The warden wouldn’t allow Michelle Kosilek to buy cosmetics, so she made them in her cell. For liquid foundation, she blended pulverized chalk—pink, yellow, and white—with Eucerin lotion. For lipstick, she melted Chapstick in the metal top of a gallon jug, then added red ink, and, as an emulsifier, Vaseline. For nail polish, she combined liquid floor wax with ink from a Sharpie and painted on the mixture with the built-in brush applicator from a Wite-Out bottle. Her eyeliner was a black grease pencil.

After a decade of this, the prison finally let Kosilek purchase her cosmetics from the women’s canteen. Kosilek feels she’s not herself without them. But during the afternoon, should she happen to lean her cheek against her hand, she’ll sometimes feel a disgusting sensation. Horrified, she’ll stop whatever she’s doing and hurry back to her cell, where she’ll stand at her sink and scrape a razor across her cheek again and again until she can find no trace of stubble.

To suffer from gender dysphoria (G.D.), as Michelle Kosilek does, is to exist in a real state for which our only frame of reference may be science fiction. You inhabit a body that other people may regard as perfectly normal, even attractive. But it is not yours. That fact has always been utterly and unmistakably clear to you, just as the fact that she has put on someone else’s coat by accident is clear to a third-grader. This body has hair where it shouldn’t, or doesn’t where it should. Its hands and feet are not the right sizes, its hips and buttocks and neck are not the right shapes. Its odors are nauseating. To describe the anguish a G.D. patient suffers, psychiatrists will allude to Gregor Samsa in Kafka’s The Metamorphosis: For Michelle Kosilek, the gulf between human being and insect is precisely as wide as that between woman and man.

Kosilek is now 64 years old, and she has spent the last 20 years of her life at MCI Norfolk, a medium-security men’s correctional institution in southern Massachusetts. She has attempted suicide twice. She has also tried to castrate herself by tying off her testicles, a grisly method farmers use on hogs.

In 2002, a judge ordered the prison to provide Kosilek with a psychiatric evaluation to determine how to treat her gender dysphoria. By 2006, no fewer than five specialists had recommended that she undergo sexual-reassignment surgery (SRS).