When the testosterone started to flow through her system, Jessica Sunderland felt the changes immediately.
“I had to do stuff to deal with the anger,” she said. “Working out and meditating, and trying to breathe. I did anything to try to not focus on the anger.”
She was an Army veteran who had served in Iraq, but at that moment, in fall 2012, she was in the Suffolk County Correctional Facility in New York on charges of burglary, kept in a cell 21 hours per day, in a body at war with her conception of who she was.
She wanted medication to make it stop, and she wasn’t getting it.
On a recent afternoon in her lawyer’s office, Sunderland presented a new phase of her life, including life as a blonde, with long braided hair extensions that she flicked away from her face. She had two prescription medications to lower her testosterone and another to provide estrogen.
And she had a court ruling against two doctors at the Suffolk County jail for denying her hormone therapy, causing her to start what her lawyer described as an involuntary sex change. The jury found that the doctors had violated her constitutional right to necessary medical care and awarded her $355,000 in damages, plus a slightly larger sum that went to her lawyers.
Advocates for transgender rights say it is the first time a jury has awarded punitive damages in such a case.
For Sunderland, 32, who filed the original complaint under her given name, Jeremy, it was vindication for a long, often solitary battle.
“I started the lawsuit back in 2013, and in the beginning it was just me by myself,” she said. “Just hearing the verdict, it means that I got what I had to say across. It shows that they can’t do what they’ve been doing without some kind of punishment.”
Transgender people are several times more likely than the general population to spend time in jail or prison and, once there, to face harassment, assault, and denial of prescribed medical care. Discrimination at home, school, the job market, and the court system all funnel people toward jail or prison.
“Transgender folks are criminalized in our society,” said Mateo De La Torre, a racial and economic justice policy advocate at the National Center for Transgender Equality. “They get kicked out of their home, they engage in the underground economy for survival. And law enforcement profiles transgender women of color as sex workers.”
Like Sunderland, transgender women are routinely held in male facilities, subjected to strip searches or pat-downs by male guards, and are often held in near solitary confinement, ostensibly for their protection, but it can feel like punishment. In 2018, the federal Bureau of Prisons reversed an Obama-era guideline that considered inmates’ gender identity when assigning them to male or female housing. The new guideline calls for housing inmates by “biological sex” except “in rare cases.”
Sunderland’s award of damages may be a break in that pattern, advocates say.
The decision came one month after a transgender woman in Massachusetts was transferred to a women’s prison after suing under the Americans With Disabilities Act — a potentially landmark case because it applies disability protections to people whose sex at birth clashes with their sense of self.
Representatives for the doctors did not respond to requests for interviews. Chief Michael Sharkey of the county sheriff’s office, which runs the jail, said policies had not changed since Sunderland’s time there but guards had “more awareness of transgender people in general.”
The jury cleared the jail on charges that its policies denied prisoners necessary care.
Sunderland felt as early as age 4 that she was born into the wrong gender (she prefers feminine pronouns even in references to her childhood). She wore her sister’s dresses in private and worried about what other children thought of her. She liked her female self — “It was a good feeling,” she said — but felt a lot of anxiety and depression at home.
Our experience of gender is sometimes described as an interaction among anatomy, identity, and expression. When our biological sex lines up with how we see ourselves and how we express ourselves to others, then gender feels like a seamless whole.
When the three panes do not line up, the condition is called gender dysphoria or incongruence. Advocates liken it to pregnancy: requiring medical care, but not a disease or a disorder.
For Sunderland, the parts clashed, and she was living in the spaces where they did not line up.
“It actually got worse as time went on,” she said. “It was becoming more of a burden keeping it inside.”
At an Army training camp in Texas, she quit smoking and got in the best shape of her life. She became engaged to a woman and adjusted to the discipline of basic training.
When she shipped out to a base in southern Iraq, near Basra, she worked with a close group of soldiers in food services. “I was out of where I was living,” she said. “There were people I could talk to.”
She felt more than ever the need to transition, and she saw a way to get there.
The internet was full of vendors selling hormones and how-to stories from people in transition. It did not seem that complicated, she said.
Still, she knew she was on shaky ground. “I’m ordering prescription drugs over the internet on a military base in Iraq,” she said. “I was wondering how that was going to play out.”
She told her fiancee that she planned to transition to living as a woman. When the engagement collapsed, she said, she was “a little heartbroken.”
But the hormones were changing her both physically and emotionally. Despite the breakup, her mood lifted, and some of the daily stress she carried around seemed to fall away. Even as the physical changes became noticeable, no one in her unit said anything.
For Sunderland, the complications began after she returned home from Iraq in 2009. She found doctors to prescribe the hormones she had bought off the internet, including those at the Veterans Affairs hospital in Manhattan.
But she developed a growth on her liver that moved her doctors to discontinue the estrogen, maintaining only the testosterone blockers.
Finally she had the liver growth surgically removed, and her doctors cleared her to resume the estrogen. But the surgery put her out of work, and she started to buy street drugs to manage the pain from the operation, then for recreation. Soon she and an acquaintance were robbing houses to get money for drugs, including heroin and crack cocaine. In September 2012, when she took stolen goods to a pawnshop, she and her accomplice were arrested.
For 16 months, until she was finally transferred to a prison upstate, she received neither the estrogen nor the testosterone blockers.
At trial, the doctors testified that they cut off treatment out of concern that the liver growth might return. They also testified that they were unfamiliar with treating transgender people and that they did not attempt to learn more about it.
The jury found that the doctors had violated her rights under the 14th Amendment to equal protection of the law. Advocates for transgender rights hope the verdict makes facilities think twice before denying care.
But for Sunderland, it has not changed her life. Though the verdict came in October, Sunderland has not received any money yet, and she has been unable to find work, even after earning a certificate in medical billing and coding at a nearby technical school.
For now she remains on Long Island with her sister and parents, stuck in the town she tried to escape a decade ago, waiting to get on with her life.