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Why inmates need gender-affirming surgery

An insider’s perspective forged by years in prison

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Gender Conference East
genital reassignment surgery, transgender, Gender Conference East, trans, transgender flag, gay news, Washington Blade

(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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Opinions

New research shows coming out is still risky

A time of profound psychological vulnerability

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(Photo by Iryna Imago/Bigstock)

Coming out is often celebrated as a joyful milestone – a moment of truth, pride, and liberation. For many LGBTQ+ people, that’s exactly what it becomes. But new research I co-authored, published in the journal Pediatrics this month, shows that the period surrounding a young person’s first disclosure of their sexual identity is also a time of profound psychological vulnerability. It’s a fragile window we are not adequately protecting.

Using data from a national sample of lesbian, gay, and bisexual people, our study examined what happens in the years before and after someone comes out to a family member or a straight friend. We weren’t looking at broad lifetime trends or comparing LGBTQ+ youth to heterosexual peers. Instead, we looked within each person’s life. We wanted to understand how their own suicide risk changed around the moment they first disclosed who they are.

The results were unmistakable. In the year a person came out, their likelihood of having suicidal thoughts, developing a suicide plan, or attempting suicide increased sharply. Those increases were not small. Suicide planning rose by 10 to 12 percentage points. Suicide attempts increased by 6 percentage points. And the elevated risk didn’t fade quickly. It continued in the years that followed.

I want to be very clear about what these results mean: coming out itself is not the cause of suicidality. The act of disclosure does not harm young people. What harms them is the fear of rejection, the stress of navigating relationships that suddenly feel uncertain, and the emotional fallout when people they love respond with confusion, disapproval, or hostility.

In other words, young LGBTQ+ people are not inherently vulnerable. We make them vulnerable.

And this is happening even as our culture has grown more affirming, at least on the surface. One of the most surprising findings in our study was that younger generations showed larger increases in suicide risk around coming out compared to older generations. These are young people who grew up with marriage equality, LGBTQ+ celebrities, Pride flags in classrooms, and messaging that “it gets better.”

So why are they struggling more?

I think it’s, in part, because expectations have changed. When a young person grows up hearing that their community is increasingly accepted, they may expect support from family and friends. When that support does not come, or comes with hesitation, discomfort, or mixed messages, the disappointment is often devastating. Visibility without security can intensify vulnerability.

Compounding this vulnerability is the broader political environment. Over the last several years, LGBTQ+ youth have watched adults in positions of power debate their legitimacy, restrict their rights, and question their place in schools, sports, and even their own families. While our study did not analyze political factors directly, it is impossible to separate individual experiences from a climate that routinely targets LGBTQ+ young people in legislative hearings, news cycles, and social media.

When you’re 14 or 15 years old and deciding who to tell about your identity, the world around you matters.

But the most important takeaway from our study is this: support is important. The presence, or absence of family acceptance is typically one of the strongest predictors of whether young people thrive after coming out. Research consistently shows that when parents respond with love, curiosity, and affirmation, young people experience better mental health, stronger resilience, and lower suicide risk. When families reject their children, the consequences can be life-threatening.

Support doesn’t require perfect language or expertise. It requires listening. It requires pausing before reacting out of fear or unfamiliarity. It requires recognizing that a young person coming out is not asking you to change everything about your beliefs. They’re asking you to hold them through one of the most vulnerable moments of their life.

Schools, too, have an enormous role to play. LGBTQ+-inclusive curricula, student groups, and clear protections against harassment create safer environments for disclosure. 

Health care settings must also do better. Providers should routinely screen for mental health needs among LGBTQ+ youth, especially around the time of identity disclosure, and offer culturally competent care.

And as a community, we need to tell a more honest story about coming out. Yes, it can be liberating. Yes, it can be beautiful. But it can also be terrifying. Instead of pretending it’s always a rainbow-filled rite of passage, we must acknowledge its risks and surround young people with the support they deserve.

Coming out should not be a crisis moment. It should not be a turning point toward despair. If anything, it should be the beginning of a young person’s journey toward authenticity and joy.

That future is possible. But it depends on all of us – parents, educators, clinicians, policymakers, and LGBTQ+ adults ourselves – committing to make acceptance a daily practice.

Young LGBTQ+ people are watching. And in the moment they need us most, they must not fall into silence or struggle alone.


Harry Barbee, Ph.D., is an assistant professor at the Johns Hopkins Bloomberg School of Public Health. Their research and teaching focus on LGBTQ+ health, aging, and public policy. 

