Others, such as convicted killer David, or Bella, Birrell, 58, who said she had been raped in prison, would like to be transferred to a women's facility. "You don't have to worry about the constant harassment like you get from the men here," she said.
Only two of the six said they would be interested in a sex change operation if a court order compelled the state to pay the costs.
"I had made plans to try to get [the surgery] done before I committed the crime that I did," said Steve Alamillo, 39, who goes by Nikkas and is serving life for first-degree murder. "If the state can do that stuff, absolutely."
Willie Murphy, 47, who is also known as Mena and is serving life on a third-strike conviction for burglary, was among the majority, preferring to "keep what I got."
Surgery is where the California Department of Corrections and Rehabilitation draws the line.
"A prison is not required by law to give a prisoner medical care that is as good as he would receive if he were a free person, let alone an affluent free person," attorney Steven J. Bechtold, who represents the receiver, wrote in the state's response to Stevens' petition for the operation.
The prison system has lost on a similar point before. The state provides hormone therapy today because a federal court found in a 1999 case that failing to continue treatment for inmates who were on hormones before coming to prison amounted to cruel and unusual punishment.
"We regularly get questions about why we are treating these patients," said Dr. Joseph Bick, chief medical officer at Vacaville. "The bottom line is, not only is it appropriate, but it's mandated by federal courts."
Stevens, who has fathered three children, argues in her court case that the cocktail of estrogen and testosterone-blockers the state has provided since her incarceration in 2003 are no longer adequate to combat her emotional distress. Failing to provide surgery could increase her "risk of future self-harm," wrote Dr. Denise Taylor, a medical expert who filed a brief on Stevens' behalf.
Taylor also argued that leaving Stevens on estrogen therapy could lead to the reemergence of a benign tumor removed from her brain in 2005.
Bick, who filed a declaration with the court in January defending the state's position, said the previous tumor was not believed to be caused by estrogen therapy. He said Stevens' treatment in prison has been "adequate and successful."
Perhaps the biggest threat to Stevens' case is the state's budget crisis, in the view of several transgender inmates interviewed. They worried that a judge might be reluctant to rule in her favor with the state facing hard times.
"If I were out there, I wouldn't understand, especially if I was unemployed or trying to support a family," Birrell said.
"But if you could only go into our heads for a day or two to see what we go through internally," she said, "you would get a greater appreciation of how devastating it is to be a transgender individual locked up in a man's prison."
