A single word changed Michelle Norsworthy’s life forever. Until she heard it, she had no way to express herself and her emotions always came out wrong. She would explode in anger, or in desperation cut herself until the blood flowed.  Related: 'I am Alena': life as a trans woman where survival means living as Christopher  Then in 1994, at the age of 30, she met a psychiatrist who gave her the gift of that one word: transsexual. “I’d never heard it before,” Norsworthy said. “I looked it up in a dictionary back in my cell and it clicked – a person who strongly identifies with the opposite sex.”  Norsworthy, who is serving a life sentence for second-degree murder, said the word was like a “magical incantation”, a “liberation”. “It gave me a language. Every opportunity I had to say the word I would, it made me feel so much better.”  That one word has set Norsworthy on a journey that began as a trickle of self-discovery and has grown over two decades into a raging torrent for change. She has become one of the most formidable voices within the transgender community, a trans woman fighting for rights within the most daunting of settings: behind bars in a male California penitentiary.  On 13 August, her struggle will reach the dizzying heights of the US court of appeals for the ninth circuit. A panel of three judges will adjudicate in her attempt, 19 years and counting, to force the prison service to allow her to complete her transition into womanhood through sex-change surgery.  Norsworthy and her lawyers argue that she should be given a sex reassignment operation, or vaginoplasty, for what is now recognized by all leading US professional bodies and international agencies as a serious medical condition. They accuse the prison authorities of violating their constitutional duty under the eighth amendment to provide healthcare wherever, and for whomsoever, it is deemed medically necessary.  “Every day that an individual is denied medical treatment they are being harmed, and the constitution of the United States is being violated,” said Norsworthy’s attorney, Ilona Turner of the Transgender Law Center in Oakland.  The case of Michelle-Lael Norsworthy versus the California department of corrections and rehabilitations (CDCR) is being watched closely across the country given its potential to set a new standard on access by transgender prisoners to transition care while in custody. The significance of the lawsuit is amplified by the size of the transgender population in US prisons.  Through a combination of poverty, discrimination, police harassment, and the destructive behavior triggered by the emotional trauma of dysphoria – the condition where a person’s gender identity and physical sex are out of sync – trans people are incarcerated at exceptionally high rates.  According to the National Center for Transgender Equality, nearly one in six transgender people experience life behind bars. The ratio rises to one in five trans women and a staggering half of all trans women who are black.  Norsworthy was sentenced to 17 years to life in 1987 after she shot and killed an acquaintance outside a bar. She takes full responsibility for the murder – “the crime I committed I’m responsible for. I’m not trying to mitigate that in any way” – but years in therapy have helped her to see the role played by her gender dysphoria.  Paradoxically, her response to the female yearnings she felt but could not understand in the absence of that word “transsexual” was to bury the emotions under mounds of hyper-macho posturing that culminated in the shooting.  After high school, as Jeffrey Norsworthy, she became a police informer, joined the army national guard, ran around town inebriated, and carried a loaded gun. “I was an extremely aggressive, non-thinking person. I did anything I could to suppress my femininity.”  In the course of a four-hour interview in Mule Creek state prison in Ione, California, Norsworthy talked about the pent-up desire for transition that has fuelled her long legal battle. For someone who has been locked up for the past 28 years, she uses a potent metaphor to portray her predicament.  “It’s an imprisonment within an imprisonment,” she said, referring to the perception of herself as a woman trapped in a male body trapped in a prison cell. “It’s like living inside of a box, and inside that box you are so confined you cannot move a limb, you cannot talk. It’s like suffocating.”  It’s like living inside of a box, and inside that box you are so confined you cannot move a limb.  We’re sitting in Mule Creek’s visitation room surrounded by burly, heavily tattooed male prisoners. Norsworthy, who has lived as a woman for the best part of 20 years, is dressed in a male convict’s uniform: men’s prison boots, blue pants and a blue denim jacket stamped CDCR Prisoner in large yellow letters. “Let me ask you – what about my clothing here looks feminine,” she said. “I can’t see it.”  