We represent Cristina Nichole Iglesias – a woman in federal custody – who was denied critical medical care, raped, physically and sexually abused, and even held hostage while housed in facilities for men. The Bureau of Prisons (BOP) recognized that Ms. Iglesias is a transgender woman and diagnosed her with gender dysphoria as far back as 1994, but 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.

After she filed a motion for preliminary injunctive relief arguing that BOP failed to provide her necessary medical care in violation of the 8th Amendment and failed to house her with other women in violation of the 5th Amendment —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.  

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 the U. S. Department of Justice (DOJ) in February 2022 and again in April 2022.

In May 2022, Ms. Iglesias reached a landmark settlement with BOP to provide Ms. Iglesias with the gender-affirming surgery she has requested since January 2016. The settlement also required BOP to provide other medically necessary gender-affirming procedures to Ms. Iglesias including permanent hair removal, breast augmentation, and facial-feminization surgery. The settlement and court order even required BOP to pay for any agreed-upon surgeries and post-operative care if Ms. Iglesias left federal custody. Moreover, BOP committed to systemic changes by setting the first-ever target timelines for considering prisoners’ requests for gender-affirming care, expanding its list of medically necessary gender-affirming treatments, and updating resources and training for BOP employees. These changes will help the more than 1,200 transgender people in BOP custody better access the constitutionally required gender-affirming care they need.

Cristina underwent gender affirmingand facial feminization surgery in 2023. 

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), Frank Battaglia, Shannon Lemaieur (Winston & Strawn LLP)

Date filed

September 8, 2020


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