"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.
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 for the state Department of Correction to pay for sex change surgery, which can cost from $10,000 to $20,000. After two lawsuits and two trials, the decision now rests with a federal judge.
Kosilek's case has become fodder for radio talk shows, often provoking outrage among callers on topic of whether the state should pay for a convicted murderer's sex-change operation.
The case is also being closely watched by attorneys and advocates across the country who say Kosilek is an example of the poor treatment transgender inmates receive in prison.
Courts in several other states have ordered prison systems to allow transgender 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.
"If people are not treated, they suffer tremendously," said Shannon Minter, a board member of the Transgender Law and Policy Institute. "It's just as cruel to withhold treatment for gender-identity disorder as it is to withhold treatment for any other medical issue."
In Massachusetts, four of the 12 inmates diagnosed with gender-identity disorder are receiving hormone shots, including Kosilek. Prison officials also allowed Kosilek to receive laser hair removal, female undergarments and some makeup.