We represent Cristina Nichole Iglesias – a woman in federal custody – who has been denied critical medical care, raped, physically and sexually abused, and even held hostage while housed in facilities for men. The Bureau of Prisons (BOP) has recognized that Ms. Iglesias is a transgender woman and diagnosed her with gender dysphoria as far back as 1994, but has refused to provide her the basic medical care she needs and refused to move her to a women’s facility choosing instead to incarcerate her with men even in the face of escalating attacks and threats on her life.

Correctional experts have long understood the high likelihood of sexual assault that transgender women face when held in facilities for men, which is why the regulations implementing the Prison Rape Elimination Act of 2003 (PREA) require prisons – including federal prisons – to make individualized placement decisions that consider where each transgender person feels they would be safest. These regulations prohibit prisons from placing prisoners in a male or female facility solely based on their anatomy or gender assigned at birth. This approach has been undermined by the Trump Administration’s change to BOP policy.

The BOP had taken various steps under the Obama presidential administration to better address the particular vulnerabilities that transgender individuals face in federal custody. However, two years ago, the Trump administration rescinded policy guidance intended to protect the lives and safety of transgender prisoners. Among other things, the Trump Administration rule makes placement decisions based on a person’s assigned gender at birth. This approach reversed the progress that had been made in finally recognizing the authentic existence of women who are transgender and the risks they face when housing them in men’s facilities and has been continued by the Biden Administration.

After she filed a motion for preliminary injunctive relief—and after more than two decades in men’s facilities—Ms. Iglesias was finally moved to a women’s prison in May 2021. In late December 2021, the court ruled on that motion and ordered BOP to evaluate her for gender-affirming surgery. This decision marked the first-ever time a court ordered the federal government to evaluate someone for gender-affirming surgery. The directive came after a day-long hearing in which the court heard directly from Ms. Iglesias about the years of harm she has endured in federal custody due to BOP’s denial of the healthcare she urgently needs. A representative from BOP admitted at the hearing that no federal prisoner had ever yet been provided gender-affirming surgery.

BOP was given until late January 2022 to determine if they were recommending Ms. Iglesias for gender-affirming surgery and report back to the court. BOP finally approved Ms. Iglesias for surgery—but used further tactics to delay the procedure, leading the court to contemplate issuing sanctions against BOP and DOJ in February 2022 and again in April 2022.

In May 2022, Ms. Iglesias reached a landmark settlement with BOP, under which she will be the first person to receive gender-affirming surgery while in federal custody. Under the settlement, BOP will provide Ms. Iglesias with the gender-affirming surgery she has requested since January 2016, as well as other medically necessary gender-affirming procedures including permanent hair removal, breast augmentation, and facial-feminization surgery. In the settlement, BOP also committed to setting the first-ever target timelines for considering prisoners’ requests for gender-affirming care. BOP will also expand their list of medically necessary gender-affirming treatments and update resources and training for BOP employees. These changes will help the more than 1,200 transgender people in BOP custody better access the gender-affirming care they need.

Find out more about our work to protect transgender prisoners in the Illinois prison system


Michelle García (ACLU of Illinois), Angela M. Povolish (Feirich Mager Green Ryan), Taylor Brown, James Esseks, Li Nowlin-Sohl (ACLU), Katherine D. Hundt, Courtney Block, Frank Battaglia, Kevin Warner (Winston & Strawn LLP)

Date filed

September 8, 2020


U.S. District Court for the Southern District of Illinois