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The interior of the Federal Building during Doors Open Milwaukee 2023 in Milwaukee, Wisconsin (United States).
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24 States Back Alaska Appeal Against Transgender Inmate Surgery Order

Idaho and Indiana have filed a 32‑page amicus brief in the Ninth Circuit backing Alaska’s appeal of a federal ruling that found denying sex‑reassignment surgery to a transgender inmate violated the Eighth Amendment, and they say 24 states have now joined the challenge. The underlying decision by Magistrate Judge Matthew Scoble ordered Alaska to refer inmate Emalee Wagoner, serving a 40‑year sentence for sexual abuse of minors, for a sex‑change surgery consultation, finding the state acted with “deliberate indifference” to diagnosed gender dysphoria. The brief, signed by Idaho Attorney General Raúl Labrador and Indiana Attorney General Theodore Rokita, argues that the Eighth Amendment requires only “basic” medical care, that sex‑reassignment operations are “risky, optional” and not a “minimal civilized measure of life’s necessities,” and notes such surgeries are not even available to the general public in roughly half of U.S. states. The states cite a 2016 Centers for Medicare and Medicaid Services review that found studies had not demonstrated clinically significant improvements after surgery and emphasize what they call a lack of medical consensus, warning that if the lower court is upheld, prisons nationwide could be forced to provide expensive and controversial gender‑transition procedures at taxpayer expense. Civil‑rights and medical groups have mounted the opposite argument in other cases, saying surgery can be medically necessary treatment for severe gender dysphoria, underscoring how this appeal could set a major precedent for transgender inmate health care and states’ obligations under the Eighth Amendment.

Transgenderism/Transexualism Courts and Constitutional Law Prison Health Care Policy

📌 Key Facts

  • Alaska is appealing a federal ruling that found denying sex‑reassignment surgery to inmate Emalee Wagoner violated the Eighth Amendment and ordered a referral for a surgical consultation.
  • Idaho and Indiana filed a 32‑page amicus brief in the Ninth Circuit, saying 24 states support Alaska and warning the ruling could force prisons nationwide to provide gender‑transition procedures.
  • The brief argues sex‑reassignment surgery is not a “minimal civilized measure of life’s necessities,” cites a 2016 CMS review that found no clinically significant post‑surgery improvements in key studies, and stresses that such operations are unavailable to free citizens in about half the country.

📊 Relevant Data

Transgender individuals have a lifetime incarceration rate of approximately 17%, compared to the general U.S. incarceration rate of 0.4%.

Transgender Health Disparities in Prisons — Institute for Criminal Justice Studies

The average cost of vaginoplasty is approximately $25,600, and phalloplasty is approximately $24,900 in the U.S.

How To Afford Transgender Surgery Expenses — Forbes

A 2025 systematic follow-up study found a cumulative detransition rate of 1.87% among 709 adults who received gender-affirming therapy.

Low detransition rates among 709 adult gender-affirming therapy recipients: motives and risk factors. Results from a systematic follow-up study — ResearchGate

As of 2026, 21 U.S. states have formally expanded access to care for transgender and gender diverse inmates, while only New Mexico, Tennessee, and Indiana disallow all forms of gender-affirming care.

The Present State of Housing and Treatment of Transgender and Gender Diverse Inmates in U.S. Correctional Facilities — Journal of the American Academy of Psychiatry and the Law

Twin studies indicate both genetic and environmental contributions to gender diversity.

Genetic and Environmental Contributions To Gender Diversity — PubMed Central

Transgender identification among U.S. college students declined from 6.8% in 2022-2023 to 3.6% in 2025.

Transgender 'trend' sharply declining on American college campuses, new analysis finds — Fox News

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