A coalition of more than 20 states, led by Indiana and Idaho, filed an amicus brief urging the Ninth U.S. Circuit Court of Appeals to reverse a lower district court order requiring the State of Alaska to evaluate a gender-confused man who is demanding a state-funded sex change operation.

The case, Wagoner v. Winkelman, stems from a lawsuit by E. Malee R. Wagoner, a male prisoner in Alaska’s Department of Corrections who claims to identify as a woman.

Wagoner is serving a 40-year sentence at Goose Creek Correctional Center outside of Wasilla, where he’s been housed since 2012. In 2022, he began taking cross-sex drugs to appear more like a woman. In 2023, the Alaska Department of Corrections’ medical advisory committee rejected Wagoner’s request for cross-sex surgery, ruling there was “insufficient evidence” to affirm that his mental health would decline without it.

The Eighth Amendment does not mandate the provision of controversial, risky, and expensive sex-change surgeries in prisons.

The district court, however, ordered Alaska to assess Wagoner for vaginoplasty, a procedure in which a man’s testicles are removed and his penis is reshaped to appear as a vagina. The court claimed that failure to do so would be a violation of the Eighth Amendment, which bans “cruel and unusual punishment.”

Alaska appealed the decision, arguing that the order exceeds constitutional limits.

In the recent March 25 brief, the state coalition argues in support of Alaska, noting that the Eighth Amendment does not mandate the provision of controversial, risky, and expensive sex-change surgeries in prisons. While the Amendment prohibits deliberate indifference to serious medical needs, it does not require states to resolve ongoing medical debates by funding irreversible sex-change procedures that entail uncertain benefits and serious documented risks.

The brief highlights “fierce scientific and policy debates” over the safety and effectiveness, and of such interventions, citing U.S. Supreme Court precedent in United States v. Skrmetti (2025) and studies showing low-quality evidence, myriad complications, regret, and persistent mental health issues post-surgery. They note that these proceedures aren’t even available in Alaska or nearly half of all the states, and that non-surgical options like psychotherapy exist.

Additionally, the brief warns of practical and federalist concerns. Providing the surgery would likely require transferring the prisoner out of state, implicating the Prison Litigation Reform Act’s limits on court-ordered transfers and raising issues of state sovereignty over prison administration. The brief warns against federal judges overriding politically accountable states in sensitive areas of health policy and corrections.

“The Eighth Amendment does not require States to provide risky, expensive, and much-debated sex-change surgeries,” the amici wrote, emphasizing that gender dysphoria treatments remain subject to legitimate disagreement among experts.

The coalition backing Alaska includes Alabama, Arkansas, Florida, Georgia, Iowa, Kansas, Louisiana, Mississippi, Missouri, Montana, Nebraska, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia, Wyoming, and the Arizona Legislature. Their brief comes amid broader national debates over gender-related medical interventions, particularly for inmates. A ruling in favor of reversal could limit similar claims nationwide, reinforcing that prisons need not provide every requested treatment amid scientific uncertainty.

Nationwide, the Trump administration has directed the Federal Bureau of Prisons to ban prisons from providing cross-sex drugs to inmates.

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