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Nature of Suit Code: 550
Nature of Suit: Prisoner - Civil Rights (U.S. defendant)
Cause of Action: 

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PUBLISH 

UNITED STATES COURT OF APPEALS 

TENTH CIRCUIT 

FILED 

Ualted States Court or AppcaJs Tenth Circuit 

AUG 1 8 1995 

PATRICK FISHER 

Clerk 

JOSEPHINE BROWN, 

Plaintiff-Appellant, 

v. No. 94-1537 

ARISTEDES ZAVARAS, ROBERT 

FURLONG, 

Defendants-Appellees. 

APPEAL FROM THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF COLORADO 

(D.C. No. 94-M-1142) 

Submitted on the briefs:* 

Josephine Brown, Plaintiff-Appellant, pro se. 

Cristina Valencia, Assistant Attorney General, Tort 

Litigation Section (Gale A. Norton, Attorney General, Stephen 

K. Erkenbrack, Chief Deputy Attorney General, Timothy M. 

Tymkovich, Solicitor General, Timothy R. Arnold, Deputy 

Attorney General, and Gregg E. Kay, First Assistant Attorney 

General, with her on the briefs), Office of the Attorney 

General, Denver, Colorado for Defendants-Appellees. 

Before SEYMOUR, Chief Judge, McKAY and HENRY, Circuit Judges. 

HENRY, Circuit Judge. 

* After exam1n1ng the briefs and appellate record, this panel 

has determined unanimously that oral argument would not materially 

assist the determination of this appeal. See Fed. R. App. P. 

34(a); lOth Cir. R. 34.1.9. The case therefore is ordered 

submitted without oral argument. 

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Appellate Case: 94-1537 Document: 01019279619 Date Filed: 08/18/1995 Page: 1 
Pro se plaintiff Josephine Brown appeals the summary judgment 

order of the district court dismissing his 42 U.S.C. § 1983 civil 

rights action.1 We have jurisdiction pursuant to 28 U.S.C. § 1291 

and remand to the district court for further proceedings 

consistent with this opinion. 

I. BACKGROUND 

Mr. Brown is an inmate at the Limon Correctional Facility, a 

Colorado state prison. In his complaint against two corrections 

officials, Mr. Brown states that he is a transsexual. The medical 

term for transsexuality is "gender dysphoria," and gender 

dysphoria is a medically recognized psychological disorder 

resulting from the "disjunction between sexual identity and sexual 

organs." Farmer v. Haas, 990 F.2d 319, 320 (7th Cir.) (collecting 

medical literature), cert. denied, 114 S. Ct. 438 (1993); see also 

White v. Farrier, 849 F.2d 322, 325-26 (8th Cir. 1988) (noting 

that gender dysphoria is a medically recognized psychological 

disorder); Meriwether v. Faulkner, 821 F.2d 408, 412 n.5 (7th 

Cir.) (same), cert. denied, 484 U.S. 935 (1987); Jan Morris, 

Conundrum (1974) (autobiographical narrative of the life of a 

transsexual) . 

Mr. Brown alleged in his complaint that the defendants have 

violated his Eighth Amendment right to be free from cruel and 

unusual punishment and his Fourteenth Amendment equal protection 

1 Although plaintiff identifies his true gender as female, 

plaintiff is biologically male and refers to himself with 

masculine pronouns throughout his pleadings. As is our practice, 

we refer to litigants as the record suggests they prefer to be 

addressed. 

2 

Appellate Case: 94-1537 Document: 01019279619 Date Filed: 08/18/1995 Page: 2 
rights. Specifically, he alleged that defendants have withheld 

medical care with deliberate indifference to his serious medical 

needs by not providing him with the female hormone estrogen and 

other medical treatment in contravention of the rule in Estelle v. 

Gamble, 429 U.S. 97, 104 (1976). 

After reviewing the complaint, a federal magistrate issued a 

show cause order stating that he would dismiss the complaint if 

Mr. Brown did not explain how the defendants personally 

participated in the alleged constitutional violations and why Mr. 

Brown felt he was entitled to hormone treatment. Mr. Brown 

responded that the named defendants were involved in his § 1983 

claim, that he was entitled to hormone treatment and "therapy," 

and that he had an equal protection right to hormone therapy. 

Rec. vol. I, doc. 5, at 2. 

Defendants then filed a motion to dismiss, attaching the 

Department of Corrections grievance process forms to the motion. 

Mr. Brown responded to the motion to dismiss with a further 

explanation of his action. After reviewing the motion and the 

materials outside the pleadings, the magistrate converted the 

motion to dismiss into a summary judgment proceeding pursuant to 

Fed. R. Civ. P. 12(b). The magistrate recommended that Mr. 

Brown's Eighth Amendment claim be dismissed because Mr. Brown had 

alleged only that Colorado had failed to provide estrogen 

treatment. 

