Absurd: Federal Judge Rules State Must Pay for Inmate's Gender Surgery

“Many transgender individuals are comfortable living with their gender role, expression and identity without surgery,” U.S. District Judge B. Lynn Winmill wrote in the Thursday ruling. “For others, however, gender confirmation surgery … is the only effective treatment.”

“The state has six months to provide Edmo with the surgery, which will restructure her physical characteristics to match her gender identity,” the Associated Press reported.

“Idaho Department of Correction spokesman Jeff Ray said IDOC will be addressing some of the issues raised by the ruling — including whether the state will appeal, and where Edmo will be housed after her surgery — in the days to come. There are currently 30 inmates with gender dysphoria in state custody, according to the ruling.”

Edmo, it’s worth noting, has already received some taxpayer-funded treatment for gender dysphoria. That includes hormone therapy. However, they also have a disturbing history of attempting a crude sort of self-surgery.

“Edmo testified that she feels depressed, embarrassed and disgusted by her male genitalia. Her gender dysmorphia was so severe that in 2015 she tried to remove her testicles using a disposable razor blade,” the AP reported.

“She was unsuccessful at that time, though she continued to be troubled by thoughts of self-castration. In December 2016 she made another attempt, studying anatomy, boiling her razor blade in an attempt to make it sterile and managing to remove one of her testicles before she began to lose too much blood and called for help.”

In Judge Windmill’s ruling, he contended that the denying Edmo gender reassignment surgery was unconstitutional.

“For more than forty years, the Supreme Court has consistently held that consciously ignoring an prisoner’s serious medical needs amounts to cruel and unusual punishment in violation of the Eighth Amendment,” the ruling read.

“I think the thing that makes this case so important is that this is a procedure that is necessary for some transgender inmates, and in fact is lifesaving care, but it’s almost universally denied and banned by prisons across the country,” said Amy Whelan, an attorney with the group that represented Edmo, the National Center for Lesbian Rights. “There is no state that I’m aware of that has ever provided the surgery without being ordered by a court to do so.”

There are two reasons why this line of thought is pretty much bunk, however: the surgery remains elective and there’s no actual evidence that it’s effective.

The first part is pretty straightforward. Adree Edmo will survive whether or not the surgery is performed. Given their past, one would hope prison officials might take more care in not allowing razors anywhere near Edmo’s cell, but there’s no risk of death if the surgery isn’t performed. When you consider the fact that surgeries like this can cost tens of thousands of dollars and there are 30 inmates with gender dysphoria in the Idaho system alone, you quickly begin to grasp the burden this would be on taxpayers for what amounts to an elective surgery.

And then there’s the efficacy of the surgery, which has always been in debate. There are plenty of studies on this, but I’d like to reference two: one by the Center for Medicare and Medicaid Services in 2016 and one by the U.K. Guardian in 2004.

I reference these specifically because neither could be categorized by the left as bastions of retrograde conservatism. The Center for Medicare and Medicaid Services conducted the study under the Obama administration, which was almost uniformly friendly to any dubious excess of political correctness when it fit under the aegis of transgender rights. The Guardian, meanwhile, has long been the paper of record if you want to know what British progressives who aren’t thinking for themselves are thinking.

The Centers for Medicare and Medicaid Services study was issued in response to a request that gender reassignment be covered under Medicare. They declined based on a paucity of evidence for the efficacy of the procedures.

“Based on a thorough review of the clinical evidence available at this time, there is not enough evidence to determine whether gender reassignment surgery improves health outcomes for Medicare beneficiaries with gender dysphoria,” the Centers concluded, according to the Heritage Foundation.

“There were conflicting (inconsistent) study results—of the best designed studies, some reported benefits while others reported harms. The quality and strength of evidence were low due to the mostly observational study designs with no comparison groups, potential confounding, and small sample sizes. Many studies that reported positive outcomes were exploratory type studies (case-series and case-control) with no confirmatory follow-up.”

Meanwhile, the Guardian discovered what opponents of the surgery have long claimed; they found “no conclusive evidence that sex change operations improve the lives of transsexuals, with many people remaining severely distressed and even suicidal after the operation.”

“There is a huge uncertainty over whether changing someone’s sex is a good or a bad thing,” Chris Hyde, the director of the University of Birmingham’s aggressive research intelligence facility, told the Guardian. “While no doubt great care is taken to ensure that appropriate patients undergo gender reassignment, there’s still a large number of people who have the surgery but remain traumatized — often to the point of committing suicide.”

That, indeed, remains the problem. Of the studies out there, one demonstrated a higher mortality rate for those who underwent sexual reassignment therapy, including a higher rate of attempted suicides. Another found that “(t)he evidence concerning gender reassignment surgery in both (male-to-female) and (female-to-male) transsexism has several limitations in terms of: (a) lack of controlled studies, (b) evidence has not collected data prospectively, (c) high loss to follow up and (d) lack of validated assessment measures.”

In short, at best we can say that we don’t know how efficacious these procedures are. At worst, there’s evidence that they cause injury to the individual involved, both physically and mentally.

This is what a judge wants the state of Idaho — which means the taxpayers of Idaho — to fund: a surgery where the effectiveness isn’t demonstrated on a prisoner with clear mental instability issues. One should certainly have the choice, in a free society, to pursue elective surgical options for conditions even if the benefit hasn’t necessarily been demonstrated.

However, one also ought not to have a claim to pursue it using someone else’s money — particularly if the reason they’re getting that money is because they’re behind bars. This is an absurd decision which desperately needs to be appealed.