Last Tuesday court-appointed receiver who has managed health care for California prisons under federal court order since the Scwarzenegger administration announced new guidelines which authorize surgical procedures for transgender inmates suffering from severe gender dysphoria who desire surgery.

The guidelines call for panels of state health professionals to review appeals for sex-reassignment surgery from inmates whose doctors say their patients are under significant distress because of a mental condition known as gender dysphoria. The inmate must have been taking hormones for at least a year and have consistently expressed a desire to change his or her biological gender before an operation can be approved.

Prison officials have estimated the cost of the state-funded operations as high as $100,000. But the Transgender Law Center in San Francisco, which has represented two inmates in suits against the state, says each operation would cost $15,000 to $30,000.

California's Department of Corrections and Rehabilitation says it has about 385 transgender inmates, most of them male-to-female, who are currently undergoing hormone therapy.