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Court orders first gender-affirming surgery for a transgender federal prisoner

Cristina Nichole Iglesias has been battling the Federal Bureau of Prisons in court for years.

In a first, the Federal Bureau of Prisons has been ordered to secure gender-affirming surgery for a transgender prisoner.

A federal judge in the U.S. District Court for the Southern District of Illinois ordered the bureau on Monday to undergo a nationwide search for a qualified surgeon to perform the surgery for the inmate, Cristina Nichole Iglesias.

The directive will bring Iglesias — who has been imprisoned since 1994 for threatening to use a weapon of mass destruction — a step closer to receiving the procedure, which she has been fighting to get for six years, the last three in the courts.

“I am hopeful that I will finally get the care I need to live my life fully as the woman I am,” Iglesias said in a statement provided to NBC News by her legal representative, the American Civil Liberties Union. “BOP has denied me gender-affirming surgery for years — and keeps raising new excuses and putting new obstacles in my way. I am grateful that the court recognized the urgency of my case and ordered BOP to act.”

Monday's court order could pave the way for other transgender prisoners to receive gender-affirming surgeries as well. LGBTQ advocates have called these procedures "life-saving," and Monday's decision could bolster the Biden administration's goal of improving the lives of incarcerated transgender people.

A 2015 report by the Justice Department estimated that 35 percent of trans prisoners surveyed had reported being sexually assaulted behind bars within the last year. Under the Trump administration, the Bureau of Prisons was required to “use biological sex as the initial determination” for housing trans prisoners.

A 2020 NBC News investigation that tracked 45 states and Washington, D.C., found that out of 4,890 transgender inmates in state prisons, only 15 were confirmed to being housed according to their lived gender.

In January, the Biden administration restored Obama-era guidelines for federal prisons to house transgender inmates by their gender identity "when appropriate." The guidelines also require prison staff to refer to trans inmates by their lived name and pronouns.

The ACLU estimates that the Federal Bureau of Prisons has more than 1,200 transgender people currently in its custody.

Iglesias has been in federal prison for roughly 28 years and currently lives in a bureau-run residential re-entry center in Florida, according to the ACLU.

Although she identified herself as a woman upon her incarceration, she has been housed in men's facilities for over two decades, and during that time has experienced physical and sexual violence, the ACLU said. In May, her lawsuit to seek gender-affirming surgery resulted in her being one of the few transgender federal prisoners moved to a facility that corresponds with her gender identity.

Iglesias then became the first transgender prisoner to be evaluated for gender-affirming surgery, which the Bureau of Prisons recommended in January. However, the ACLU said in a statement that the bureau had "sought to postpone any referral to a surgeon for months."

In Monday's ruling, Judge Nancy Rosenstengel slammed the prison bureau's handling of Iglesias' case and compared its "tactics" to a game of “whack-a-mole.” Rosenstengel also ordered the bureau to provide the court with weekly updates and a detailed plan to ensure that Iglesias gets the surgery before her release in December.

The Bureau of Prisons told NBC News in a statement that it does not comment on “pending litigation or matters subject to legal proceedings,” nor on “the conditions of confinement for any individual or group of inmates.”

“For years, Cristina has fought to receive the health care the Constitution requires," Joshua Blecher-Cohen, an ACLU of Illinois staff attorney who represents Ms. Iglesias, said in a statement.

"The court’s order makes clear that she needs gender-affirming surgery now and that BOP cannot justify its failure to provide this medically necessary care," he said. "We hope this landmark decision will help secure long-overdue health care for Cristina — and for the many other transgender people in federal custody who have been denied gender-affirming care.”

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