Eventually, De'lonta couldn't take it anymore. She bought disposable razor blades at the prison commissary and tried to cut her penis off.
After her hospitalization, she filed a federal lawsuit in 2011, claiming that the state failed to provide adequate medical care because it refused to give her a sex change operation.
In January, the 4th U.S. Circuit Court of Appeals found that De'lonta can argue that denying her the surgery violates the 8th Amendment's prohibition against cruel and unusual punishment.
As De'lonta's case makes its way through the courts, there could be more to come across the nation.
In 2012, the Federal Bureau of Prisons updated its health care policy to include transgender inmates.
Bureau spokesman Chris Burke said officials would not be giving interviews on the topic, but he forwarded its patient policy (PDF), which says an inmate has the right to an evaluation to determine whether treatment is necessary.
A unstudied population
Correctional professionals know little about how many inmates like De'lonta or Kosilek are inside U.S. prisons.
That could be a big problem, some experts say, because transgender people are more likely to wind up in the criminal justice system than others in the general population, and they are at higher risk for security problems behind bars.
The National Gay and Lesbian Task Force and the National Center for Transgender Equality published a 2011 report based on a survey of 6,450 people who identified as transgender or gender-nonconforming. Sixteen percent said that they had been compelled to make a living illegally, such as prostitution or selling drugs, due to discrimination that led to bad work environments, loss of a job, poverty and other tough situations.
Once in jail or prison, those people reported that they had been physically or sexually assaulted because of their gender issue.
A 2007 University of California, Irvine study found that people who identify as transgender are 13 times more likely to be sexually assaulted in prison.
There were 1.6 million inmates in state and federal prisons in 2011, according to the Bureau of Justice Statistics. Yet only a few studies appear to have been done on identifying prisoners who are transgender.
A 2009 study of California's men's prisons identified more than 330 transgender inmates -- people born as men but identifying as women -- out of a population of approximately 160,000.
More than 80% of the inmates said they live as women before being prisoners, and nearly half had lived on the streets.
These figures are partly why, in 2011, authorities in the Chicago area began housing transgender detainees based on the gender they identify with rather than the one they were born with, according to The New York Times.
Transgender detainees at the Cook County Jail are allowed to meet with a panel of doctors and therapists to determine where they should be housed, and correctional employees are instructed to let transgender inmates wear clothing or use hygiene products that they feel suit their gender.
Corrections employees are also trained in how to interact with transgender people.
A similar program was implemented in Denver last year.
When an arrested person is booked, they are evaluated to determine where they should be placed: a female or male housing unit, taking into consideration which gender the person lives as.
"It seemed like a no-brainer to us to have this both from a security standpoint and to make the people who come through the justice system feel like they are being treated equally," Denver Undersheriff Gary Wilson said.
"And it's saved us a lot of money," he explained. "Before this, we had to have 23-hour lockdowns to protect someone vulnerable. This made more sense, and with training, it was fairly simple to get off the ground."