounds that such disabilities were hereditary. As Justice Oliver Wendell Holmes opined, “three generations of imbeciles are enough.” Look at what happens when we listen to medical expertise, today’s court seems to say, as an excuse to disregard the LGBTQ-affirming medical evidence they don’t like.
But the court has missed the key lesson of Buck. The law at issue in Buckdiscriminated against a certain group, seeking, through sterilization measures, to erase it from existence. Indeed, LGBTQ people (whom doctors of the day would have referred to as sexual “inverts”) were exactly the kind of people that the eugenic program of Bucksought to eliminate. Conversion therapy seeks similar erasure.
The lesson of the 1960s LGBTQ rights movement remains as relevant today as it was then. Without an unapologetic LGBTQ identity, LGBTQ Pride, LGBTQ rights and the LGBTQ movement itself can all founder. By supporting only the anti-LGBTQ side in this medical saga — and by suggesting that LGBTQ existence is subject to medical debate at all — the court is reaffirming, rather than repudiating, minority erasure.
Craig Konnoth is a professor of law at University of Virginia School of Law.
I was disappointed when the Blade didn’t publish my response to a personal attack on me in a column by Hayden Gise, in last week’s print edition. They did publish it online. To be clear, I have no problem with people disagreeing with my columns and opinions. That is absolutely fair. But when they get into personal attacks, it often means they don’t have enough to say about the ideas they are trying to criticize.
In a recent column ‘Why the Democratic Socialists of America are right for D.C.,’ the author decided to attack me personally. Here is the response I wrote to her column:
“I am responding to a column by Hayden Gise who says in her column she is a transgender, lesbian, Jewish, Democratic Socialist, and supports having the Democratic Socialists of America (DSA) in Washington, DC. She is definitely as entitled to her view on this, as I am to mine. However, I was surprised she clearly felt it important to use the column to attack me personally, without even knowing me. What she didn’t do is respond to the issues in the DSA platform I wrote having a problem with, and which I asked candidates endorsed by the DSA to respond to. 1. Are they for the abolishment of the State of Israel? 2. What is their definition of a Zionist? 3. What is their definition of antisemitism? 4. Will they meet with Zionist organizations? 5. Do they support BDS? One needs to know when a candidate claims they are only a member of the local DSA, according to the DSA bylaws no person can be a member of a local DSA without being a member of the national organization. So Hayden Gise has a little better idea of who I am she should know: I was a teacher and a union member. I worked for the most progressive member of Congress at the time, Bella S. Abzug (D-N.Y.), and supported her when she introduced the Equality Act in 1974, to protect the rights of the LGBTQ community, and have fought for its passage ever since. I have spent a lifetime fighting for civil rights, women’s rights, disability rights, and LGBTQ rights. I have no idea what Hayden Gise’s background is, or what her history of working for the causes she espouses is. But I would be happy to meet with her to find out. But she should know, I take a back seat to no one in the work I have done over my life fighting for equality, including economic equality, for all. So, I will not attack her, as I don’t know her, and contrary to her, don’t personally attack people I don’t know much about.
“I have, and will continue to attack, what the government of Israel is doing to the Palestinian people, and now to those in Lebanon and Iran. I will also attack the government of my own country, and the felon in the White House, and his sycophants in Congress, for what they are doing to our own people, and people around the world, and will continue to work hard to change things. However, I will also continue to stand for a two-state solution with the continued existence of the State of Israel, calling for a different government in Israel. I also strongly support the Palestinian people and believe they must have the right to their own free state.”
I have not heard from Gise, but I hope she knows that since she wrote her column indicating her support for Janeese Lewis George for mayor, her preferred candidate has attended a birthday party to celebrate a person who still refers to gay people as ‘fags.’
We should not personally attack people we don’t know as a way to criticize their views on an issue. Once again, I have no problem with people disagreeing with what I write, and having the Blade publish those contrary columns. But a plea to all who disagree with any columnist, or story: disagree with the issues and refrain from making personal attacks on the writer. That actually takes away from whatever point you are trying to make.
Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.
