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Why inmates need gender-affirming surgery

An insider’s perspective forged by years in prison

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(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.

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Anti-science, anti-LGBTQ movements go hand in hand

HHS under RFK Jr. has blocked gender-affirming care for youth

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HHS Secretary Robert F. Kennedy Jr. (Washington Blade photo by Michael Key)

A newborn baby died after contracting measles in Pennsylvania last month, and, as if it wasn’t enough grief for his parents, anti-vax activists are trying to track down and harass his family. Apparently, Gov. Josh Shapiro tangled with Robert F. Kennedy Jr. over his “inaccurate and misleading claims.”

On Aug. 26, RFK Jr., the secretary of the U.S. Department of Health and Human Services, declared that the deaths could be fabricated. We live in peculiar times, when it is government officials, not freaks on the internet, who are spreading conspiracy theories. The new spread of measles in the United States since Donald Trump came to power is one of the most shameful parts of the story of modern American politics, and the tragedy of parents who lost their baby because more and more people refused to vaccinate may seem absolutely unrelated to LGBTQ rights, but actually, there is a pretty solid connection.

Because RFK Jr., the same man who was fighting vaccination, promoted the false idea that vaccines caused autism, and even curated the anti-vaccine organization Children’s Health Defense before going into politics, is also a known opponent of transgender rights. Under his “leadership,” gender-affirming care for trans minors was banned, and there were also created new healthcare guidelines recognizing only two genders.

All around the globe, there is a weird correlation between anti-LGBTQ — particularly anti-trans — ideas and anti-science movements. And it should be clearer to the general public. People who are speaking against LGBTQ rights are not just threatening minorities. They are a danger to everyone.

The Trump-Vance administration is an iconic example of such tendencies. 

Trump himself is a known critic of modern scientific studies — for example, believing in the same anti-vax conspiracies that Kennedy promoted, and showing obvious skepticism that global warming exists, despite all the evidence that has been shown by climatologists. And he is also a man who used trans people as boogeymen. Under his command, trans people were kicked out of the military. And even worse, recently he made an extremely chilling statement about the 2026 midterm elections, urging voters to “pretend I’m on the ballot” and vote for Republicans, and while discussing what he says is at stake, he said that if Republicans win, “transgenderism” will “end.” This is an offensive statement at best and genocidal at worst.

And, of course, I think everyone remembers the Department of Government Efficiency (DOGE), which was led by infamous billionaire Elon Musk, who announced to the world that he would destroy the “woke mind virus” that killed his child just because his trans daughter, Vivian Wilson, well, is happy to be a trans person.

DOGE is known not just for cancelling academic research around LGBTQ studies and gender studies. No, this agency abruptly canceled and froze thousands of federal science, research, and health grants, attacking such vital health programs as cancer research, vaccination research, and diabetes research, among others. As you can see, they are not just attacking people who are “affected” by the “mind” virus — they are dangerous to everyone, even if most of the public standing of Musk was around his anti-trans politics and he tried to present himself as a pro-science, pro-progress man by supporting the space industry.

An even more vivid example is the so-called Dark Enlightenment movement. 

This extremely reactionary political movement was born in the late 2000s, and originally grew from very democratical classical liberal ideas. Until it became anti-democratic itself. And also often It was created by American software engineer Curtis Yarvin (writing under the pseudonym Mencius Moldbug) and expanded by British philosopher Nick Land. The movement is popular among some Silicon Valley businessmen, and got support from PayPal founder Peter Thiel, and one of their main ideas is that modernity is bad. They are basically obscurantists, who see modern universities as part of “the Cathedral” — a system that, in their opinion, promotes equality and modern science that society doesn’t need. Of course, the movement’s followers are mostly anti-LGBTQ rights, and, as you can see, anti-queerness once again go hand in hand with obscurantism. Unfortunately, the movement got the support of extremely prominent politicians, including U.S. Vice President JD Vance. 

In his speech from 2021, Vance proved to be an obscurantist when he claimed that universities are the enemy. He is also a known homophobe and transphobe.

So, why are anti-vaxxers, people who oppose modern scientific studies, and people who hate universities more likely to be queerphobic? Why do the same people who are defending their transphobia by showing that they support common sense actually often show zero such sense when it comes to protecting themselves and their children from measles or decreasing the chances of getting cancer?

We don’t have any statistics or studies that show that all obscurantists are queerphobic, but around the globe, the same dynamic is visible.

In Russian anti-LGBTQ censorship, books about animal biology and zoology have been censored because the censors saw “LGBT propaganda” in them. The famous pro-Putin philosopher Alexander Dugin, who is extremely anti-queer, also speaks up against modernity itself.

In Taliban’s Afghanistan, modern science and LGBTQ rights are attacked at the same time.

