Cristina Iglesias has been denied medically necessary care for more than two decades because she is transgender.

In December, the federal Bureau of Prisons was court ordered to provide ACLU client Cristina Iglesias with gender-affirming surgery following a lawsuit filed in September 2020. The Bureau of Prisons failed to approve surgery by the court ordered deadline of January 26.

I’m an outgoing person, which makes me want to meet new people and learn about them. I’m a caring person, too, which means I often want to find a way to make things better for others, if I can. I’m also a transgender woman. And as someone who is different, it’s easy for me to be patient with other people who are having problems and to sympathize with what they are going through.

For more than 27 years, I’ve lived in federal prisons across the country. The Bureau of Prisons has known that I am a woman since 1994, though they housed me in men’s prisons for decades. I have also had to spend years fighting to get the health care I need for my gender dysphoria.

Being denied the gender-affirming care I need has had a huge impact on me, because I’m unable to complete myself. Not having a body that matches who I know myself to be affects me every moment of every day. It is very difficult and hard to keep hope.

Last month, a federal court ordered the Bureau of Prisons — for the first time ever — to finally evaluate me for gender-affirming surgery. When I heard about the ruling from my lawyers, I went back to my cell to process just how huge this is. After being denied for so long, I cried — but it was tears of relief. This week, however, I found out that the Bureau of Prisons has decided to recommend me for surgery on paper but delay actually referring me to a surgeon until mid-April 2022.

Getting medical care is necessary to allow me to finally live my life fully as the woman I am. Living with gender dysphoria — and being denied the treatment I need — has caused me torture every day. Gender-affirming surgery would help end that torture and remove one of the biggest obstacles facing me for decades. Putting this barrier behind me would let me devote my time to living a productive life and advocating for others when I leave prison later this year.

Preparing for my lawsuit has been a long and difficult journey, but it has taught me how to advocate for myself. I am fighting not just for me, but for other people like me, too. I am fighting to make sure that transgender people in prison get the care we urgently need, just as other trans people have done before me.

Working with my legal team has also reminded me that there are people who care about transgender people and are willing to help us fight for what we need. My message to people who want to do something to help is that you can be an advocate by encouraging your friends and family members to be more accepting of transgender people. Everyone needs to understand that being trans is real and that our medical needs are real and serious.

I wish that prison officials and other people understood how hard it is to be transgender in prison because we have to fight not just for our basic rights, like medical care, but also for our safety. I have faced violence and discrimination from staff and other prisoners just for being who I am, and it has not been easy.

I want the Bureau of Prisons to do the right thing and give me the surgery I need. It shouldn’t take a court order for me and other transgender people to get adequate health care, as has happened in the past. A federal judge has already ordered the Bureau of Prisons to evaluate me for surgery, but they are still dragging their feet. I want them to stop creating barriers — and to understand that we are human, too.