Having spent her entire adult life until recently in prison, Cristina Nichole Iglesias marvels at how the outside world has changed.
“Literally, this phone is your lifeline,” said Iglesias, clutching an iPhone with a pink cover.
“Brick” cellphones were still in use when Iglesias first saw a jail cell in the early 1990s. Now, months after her release, she’s adjusting to a personal change that’s far greater than getting used to an iPhone. That’s living life as a woman.
Last year, she became just the second person ever to have gender-affirmation surgery while in federal custody — at Rush University Medical Center. The Federal Bureau of Prisons picked up the entire tab after a three-year legal fight that began when she was housed in downstate Marion. Her attorneys argued, among other things, that she was being denied her constitutional right to necessary medical care.
“It’s just feeling like I belong,” said Iglesias, who was released from prison last October and lives on the West Side.
In an interview at the downtown offices of her ACLU of Illinois lawyers, Iglesias, 49, said she keeps up with the news and knows that she has regained her freedom at a time a national debate on transgender rights is at a fever pitch.
“It’s absolutely pathetic,” she said of efforts in several states, including Missouri and Idaho, to place restrictions on gender-affirming care.
‘I wanted to be a girl at a young age’
Iglesias grew up in Central Florida and said she felt at a young age that she needed a “sex change.” Her father couldn’t accept that.
“At the age of 12, he put a gun in my mouth and told me to take my sister’s clothes off,” she said.
Iglesias ran away from home but returned, committing crimes that included stealing everything from checks to cars, she said because of a “lack of structure” in her life.
On June 16, 1992, she began her prison life, in Florida.
While in prison in 2002, she wrote a profanity-laced letter to British government officials in London, saying the white powder inside the envelope was anthrax — something she says now was a lie, that the powder was harmless. Streets and offices in London were shut down while police, firefighters and explosives experts investigated, U.S prosecutors said in court documents from the resulting criminal case.
Iglesias’ letter included these words: “I hope to see to it [that] you people die a slow and painful death!!!”
Prosecutors said Iglesias told federal investigators she’d written the letter in hopes of being charged in the United Kingdom so she could be transferred to a prison there. Iglesias said she thought that, if she were held in the British prison system, she’d have a better chance of having the surgery she so wanted.
In 2005, she pleaded guilty to a charge of threatening to use a weapon of mass destruction outside of the United States.
She didn’t get the transfer overseas she’d hoped for.
But she says she ended up developing a sense of belonging in prison. Even though she was housed with men, she had more freedom, she said, to be feminine, something she’d always wanted. She could wear makeup and some jewelry.
“You get called a girl,” she said.
Still, living with gender dysphoria — the sense that one’s biological sex doesn’t match one’s gender identity — is “torture,” and makeup and jewelry can’t cure that, Iglesias said.
‘They treated me with respect’
In 2019, about three years after being moved to the federal prison in downstate Marion, Iglesias filed a lawsuit against the U.S. Bureau of Prisons, seeking to force the agency to allow and pay for gender-affirmation surgery. She later enlisted the help of the American Civil Liberties Union, which said in court papers, “BOP officials have knowingly disrupted her medically necessary social transition treatment and have discriminated against her because of her sex and transgender status.”
The Bureau of Prisons fought the case for three years, asserting in late 2021 that the agency had provided Iglesias with appropriate medical care but also saying the agency’s Transgender Executive Council planned to consider Iglesias’ request for surgery in April 2022.
Around the same time, U.S. District Judge Nancy J. Rosenstengel, hearing the case in Southern Illinois, accused the Bureau of Prisons of unacceptably delaying the court case and threatening to fine the agency.
The lawsuit was settled that year, with the Bureau of Prisons agreeing to pay for the surgery and Iglesias being transferred to Chicago, to the Metropolitan Correctional Center, a federal jail.
And Iglesias’ lawyers in Chicago found her a plastic surgeon at Rush, Dr. Loren Schechter, who, in 30 years as a surgeon, says he has done “thousands” of procedures, many for people who want to be something other than their sex assigned at birth. Others, he said, need reconstructive surgery because they’ve had cancer or been in an accident. All of that work is “medically necessary care,” he said, an opinion that’s widely shared by professional medical organizations and insurers.
It wasn’t until 2014, though, that Medicare began paying for gender-affirmation surgeries.
“For many years, people didn’t have access to care, and you could see the struggles and the challenges,” Schechter said. “People had to go abroad, which was always very troubling to me, that here we are, living in the richest, most advanced country in the world, and people can’t get access to medically necessary care.”
Iglesias had vaginoplasty surgery in March 2023 and facial feminization surgery last June. For each recovery, she returned to the MCC, where, she said, “They treated me with respect.”
Neither the Bureau of Prisons nor Rush administrators would say how much Iglesias’ surgeries cost.
A study reported in the Journal of Law, Medicine and Ethics in 2022, using 2019 figures, said the average cost of vaginoplasty in the United States was about $54,000, though Kellan Baker, one of the study’s authors, said costs might differ substantially for someone in prison.
Iglesias said some people might think the government shouldn’t have to pay for gender-affirmation surgery for someone in prison. To them, she’d say: “Every human in this country ... has the right to health care.”
Finding ‘sanctuary’
She was released from prison last October, then spent months at a halfway house. She now has her own apartment — her first ever — in Chicago.
“It’s my sanctuary,” she said.
Iglesias is enjoying things many people take for granted.
“I went to Brookfield Zoo, and it was amazing,” she said. “The everyday freedom to live my life and get my hair and nails done is wonderful.”
She got a bachelor’s degree in psychology from Ohio State University while in prison. She hopes to attend law school and then use that to assist people with gender dysphoria, who can develop depression that can be a “death sentence,” she said, adding that suicide had been her Plan B had she not won her legal fight for care.
A law degree would be helpful, she said, in helping people like her to get treatment.
“It doesn’t necessarily have to be an inmate. It can be someone who can’t afford [the care],” she said.
Despite her ties to Florida, she wants to stay in Chicago — a place she says is more welcoming to the LGBTQ+ community. She’s working two jobs — one at a soul food restaurant in the suburbs, the other with a job placement agency downtown.
With trans rights a hot-button issue, she said she worries about the future for herself and other trans people.
“With the Supreme Court the way that it is, there could be a rollback of rights — like the right to marry or even get health insurance or medical care,” she said.
