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 However, two years ago, the Trump administration rescinded policy guidance intended to protect the lives and safety of transgender prisoners.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 landmark decision marks the first time a court has ordered the federal government to address someone’s medical need 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 her denial of the healthcare she needs. A representative from BOP admitted at the hearing that no federal prisoner had ever yet been provided gender-affirming surgery even though BOP currently houses approximately 1,200 transgender prisoners in federal custody.

BOP must decide by late January 2022 if they are recommending Ms. Iglesias for gender-affirming surgery and report back to the court.

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


John Knight, Josh Blecher-Cohen (ACLU of Illinois) Angela M. Povolish (Feirich Mager Green Ryan), Taylor Brown (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