Kosilek, 58, who legally changed her name to Michelle in 1993 and has been living as a woman, first sued the Department of Correction in 2000, saying its refusal to allow her to have sex-change surgery violates the Eighth Amendment protection against cruel and unusual punishment.
In 2002, US District Judge Mark Wolf ruled that Kosilek was entitled to treatment for gender identity disorder - including hormone treatments, laser hair removal, and psychotherapy - but stopped short of ordering sex-reassignment surgery.
Kosilek sued again in 2005, saying the treatments were not enough to relieve her anxiety and depression.
"I would not want to continue existing like this," Kosilek testified in June 2006.
The trial lasted on and off from May 2006 until March 2007, with expert testimony from 10 doctors, psychiatrists, and psychotherapists. An Associated Press review last year found that the Corrections Department and its outside health care provider had spent more than $52,000 on specialists to testify about the surgery, which would cost about $20,000.
Though testimony ended almost a year ago, Wolf has given no indication when he will rule in the case, which is being closely watched by advocates for other inmates who want to undergo a sex change. Transgender inmates in other states have sued prison officials, but none has persuaded a judge to order a sex-change operation.
The Department of Correction says Kosilek's surgery would create a security quagmire and make her a target for sexual assault. Department spokeswoman Diane Wiffin would not comment on Kosilek's recent assertions that her treatment is being neglected, citing the litigation.
In court papers filed last month, Kosilek said that prison officials have stopped following the treatment plan outlined by Wolf in 2002, causing a "serious revision" in her attempts to complete her transformation into a woman.
Kosilek said that she has not received any laser hair removal or electrolysis since May 2006, and that prison officials have refused to let her see an endocrinologist since October 2007. She said she has repeatedly told prison authorities that the testosterone blocker Lupron has stopped functioning effectively.