Even in the UK, Reform UK is known as the most anti-trans and anti-queer party, and they are facing widespread criticism from scientists and medical experts for promoting climate change denial and anti-vaccine ideas. It doesn’t mean that LGBTQ supporters never believe in conspiracy theories or that progressive politicians always support science.

No, it just means that explicit anti-science and anti-LGBTQ statements often go hand in hand.

I think there are two reasons for this correlation.

First, LGBTQ people are real. You cannot deny that sex is not binary, gender and sex are different, and transition improves the quality of life of actual trans people. Or that same-sex relationships are natural, because even animals have same-sex sexual contacts. To deny it, you need an ideology or a conspiracy theory.

The second reason is that anti-scientific populism and anti-LGBTQ conspiracy theories are popular among the same category of people. It’s a “bundle” of ideas — a trend that conservative voters often adopt together. Studies also show that people who are likely to believe in one conspiracy theory are more likely to believe in another.

But the question is more broad. We don’t speak enough about the harm anti-scientific conspiracy theories and obscurantist politicians around the globe create for mankind in general. Not all people would suffer from a prohibition of hormone therapy, or attacks on same-sex marriage. But anti-global warming ideas, anti-vax advocates, and restrictions on modern research, especially medical research, are potentially dangerous to any human being.

And one of the best things LGBTQ activists could do is just show society that they are being used — that the same people who are stealing LGBTQ rights are also destroying medicine and the environment, and it’s a threat to their own traditional families and future of all kids no less than to queer people.

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Trans people need a politics of ordinary life

Seeking the freedom to stop explaining ourselves

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(Image by smarnad/Bigstock)

For much of the modern transgender rights movement, our political vocabulary has understandably been a vocabulary of emergency. We talk about healthcare bans, bathroom restrictions, discrimination, violence, court decisions, and executive orders. We organize because something is being taken away, prohibited or threatened.

Those fights are necessary. But they cannot constitute our entire vision of transgender life.

The Williams Institute at UCLA estimates that approximately 2.8 million Americans ages 13 and older identify as transgender, including roughly 2.1 million adults. Transgender people are only about 0.8 percent of the adult population. Yet transgender Americans occupy an extraordinary amount of the country’s political attention.

Behind those political arguments are millions of people doing profoundly ordinary things.

We commute to work. We complain about rent. We walk our dogs. We sit in traffic. We buy groceries. We fall in love with people who sometimes disappoint them. We worry about our parents getting older. We try to make enough money to retire. We drink coffee before work and wonder what to make for dinner.

This ordinariness should be part of the political project.

For years, LGBTQ advocacy has emphasized visibility. Visibility was necessary because silence allowed discrimination to flourish. Americans needed to understand that gay and transgender people existed in their families, workplaces and communities.

But visibility is a means, not an end.

The endpoint of civil rights is not permanent visibility. It is freedom.

And freedom includes the freedom to stop explaining yourself.

There should be nothing remarkable about a transgender accountant preparing someone’s taxes, a transgender teacher grading papers, a transgender novelist writing a book that has absolutely nothing to do with gender, or a transgender retiree arguing with the homeowners association about somebody’s fence.

That sounds almost comically mundane. That is precisely the point.

For many transgender Americans, mundane life remains harder to obtain than it should be. The 2022 U.S. Transgender Survey, which collected responses from more than 92,000 people, found that 34 percent of respondents were experiencing poverty and 18 percent were unemployed. Eleven percent of respondents who had ever worked reported losing a job because of their gender identity or expression. Nearly 30 percent had experienced homelessness during their lives.

Those numbers tell us something important about what transgender politics should accomplish.

A successful movement cannot measure progress exclusively by representation in television shows, corporate Pride campaigns or the number of transgender politicians elected to office. It must also ask whether transgender people can build stable, boring lives.

Can you find a job?

Can you rent an apartment?

Can you go to the doctor without becoming a political subject?

Can you walk into a restaurant with your spouse without calculating whether everyone is staring at you?

Can you spend an afternoon thinking about something other than being transgender?

Even healthcare illustrates the distance between formal inclusion and ordinary dignity. A 2024 KFF analysis found that 33 percent of LGBT adults who had recently used healthcare reported being treated unfairly or disrespectfully by a healthcare provider, compared with 15 percent of non-LGBT adults. Thirty-nine percent said a negative healthcare experience had made them less likely to seek care.

Equality therefore cannot simply mean keeping a clinic open. It must mean being able to enter that clinic, receive competent treatment and leave without feeling that your identity has swallowed the entire encounter.

There is a broader political lesson here.

Transgender Americans have sometimes been transformed into abstractions by both sides of the culture war. To some conservatives, we are evidence of social decline. To some progressives, we become symbols of resistance. Neither description leaves much room for the complicated, frequently uninteresting reality of being a person.

Most people do not wake up every morning thinking about their demographic categories. They think about deadlines, relationships, bills, ambitions, annoyances and whether there is enough milk in the refrigerator.

