Opposes Forced Medical Mutilation Surgery for “Transgender”Inmate

San Francisco, CA – March 31, 2026

On March 25, 2026, Dr. Simone Gold and the AFLDS legal team filed an amici curiae brief with the U. S. Ninth Circuit Court of Appeals in support of the Defendant-Appellant in Wagoner v. Winkelman (25-6813). The Plaintiff-Appellee is a biological male currently imprisoned in Wasilla, Alaska. The Defendant-Appellant, Jennifer Winkelman, is a state official responsible for overseeing correctional medical care. The appeal asks the Ninth Circuit to reverse a district court ruling that ordered the State of Alaska to provide the prisoner a vaginoplasty surgery—a complex, irreversible surgical intervention to create a pseudo-vagina.

This case arises from a challenge to Alaska’s medical judgment after the state provided extensive treatment, including mental health care, allowing social transition, providing hormone therapy, and accommodations to the prisoner, but declined to authorize the irreversible vaginoplasty surgery based on medical and safety concerns.

The lower court nevertheless ruled that failure to provide the surgery constituted “cruel and unusual punishment” because of “deliberate indifference” by Alaska under the Eighth Amendment, and issued an order compelling Winkelman to provide the procedure. This ruling raises a fundamental constitutional question: Does the Eighth Amendment require states to perform medically disputed, irreversible surgeries on inmates?

America’s Frontline Doctors maintains that the answer is no.

The Eighth Amendment prohibits cruel and unusual punishment. It does not require states to perform experimental or highly controversial medical procedures that lack clear consensus, carry significant risks, and impose lifelong medical burdens. As detailed in our amici curiae brief, this procedure involves permanent destruction of healthy tissue, requires intensive and continuous postoperative care, and presents serious complications that correctional systems may be unable to safely manage. Further, a vaginoplasty is not “care.” It is medical mutilation. 

The district court itself acknowledged that medical opinion in this area remains unsettled and that evidence regarding the effectiveness of such surgeries is limited and disputed. Yet it believed it was bound by prior Ninth Circuit precedent to order the procedure anyway.

If allowed to stand, this ruling would have sweeping consequences. It would open the door for courts to override medical judgment and force prison systems across the country to provide controversial procedures regardless of risk, feasibility, or evolving scientific evidence.

AFLDS attorney David Dalia states,  “This case lays bare a dangerous expansion of judicial authority into the practice of medicine. The Constitution does not require the State to perform irreversible, high-risk surgical procedures that remain medically disputed and demand lifelong care and compliance. It is not ‘cruel and unusual punishment’ for a state to avoid these consequences. The Eighth Amendment prohibits deliberate indifference, not differences in medical judgment. Here, Alaska provided extensive care and exercised reasoned clinical judgment. For a court to override that and compel a specific surgical intervention is not constitutional law, it is judicial overreach. If this ruling stands, it invites judges to practice medicine without a license, placing patient safety, physician independence, and institutional integrity at serious risk. It would also open the floodgates to litigation, drawing courts into individualized medical decision-making where they do not belong.”

AFLDS Founder and President Dr. Simone Gold added, “This is the destruction of healthy human organs, and it violates the most basic principles of medicine. These procedures remove functioning anatomy, eliminate fertility, and leave patients with lifelong medical dependency and risk. This is not medically necessary care, and it is not compassionate. And yet, the court is demanding that a prison system carry it out, even though there is not even a surgeon in the state to perform this procedure. That alone shows how detached this ruling is from both medical reality and basic common sense. The government does not have the authority to compel physicians or institutions to carry out procedures that mutilate healthy tissue and fundamentally alter the human body in this way.”

The Ninth Circuit now has an opportunity to reaffirm clear constitutional boundaries and ensure that courts do not mandate medical procedures that remain contested, high-risk, and beyond the practical capabilities of the institutions ordered to provide them.

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Media Contact Lisa Alexander, Executive Director | Media@AFLDS.org