CW: This article contains mentions of self-harm and mutilation

A trans woman incarcerated in a New Jersey men’s prison severely mutilated herself after waiting years for gender-affirming surgery that would create a pathway for her to move to the state’s only women’s prison. She is one of several trans women in recent years to resort to self-harm amid delays in necessary medical care.

Gia Valentina told Prism that she removed her testicles with a razor in early October after waiting years for vaginoplasty surgery. She said she first requested the surgery in September 2021 but has been facing delays that left her in severe mental anguish while trapped in isolating protective custody—conditions she was forced to seek amid fears she would be assaulted by others in the prison.

“Emotionally, they have broken my spirit to feel because of no treatment at all and they keep me locked in a cell 23 and a half hours a day,” Valentina said in an email. “My fear of being raped or sexually assaulted overrides any type of emotion I could possible have. Each day all I can do is survive the day locked in my room.”

The New Jersey Department of Corrections (NJDOC) contracts with University Correctional Health Care (UCHC) at Rutgers University to provide medical, dental, and mental health care for those in NJDOC custody. Valentina and other trans women have repeatedly criticized UCHC and NJDOC for what they say is substandard treatment, unreasonable delays, and opaque decision-making.

NJDOC and UCHC officials did not respond to requests for comment. 

“I can honestly express with truth and sincerity that I have never in my life encountered or felt such discrimination, hatred, and transphobic opposition as I have experienced since coming out here in the NJDOC,” Valentina said. 

Other trans women incarcerated in New Jersey took similar actions when denied gender-affirming care and housing. In 2022, Demi Grace-Minor, a trans woman currently incarcerated at East Jersey State Prison, tried to remove one of her testicles, which she said was in response to transphobia and delays in receiving gender-affirming surgery. Another trans woman, Jamie Kim Belladonna, also attempted to remove her testicles in February 2023 at Garden State Youth Correctional Facility after facing delays. Belladonna said she finally received vaginoplasty surgery this June and was eventually moved to the Edna Mahan Correctional Facility for Women in Union Township, New Jersey.

Though Belladonna said she was first sent back to a men’s prison after her surgery, she said the transfer to Edna Mahan was still relatively smooth despite delays.

“Everyone welcomed me and made sure that I had what I needed because, when you’re transferred, your property can’t come with you,” she said in an email. “[I]t took longer than it should have, but they were punishing me for who I am, the complaint that was filed against them, and because I mutilated myself the way that I did.”

Now that she’s in a women’s prison, Belladonna said her experience is like night and day.

“My mental health has significantly improved since moving to the female prison, and no, I’m not in protective custody, nor would I ever ask for it or need it for that matter,” Belladonna said.

The dispute over the treatment of trans women in New Jersey prisons dates largely back to October 2022, when the state changed an internal policy to give corrections officials greater leeway to override trans prisoners’ housing preferences. The policy was amended to add “reproductive considerations” to a list of why officials could override trans people’s housing preferences after Grace-Minor, consensually but controversially, got two women pregnant while incarcerated at Edna Mahan. 

In response to the uproar, Grace-Minor was transferred to Garden State Youth Correctional Facility. Weeks later, she attempted to remove one of her testicles with a razor. 

Other trans women, including Valentina and Belladonna, say the policy change—coupled with yearslong delays in obtaining surgeries that would alleviate officials’ concerns—was used to similarly relegate them to men’s prisons where they’ve face sexual abuse, harassment, and violence from both staff and incarcerated men.

“I believe that the women are going to this extreme because the DOC is encouraging them to do this,” Grace-Minor said in an email. “I believe that the conditions for a transgender woman are so humiliating and hard that transgender women believe they have to prove themselves.” She pointed to the PREA Accommodation Committee—formed under the Prison Rape Elimination Act and responsible for determining privacy and housing assignments for trans, intersex, and nonbinary people in prison—as an example, stating that the committee often told transgender women “they were men simply because of their genitals.”

Grace-Minor said she has still not been provided the surgery she has been requesting since March 2022, which would allow her to move back to the women’s prison. 

The surreptitious policy change came more than a year after the state settled a lawsuit filed by the American Civil Liberties Union of New Jersey over the NJDOC’s treatment of transgender people in custody. The plaintiff accused NJDOC of intentionally misgendering her and treating her “like a man” by housing her in male facilities and denying her gender-appropriate commissary items. A June 2021 agreement stipulated that NJDOC would maintain a policy for at least a year that gave the “presumption” that trans prisoners would be housed according to their gender identity.

The policy change came just months after that yearlong period had expired.

Incarcerated trans people’s concerns about abuse are well-documented and well-founded. In a 2022 national survey conducted by legal advocacy group Lambda Legal and prison abolitionist organization Black and Pink, more than half of detained respondents said they had been sexually harassed by prison staff, while about 1 in 6 said they had been sexually assaulted. Additionally, the 2015 U.S. Transgender Survey—the most recent report to date—shows that incarcerated trans people are over five times more likely than the general population to be sexually assaulted by facility staff and over nine times more likely to be assaulted by others incarcerated in prison.

In the aftermath of her incident, Valentina said officials have all but ignored her pleas for surgery, returning her to protective custody in New Jersey State Prison. In addition to these delays, Valentina and other trans women say they are routinely isolated for all but one or two hours a day, despite the 2019 Isolated Confinement Restriction Act, which put strict limits on the use of solitary confinement in state detention facilities. The law still gives corrections officials broad discretion over when to use isolation, particularly when labeled as protective custody. Trans women like Grace-Minor, Valentina, and Belladonna say they have had to seek out protective custody to prevent much of the violence they traditionally endure behind bars. 

Concerns over the treatment of incarcerated trans people have also escalated significantly after the presidential campaign, during which President-elect Donald Trump took particular aim at health care for trans people behind bars. In a September debate, Trump claimed that Vice President Kamala Harris supported “transgender operations on illegal aliens that are in prison,” referencing an apology she made for a stance she took as California’s attorney general to fight against medical care for trans incarcerated people. Attack ads by the Trump campaign also blasted Harris on the topic. 

However, according to ACLU attorney and expert on transgender rights Chase Strangio, courts have repeatedly found that denying incarcerated people medical care, including transition-related care, is unconstitutional—though the practice of providing that care remains a different story.  

“The government, once it confines someone against their will, cannot deliberately withhold needed medical care,” Strangio said in an interview with Them. “This basic constitutional requirement is being treated as controversial because the media and state and federal lawmakers have so effectively demonized transgender people … that the idea that the Constitution would protect us is itself seen as something bordering on a joke.”

With Trump soon to retake the White House, Jennifer Love Williams, a board member of Black and Pink and organizer with the group’s New York City chapter, said she worries that efforts to undo the protections for incarcerated trans people will have dangerous, possibly even deadly, consequences.

“When you have officers who are homophobic and transphobic, and you have a bunch of other [incarcerated people] who are non-LGBT, who are transphobic or homophobic, they can kill you, they can beat you,” Williams said. “And who’s there to help you? No one.”