The value of transgender life
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California is now the first state in the nation to pay for a transgender inmate's sexual reassignment surgery. The inmate, Shiloh (formerly Rodney) Quine is serving a life sentence without parole for a 1980 murder.

Quine was diagnosed with severe gender dysphoria, a condition once treated with hormones and other therapies. Shiloh and her physicians have determined that surgery, estimated to cost as much as $25,000, is best for her, so that her body will match her psychological gender.


California Gov. Jerry Brown (D) and prison officials tried to deny Quine's case and prevent the state from paying for it. Officials expect many other inmates to request similar surgery. Surely Brown will not agree to consider each request on a case-by-case basis. He needs a policy and, as of now, he has none.

In the end, Brown decided the state should pay for Quine's reassignment in order to lessen her adverse health effects, including depression, anxiety and suicide attempts.

Browns decision is a settlement on Quine's federal suit seeking surgery, rather than a policy to provide reassignment surgery to all transgender inmates in the California prison system — currently estimated at over 500. This political sidestep by Brown leaves until another day, and another transgender inmate to test, whether there is a constitutional right to reassignment surgery.

Since gender dysphoria is a real medical condition, like lung cancer and kidney disease, and since prison systems are responsible for the health of their inmates, it seems clear, on the surface, that transgender inmates deserve the right to the same medical treatment provided other inmates with serous health conditions. Thus, it is puzzling why the progressive Democrat Brown danced around this issue.

"Every medical doctor and mental health clinician who has reviewed this case, including two independent mental health experts, determined this surgery is medically necessary for Quine," a prison spokesperson said.

This is a major health victory for transgender inmates in that it is a positive step toward improving their health so that upon release from prison, Quine and the thousands of others like her can live happy and productive lives.

In another case of a transgender inmate asking for reassignment surgery, Brown paroled the woman. Some California health plans managed by cities, like San Francisco, offer coverage for sexual reassignment surgery.

Amazingly, while California is on the frontlines in the fight for transgender rights, state prison officials argued that Quine's sexual reassignment was not medically necessary. A convincing response came from a psychologist who specializes on these cases.

"Sex reassignment surgery is medically necessary to prevent Ms. Quine from suffering significant illness or disability, and to alleviate severe pain caused by her gender dysphoria," wrote Richard Carroll, director of the Sexual Disorders Program at Chicago's Northwestern University. Surgery, he said, would reduce her "depression, anxiety and risk of suicide attempts."

This is, based on my interviews and reach, valid medical reasoning. State prison systems that ignore the expert testimony of medical professionals on sexual disorders and increase the pain, suffering and disability of transgender inmates could be held legally accountable for worsening the health of these inmates. Damages, if awarded, could far exceed the minor cost of sexual reassignment surgery.

While the public may not understand the medical and psychological reasoning behind Brown's decision to use state funds to pay for sexual reassignment surgery, perhaps this case, future cases and a supportive healthcare and education infrastructure will change social views on the medical necessity of this surgery.

Medical needs for the transgendered are a hugely important social, political and economic issue for California and other states. Opposition to meeting the medical needs of these individuals is based on outdated views of the transgendered as sick, criminal and people without value to society.

Such views cannot disappear from public health thinking quickly enough. Medicare covers healthcare needs of the transgendered and "gender-confirming" procedures. This is another important step in the evolution of transgender health as lives are at stake; valuable lives who have suffered long enough.

It is time sexual reassignment, for too long a laughing matter, to be seen as a serious healthcare matter that can improve lives of many from transgender Olympic gold medalists to your transgender office colleague to transgender U.S. military troops. It is a procedure that puts one's body into conformity with one's mind. It is a healing process that should not be denied one who is suffering.

Patterson is a San Francisco-based writer and speaker who blogs at