Transgender people deserve that luxury too.

A politics of ordinary life would therefore defend transgender healthcare and civil rights vigorously while articulating something beyond defense. Its objective would be integration: transgender Americans participating in civic life without every interaction becoming a referendum on gender.

That means protecting employment and housing. It means making competent healthcare routine rather than exceptional. It means creating communities where transgender children can imagine futures that extend beyond surviving adolescence. And it means allowing transgender adults to become bankers, mechanics, professors, parents, entrepreneurs and retirees without expecting them to become activists simply because they are transgender.

There will always be people who choose activism. We need them. There will always be people who speak publicly about their transitions. Their testimony matters.

But there should also be room for the transgender person who wants none of that.

Civil rights movements succeed not merely when marginalized people become visible, but when their presence stops requiring explanation.

The most radical future I can imagine for transgender Americans is therefore surprisingly conventional: a country in which being transgender can become one fact among hundreds about a person rather than the organizing principle of a life.

Perhaps the ultimate measure of transgender equality will not be how frequently America talks about transgender people. It will be the day when it no longer has to.


Isaac Amend is a transgender man and writer based in D.C. In 2017, Isaac starred in National Geographic’s “Gender Revolution” documentary. He sits on the board of the LGBT Democrats of Virginia. His author’s portfolio is available at isaacamend.com and you can find him on Instagram at: @isaacamend.

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Enlarging the Supreme Court keeps making more sense

If effort to restrict mail in voting stands, we are in major trouble

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(Washington Blade photo by Michael Key)

I have been going back and forth on whether I think adding justices to the Supreme Court is the right thing to do. But if the court takes the final step of allowing the felon’s executive order on mail in ballots to move forward, I am definitely for enlarging the court. There are many things this court has done that I find reprehensible, but this would be by far the worst. It would irreparably impact the very cornerstone of our democracy — the right to vote.

The order requires the Department of Homeland Security (DHS) be sent voter lists from each state, and then compile/verify a list of U.S. citizens in each state who are eligible to vote. DHS would undertake the effort to compile the list with the Social Security Administration. We are talking about a list of more than 200 million names. The list would be by state, and then sent to each state. It then directs the U.S. Attorney General to prioritize the investigation and prosecution of “election officials, individuals, and other entities that violate the law by issuing or distributing Federal ballots to ineligible voters.” Then according to the White House fact sheet on the EO, It directs the AG to withhold federal funds from noncompliant states. 

In addition, it involves the Postal Service in determining correct ballots, and instructs ballots it transmits to be “placed in secure ballot envelopes marked as Official Election Mail, with unique Intelligent Mail barcodes, that facilitate tracking. So, one has to question does Homeland Security then track every ballot? It is all insane, meant to limit voting, and scaring people into not voting when we already have a safe, proven system in place. All this being done at the whim of the felon in the White House when it is very clear the Constitution vests the administration of elections with the states. It does allow Congress to pass laws pertaining to elections, but is clear the Executive Branch has NO official role in changing election laws, or carrying out elections. The court must be deaf, blind, and dumb, if they don’t know the Congress has refused to pass the President’s SAVE Act, which would have made some changes. Again, they know this, and if they choose to disregard this, and the constitution, and allow the felon to proceed to implement any part of his EO, they should be impeached. 

It is clear to anyone with half a brain, that all this, even if it were constitutional, would be totally impossible to do in the eight weeks before the midterm elections. In the 2022 midterm elections, nearly 107.7 million valid votes were cast. Currently, is it difficult to determine the exact number of registered voters, as they are registered by state, but it is generally agreed to be approximately 200 million. The idea the Trump administration could in any way try to validate 200 million names in the next eight weeks is totally insane. Again, this is why it is left to the states to do, and it is an ongoing process. Trump filed 60 lawsuits to try to prove invalid votes in the 2020 election, and he lost all 60. Recently, DHS looked at the Nevada voting rolls, and initially claimed there were about 16,000 illegal voters listed. But when it came down to returning the supposed illegal names to Nevada, election officials there received a list with only about 185 names on it. Over the years where Trump has sued, and there have been recounts, there have never been more than a handful of illegal votes and it was clear they made no difference in the results.

Voting by mail is crucial for so many. Even the felon votes by mail. So, if the court were to side with the felon on this, and approve even part of his executive order, they are clearly doing it to screw up our elections, and be complicit with the felon. Based on such an outcome I would lobby the Senate to add justices to the court. The number of justices on the court has changed five times before. Today we have two justices, Alito and Thomas, whose votes you know in advance on any case before it is even heard. We know there are six conservative justices. So, if Democrats take the Senate they could add four more liberal justices to the court for a liberal majority. Even adding three would provide for an even balance which could make for a serious debate on the issues within the court, and final decisions wouldn’t be forgone conclusions as they so often are today. 


Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.

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