BOSTON (AP) — Wearing lipstick, a scooped-neck sweater and nearly waist-length hair, the witness cried while describing what it feels like to be a woman trapped inside a man's body.
"The greatest loss is the dying I do inside a little bit every day," said Michelle Kosilek, an inmate who is serving a life sentence for murder.
Michelle Kosilek was Robert Kosilek when he was convicted in the killing of his wife. In 1993, while in prison, he legally changed his name to Michelle. Since then, Kosilek has been fighting with prison officials to complete his transformation into a woman.
Kosilek, 57, wants the state Department of Correction to pay for a sex-change operation. After two lawsuits and two trials, the decision now rests with a federal court judge.
Kosilek's case has become fodder for radio talk shows, where the topic of whether the state should pay for a sex-change operation for a convicted murderer often attracts outraged callers.
The case is also being closely watched by attorneys and advocates across the country who say Kosilek is an example of the poor treatment transgendered inmates receive in prison.
Courts in several other states have ordered prison systems to allow transgendered inmates to receive psychotherapy and, in some cases, hormone shots. But no inmate in the country has ever succeeded in getting a court to order a sex-change operation, according to advocates.
"People often have a knee-jerk reaction that public money shouldn't be spent on this," said Shannon Minter, a board member of the Transgender Law and Policy Institute.
"If people are not treated, they suffer tremendously," said Minter. "It's just as cruel to withhold treatment for gender identity disorder as it is to withhold treatment for any other medical issue."
Some states allow inmates to continue hormone treatments if they are already on hormones when they begin their sentences. But most do not allow inmates to initiate hormone therapy while in prison, and many states do not have any written policy for the treatment of transgendered inmates, said Cole Thaler, a transgender-rights attorney for Lambda Legal, a national advocacy group for homosexual, bisexual and transgendered people.
"The majority of states don't seem to have formal or informal policies or practices," said Thaler.
Inmates in several other states have sued prison officials for sex-change operations. Like Kosilek, they argued that gender identity disorder is a serious illness that can lead to severe anxiety, depression, suicide attempts and self-castration. They argue that treatment for their condition is a "medical necessity" and denying it would violate the Eighth Amendment's prohibition against cruel and unusual punishment.
Those arguments have fueled the anger of some taxpayer groups and politicians.
"It's the most absurd thing I've ever heard of," said state Rep. Mark Gundrum of Wisconsin, who helped author a state law that bars the Department of Correction from using tax dollars for hormone therapy or sex-reassignment surgery.
"I think the founders of our country — when they wrote that clause — they were envisioning preventing people from being burned in oil or burned at the stake, not simply refusing to use taxpayer dollars to allow inmates to get a sex change or breast implants or whatever else," Gundrum said.
The "Inmate Sex Change Prevention Act" was introduced after Wisconsin inmate Scott Konitzer filed a lawsuit seeking a sex-change operation. The law took effect in January, but is being challenged by the American Civil Liberties Union and Lambda Legal.
In Colorado, inmate Christopher "Kitty" Grey, who is serving 16 years to life for molesting an 8-year-old girl, is suing the state to provide him with a gender specialist he hopes will determine that he needs a sex-change operation. The state Department of Corrections is already giving Grey female hormones.
"For all intents and purposes, I am a woman in a man's prison," Grey told the Denver Post in an interview earlier this year. "That's like putting a cat in a dog kennel," Grey said.
Colorado officials say that providing a sex-change operation for Grey or any of the other two dozen transgendered inmates in the state's prisons would create security concerns.
Dr. James Michaud, chief of mental health for the Colorado DOC, said he does not believe sex-change operations are "medically necessary."
"There are certainly people who are transgendered who want surgery and who want to appear different, but I don't think that makes it medically necessary," said Michaud.
In addition to the cost — estimates for sex-change operations are in the $10,000 to $20,000 range — prison officials cite the safety risks of housing a male inmate who has been transformed into a female.
During Kosilek's trial, Massachusetts Correction Commissioner Kathleen Dennehy said that if Kosilek has the surgery, prison officials believe Kosilek could end up being a target of sexual assault in prison.
"The safety and security concerns are enormous," Dennehy testified.
In Massachusetts, four of the 12 inmates diagnosed with gender identity disorder are receiving hormone shots.
Kosilek has been receiving hormone therapy since a federal judge ruled in 2002 that he was entitled to some treatment for gender identity disorder. Although Judge Mark Wolf did not order a specific treatment plan, he ruled that Kosilek had proven he has a serious medical condition that had not been adequately treated.
After Wolf's ruling, the corrections department allowed Kosilek to receive female hormones and laser hair removal. He was also given access to female undergarments and some makeup.
During testimony this spring in his second lawsuit, Kosilek said the female hormones and other treatments have not been enough to relieve his suffering and said he would likely commit suicide if he does not get the surgery.
Such talk infuriates state Sen. Scott Brown, who filed legislation seeking to ban sex-change operations for inmates in 1998. The legislation died in committee.
Brown points out that most private health insurers do not cover sex-change operations, and says taxpayers should not have to pay for such "elective" surgery for inmates.
"I just think it would be deemed a luxury for him to have that operation. He is in there because he murdered his wife," Brown said. "There are no luxuries that are supposed to be available."
But advocates for transgendered inmates say that in some cases, sex reassignment surgery is a medical necessity, not a luxury.
Dr. George Brown, a psychiatry professor at East Tennessee State University who has treated hundreds of transgendered people, testified during Kosilek's trial that he believes Kosilek will commit suicide if he does not get a sex-change operation. Kosilek said he has twice tried to kill himself and once tried to castrate himself.
"For severe gender-identity disorder, after that person has already been through other less invasive treatments like psychotherapy, hormones, electrolysis, group support — there's nowhere else to go," Brown said in a recent interview. "At a certain point, there are no other treatments that actually work."
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