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Candidates should pledge to nominate LGBTQ judge to Supreme Court

Presidential, Senate hopefuls need to go on the record

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U.S. Supreme Court (Washington Blade photo by Michael Key)

As soon as the final votes are cast and counted and verified after the November 2026 elections are over, the 2028 presidential cycle will begin in earnest. Polls, financial aid requests, and volunteer opportunities ad infinitum will flood the public and personal media. There will be more issues than candidates in both parties. The rending of garments and mudslinging will be both interesting and maybe even amusing as citizens will watch how candidates react to each and every issue of the day.

There is one particular item that I am hoping each candidate will be asked whether in private or in public. If a Supreme Court vacancy occurs in your potential administration, will you nominate an open and qualified LGBTQ to join the remaining eight?

Other interest groups on both sides have made similar demands over the years and have had them honored. Is it not time that our voices are raised as well? There are several already sitting judges on both state and federal benches that have either been elected statewide or approved by the U.S. Senate.

Our communities are being utilized and abused on judicial menus. Enough already! Challenge each and every candidate, regardless of their party with our honest question and see if honest answers are given. By the way … no harm in asking the one-third of the U.S. Senate candidates too who will be on ballots. Looking forward to any candidate tap dancing!

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Opinions

2026 elections will bring major changes to D.C. government

Mayor’s office, multiple Council seats up for grabs

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(Washington Blade file image by Aram Vartian)

Next year will be a banner year for elections in D.C. The mayor announced she will not run. Two Council members, Anita Bonds, At-large, and Brianne Nadeau, Ward 1, have announced they will not run. Waiting for Del. Norton to do the same, but even if she doesn’t, there will be a real race for that office. 

So far, Robert White, Council member at-large, and Brooke Pinto, Council member Ward 2, are among a host of others, who have announced. If one of these Council members should win, there would be a special election for their seat. If Kenyon McDuffie, Council member at-large, announces for mayor as a Democrat, which he is expected to do, he will have to resign his seat on the Council as he fills one of the non-Democratic seats there. Janeese George, Ward 4 Council member, announced she is running for mayor. Should she win, there would be a special election for her seat. Another special election could happen if Trayon White, Ward 8, is convicted of his alleged crimes, when he is brought to trial in January. Both the Council chair, and attorney general, have announced they are seeking reelection, along with a host of other offices that will be on the ballot.  

Many of the races could look like the one in Ward 1 where at least six people have already announced. They include three members of the LGBTQ community. It seems the current leader in that race is Jackie Reyes Yanes, a Latina activist, not a member of the LGBTQ community, who worked for Mayor Fenty as head of the Latino Affairs Office, and for Mayor Bowser as head of the Office of Community Affairs. About eight, including the two Council members, have already announced they are running for the delegate seat.

I am often asked by candidates for an endorsement. The reason being my years as a community, LGBTQ, and Democratic, activist; and my ability to endorse in my column in the Washington Blade. The only candidate I endorsed so far is Phil Mendelson, for Council chair. While he and I don’t always agree on everything, he’s a staunch supporter of the LGBTQ community, a rational person, and we need someone with a steady hand if there really are six new Council members, out of the 13. 

When candidates call, they realize I am a policy wonk. My unsolicited advice to all candidates is: Do more than talk in generalities, be specific and honest as to what you think you can do, if elected. Candidates running for a legislative office, should talk about what bills they will support, and then what new ones they will introduce. What are the first three things you will focus on for your constituents, if elected. If you are running against an incumbent, what do you think you can do differently than the person you hope to replace? For any new policies and programs you propose, if there is a cost, let constituents know how you intend to pay for them. Take the time to learn the city budget, and how money is currently being spent. The more information you have at your fingertips, the smarter you sound, and voters respect that, at least many do. If you are running for mayor, you need to develop a full platform, covering all the issues the city will face, something I have helped a number of previous mayors do. The next mayor will continue to have to deal with the felon in the White House. He/she/they will have to ensure he doesn’t try to eliminate home rule. The next mayor will have to understand how to walk a similar tightrope Mayor Bowser has balanced so effectively. 

Currently, the District provides lots of public money to candidates. If you decide to take it, know the details. The city makes it too easy to get. But while it is available, take advantage of it. One new variable in this election is the implementation of rank-choice voting. It will impact how you campaign. If you attack another candidate, you may not be the second, or even third, choice, of their strongest supporters. 

Each candidate needs a website. Aside from asking for donations and volunteers, it should have a robust issues section, biography, endorsements, and news. One example I share with candidates is my friend Zach Wahls’s website. He is running for United States Senate from Iowa. It is a comprehensive site, easy to navigate, with concise language, and great pictures. One thing to remember is that D.C. is overwhelmingly Democratic. Chances are the winner of the Democratic primary will win the general election. 

Potential candidates should read the DCBOE calendar. Petitions will be available at the Board of Elections on Jan. 23, with the primary on June 16th, and general election on Nov. 3. So, ready, set, go! 


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

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