In 1983 defendant was convicted of rape of a child, robbery, and kidnapping. After release from prison, he was involuntarily committed in 2003 in a civil proceeding, Mass. Gen. Laws ch. 123A, 14, to the Massachusetts Treatment Center for Sexually Dangerous Persons, where such persons are held without limit until adjudged safe for release. Defendant is anatomically male but suffers from gender identity disorder(GID), a psychological condition involving strong identification with the other gender. The Center has resisted demands for female hormones and clothing and defendant recently sought to castrate herself with a razor blade. The district court ordered the Center to begin hormone therapy, The Center concedes that defendant needs treatment and that hormone therapy has been recommended as medically necessary, but says that security concerns reasonably underpin its refusal. The First Circuit affirmed, noting that those under civil commitment are entitled to an extra margin of protection and that punishment of the defendant's behavior and the defendant's risky behavior are not determinative. Regardless of motives, the Center failed to exercise reasonable professional judgment; the court noted its history of delays, poor explanations, missteps, changes in position, and rigidities.