BOISE, Idaho — Attorneys for Idaho prison officials argued Thursday that a transgender inmate who is suing for access to gender confirmation surgery is too mentally unstable to receive the irreversible medical procedure.

Lawyer Brady Hall told a three-judge panel of the 9th U.S. Circuit Court of Appeals that Idaho has no policy barring gender confirmation surgery for transgender inmates and that the Department of Correction specifically allows the treatment if it's deemed medically appropriate.

"It's the same policy that, for the last seven years, Ms. (Adree) Edmo has been closely followed and monitored by staff to meet her needs," Hall said.

This Dec. 10, 2014, photo provided by the Idaho Department of Correction shows Adree Edmo. Idaho Department of Correction via AP file

The question of whether to provide treatment to inmates with gender dysphoria — and how much treatment to provide — is not an unusual one in prison systems across the country.

Edmo has been housed in a men's prison since she first began serving time on a charge of sexually abusing a child younger than 16 in 2012.

She sued in 2017, contending that the state's refusal to provide her with gender confirmation surgery amounts to cruel and unusual punishment and causes her severe distress because she has gender dysphoria. The condition occurs when the incongruity between a person's assigned gender and their gender identity is so severe that it impairs their ability to function.

A federal judge ordered prison officials to provide the surgery earlier this year, and Idaho appealed.

Hall said Edmo's medical professionals "universally agreed that she did not qualify for the surgery given her uncontrolled mental health issues" but that Edmo refused to participate in therapy that would have helped get her ready for the procedure.

Edmo's attorney, Lori Rifkin, said Idaho officials are treating Edmo's condition differently than they would any other medical concern. Prison officials wouldn't be allowed to refuse life-saving treatment to an inmate with a tumor, and they shouldn't be allowed to deny Edmo her needed treatment either, Rifkin said.

"They can say they were well meaning, but we have a person whose medical condition is being treated differently," Rifkin said. "A safe, established, effective treatment and they continue to deny it."

Rifkin said Edmo was receiving hormone therapy and counseling, but her suffering was so great that she twice tried to mutilate herself in her prison cell. She said that since those attempts, the state has offered Edmo no additional treatment.

"She shouldn't have to attempt self-castration again or attempt suicide to get the care" she needs, Rifkin said. "Every day is a struggle to survive."

The three-judge panel will issue a written ruling later.

Another transgender Idaho inmate, Jenniffer Spencer, sued the state more than 10 years ago after prison officials refused to diagnose or treat her. Spencer requested treatment 75 times and finally attempted suicide. She then performed her own castration and nearly bled to death. Only then did the department provide her with hormone therapy but would only give her male hormones, not the female hormones she sought.

In 2007, a federal judge ordered the state to provide Spencer with female hormone therapy.

Prison officials in California wrestled with the issue when inmate Michelle Lael Norsworthy sued for sex-reassignment surgery. But just one day before a federal appeals court was set to hear her case in 2015, the state paroled her, effectively ending the lawsuit.

In a separate case, transgender inmate Shiloh Heavenly Quine sued California for the same surgery. Quine, who is serving a life sentence for murder, became the first U.S. inmate to receive state-funded sex-reassignment surgery when California officials agreed to provide the treatment as part of a settlement to end her lawsuit.

In March, the 5th U.S. Circuit Court of Appeals ruled against Texas inmate Vanessa Lynn Gibson in her lawsuit seeking gender confirmation surgery. Circuit Judge James Ho said that while it is cruel and unusual punishment to deny essential medical care to an inmate, "that does not mean prisons must provide whatever care an inmate wants."