She has long brown hair which she sweeps back into a simple ponytail. Beneath her glasses you can see she’s wearing eyeliner, which she said she’d improvised by crushing colored pencils, since cosmetics are banned.  Since the revelation of the word transsexual in 1994, Norsworthy has engaged in a prolonged tug-of-war with the corrections department over key aspects of daily life. Starting with her name. She is still officially known on record and on the nameplate tagged to her cell door as Jeffrey Norsworthy, the name given to her at birth, despite having asked repeatedly to have her name changed officially to Michelle.  The answer given by the CDCR is that a name change is impossible as she’s housed in a male prison, which puzzles her as the authorities have equally rebuffed her request to be moved to a women’s prison. So now she does just what she can. Whenever guards call her Jeffrey, she quotes prison regulations at them and demands that they address her either by her last name only or by her ID number: D54100.  In its legal defense to the Norsworthy case, the state of California has argued that it treats her very permissively, allowing her to grow her hair, shower out of sight of other inmates and wear a bra.  But Norsworthy indignantly disputes those claims. She is allowed to grow her hair long, she points out, purely because male prisoners won that concession in the 1990s – it has nothing to do with her transgender status. She has constantly had to lobby officials to be allowed to wear bras – “everything’s a fight with these people” – and as for showers: “I don’t shower. I wash in the sink in my cell because there are card tables placed right in front of the showers and we are not allowed to cover the door. So where’s the privacy in that?”  In court filings, the state has also stressed that it houses Norsworthy together with other trans women prisoners in protective custody in the so-called “sensitive needs yard”. That is supposed to be for their safety. But as a result they are placed with other vulnerable prisoners who need separation from the general population – and that, in practice, she said, means some of the most extreme male sex offenders in California.  One of her current fellow inmates in the yard is Andrew Luster, an heir to the Max Factor empire, who is serving 50 years for the drugging and raping of three women. Patrick Kearney, the prolific “Freeway Killer” from the 1970s, lives three cells down. “They’re putting food in a cage with hungry tigers,” Norsworthy said.  In 2009, the hungry tigers pounced. She later learned that she had been put in a cell, without warning, with a serial rapist.  “I was partying with my cellmate and his friends and one thing led to another and they kicked my teeth out and sexually assaulted me for six hours. The staff looked on and let it happen.”  Neither Luster nor Kearney was involved in the group assault. Terry Thornton, a spokeswoman for the CDCR, said she couldn’t comment on the assault as it was part of ongoing litigation. But she added that “the safety and security of all inmates is a priority”.  Since the “life-changing” gang rape, as Norsworthy described it, she has redoubled her efforts to cajole the authorities into allowing her to complete her transition as a woman and to move to a women’s prison. The CDCR has consistently blocked both demands.  That’s a pattern that is replicated across the nation. Transgender prisoners are routinely denied access to treatment despite it being defined, according to individual circumstances, as a medical necessity by all major US professional bodies. Most states have blanket policies that prohibit transgender inmates from receiving sex-change surgery and even in those states that have introduced progressive policies, advocates say it is still extremely difficult to work the system.  Then there are the many states that adopt the so-called “freeze-frame” approach, where prisoners are given hormones at the same levels prescribed to them by doctors on the outside. That sets up a classic catch-22 for the many trans prisoners who used to get their hormones on the black market: with no official record of medically supervised hormone use, they find that as soon as they enter prison their supply of medication is cut off.  Janetta Johnson, a director of TGI justice, an advocacy group for transgender prisoners, was herself a victim of freeze-frame rules when she was incarcerated in California for three years until 2012. Suddenly deprived of black-market hormones that she had been taking steadily for the previous 15 years, she was horrified to find her body rapidly reverting to masculine type.  “My facial hair grew back into this fistful of beard; I had thick hair on my arms which I’d never had before. When I looked in the mirror, I didn’t recognize who I saw. It was like having somebody screaming at you, yelling at you that you are not a woman. It was just awful.”  Johnson felt so depressed that she turned to an alternative method of self-feminization: tattooing. When the guards weren’t looking, she used a razor and a marker pen to tattoo a line permanently on her lips. DIY tattooing is commonly used by trans women inmates to combat the despair of being denied their identity – of what Norsworthy articulated as being confined to a prison within a prison.  It took Norsworthy herself six years of persistent agitation to persuade the corrections department to begin giving her hormones. She was diagnosed in 1999 with gender identity disorder and a year later was prescribed the medicines. Regular treatments of estrogen and a female contraceptive have helped her cope with the symptoms of dysphoria but have left the underlying condition festering.  She likens it to a painful knee. “If I hurt my knee, you would give me painkillers to make me more comfortable. But when the pills wear off I’m going to be in agony again. If you then find out that surgery is available that would cure the problem, aren’t you obliged to try it?”  Fifteen years of hormone treatment may not have cured her dysphoria, but it has for all intents and purposes emasculated her. “It’s a done deal for me; they’ve effectively castrated me,” she said. “My hormone levels will never return to those of a male, even if I stopped taking the medicines today. It’s like they’ve created this Frankenstein monster and now want to walk away from me without finishing the job. But I won’t let them. I won’t let them walk away.”  Norsworthy has been consistently asking for sex reassignment surgery since 1996. But it was not until 2012 that a prison psychologist, William Reese, approved the procedure on medical grounds. He concluded: “It is clear that clinical necessity suggest and mandate a sex change medical operation before normal mental health can be achieved for this female patient.”  The state reacted to Reese’s unambiguous medical opinion by transferring him to another institution, terminating all his contact with Norsworthy.  I have every intention when I’m out of keeping the CDCR on notice.  CDCR’s persistent denial of Norsworthy’s demands has provoked the disapproval of the courts. In April, a federal judge issued a strongly worded ruling that castigated the state for violating its constitutional duty to provide medical care for an inmate who was “suffering serious psychological and emotional harm”.  The judge, Jon Tigar, ordered the state to arrange for an immediate operation for Norsworthy. True to form, California immediately appealed against the ruling, paving the way for next month’s ninth circuit hearing.  With the appeal court date approaching, Norsworthy’s hopes are rising that she might finally be allowed to finish her long march toward womanhood. She knows that many people will question why a convicted murderer should be rewarded with a sex change at taxpayers’ expense.  But that’s precisely the point, she said. “Medical treatment is not a reward. It’s an obligation that the state takes on when it decides to confine people for a long time.”  On 21 May, she was given a further reason to hope when she was officially deemed suitable for release on parole. The adjudication was recognition of Norsworthy’s model behavior – she hasn’t been written up for a disciplinary infraction for years, and should be out by November.  The likelihood of imminent release has got her thinking about her ambitions for the future. They’re straightforward, she said. “What I want most of all is to be a woman living in the suburbs. I hope for an ordinary life, a quiet life, where nobody knows I was born a man.”  She’s aware that pending parole might mean that the California prison service is let off the hook over the issue of her transition. But she hopes that the appeals court will rule in time to set a precedent.  Besides, it is clear even in the short time we spend together that Michelle Norsworthy is not the kind of woman who quits. Nor is she one to forget her fellow trans inmates – “my girls”, as she calls them – once she steps through the prison gates.  “I have every intention when I’m out of keeping the CDCR on notice,” she said as our conversation drew to a close. “Those girls will never be alone, because I’m not done. I’m not done at all. This is just the beginning.”  • Read part one here: ‘I am Alena’: life as a trans woman where survival means living as Christopher
Michelle Norsworthy spent six years seeking hormone treatment and survived a gang rape, but her requests for recognition have been rebuffed