In his response to the magistrate's recommendation, Mr. Brown 

asserted that "[t]here has been a total failure by the defendants 

to provide any kind of medical attention to the plaintiff for his 

3 

Appellate Case: 94-1537 Document: 01019279619 Date Filed: 08/18/1995 Page: 3 
transsexual condition," and argued that the magistrate had not 

addressed his equal protection argument. Rec. val. I, doc. 14, at 

3. The district court accepted the magistrate's recommendation 

regarding the Eighth Amendment claim. The district court further 

noted that Mr. Brown was not a member of a "protected class" and 

dismissed the equal protection claim. On appeal, Mr. Brown argues 

that the district court erred in dismissing both his Eighth 

Amendment and Equal Protection claims. 

II. DISCUSSION 

A. Summary Judgment Conversion 

We begin by noting that it appears that the magistrate made a 

procedural mistake in this case by not notifying Mr. Brown that 

the magistrate was converting the motion to dismiss into a summary 

judgment motion. A court may convert a Rule 12(b) (6) motion to 

dismiss into a summary judgment proceeding in order to consider 

matters outside of the plaintiff's complaint. Jackson v. Integra 

Inc., 952 F.2d 1260, 1261 (lOth Cir. 1991); Miller v. Glanz, 948 

F.2d 1562, 1565 (lOth Cir. 1991). In so doing, however, a court 

must follow Fed R. Civ. P. 12 and 56, which require "'the trial 

court [to] give the parties notice of the changed status of the 

motion and thereby provide the parties to the proceeding the 

opportunity to present to the court all material made pertinent to 

such motion by Rule 56.'" Miller, 948 F.2d at 1565 (quoting Ohio 

v. Peterson, Lowry, Rall, Barber & Ross, 585 F.2d 454, 457 (lOth 

Cir. 1978)). 

4 

Appellate Case: 94-1537 Document: 01019279619 Date Filed: 08/18/1995 Page: 4 
In this case, the magistrate relied upon matters outside of 

the complaint. However, there is no indication in the record that 

the court notified Mr. Brown of the conversion to a summary 

judgment proceeding or that he had the opportunity to introduce 

evidence supporting his claims. We therefore will not review the 

district court's grant of summary judgment. 

Nevertheless, a district court's failure to comply with Rule 

56 is harmless if the dismissal can be justified under Rule 

12(b) (6) without reference to matters outside of the plaintiff's 

complaint. Miller, 948 F.2d at 1566. We therefore review this 

case only under Fed. R. Civ. P. 12(b) (6) and determine whether Mr. 

Brown's complaint states a cause of action for which relief can be 

granted. 

B. Eighth Amendment 

Mr. Brown argues that the defendants have provided inadequate 

medical care under the Eighth Amendment. Deliberate indifference 

by prison officials to a prisoner's serious medical need 

constitutes cruel and unusual punishment in violation of the 

Eighth Amendment. Estelle, 429 U.S. at 104. 

This circuit was one of the first to consider whether 

transsexuals had an Eighth Amendment right to estrogen. See Supre 

v. Ricketts, 792 F.2d 958, 962-63 (lOth Cir. 1986). We held in 

the context of that case, where the provision of estrogen was 

medically controversial, that although prison officials must 

provide treatment to address the medical needs of transsexual 

prisoners, the law did not require prison officials to administer 

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Appellate Case: 94-1537 Document: 01019279619 Date Filed: 08/18/1995 Page: 5 
estrogen or provide any other particular treatment. Id. at 963. 

Since Supre, most courts have reached the same conclusion. 

Farmer, 990 F.2d at 321; White, 849 F.2d at 327-28; Meriwether, 

821 F.2d at 414; Long v. Nix, 877 F. Supp. 1358, 1364 (S.D. Iowa 

1995); see also Connie Mayer, Survey of Case Law Establishing 

Constitutional Minima for the Provision of Mental Health Services 

to Psychiatrically Involved Inmates, 15 New Eng. J. on Crim. & 

Civ. Confinement 243 (1989) (discussing transsexual prisoner 

cases) .2 

The defendants' sole response to Mr. Brown's Eighth Amendment 

claim is that Mr. Brown failed to raise the issue in the district 

court. In light of our obligation to construe pro se pleadings 

liberally, see Haines v. Kerner, 404 U.S. 519 (1972), we cannot 

agree. In our view, Mr. Brown claimed a medical need and 

therefore a general right to medical treatment for gender 

dysphoria in his complaint. In addition, Mr. Brown clarified his 

pleadings, specifically alleging that he has not been offered any 

treatment at all, in his response to the magistrate's 

recommendation. Cf. Green v. Johnson, 977 F.2d 1383, 1388-91 

2 However, in addressing the Eighth Amendment claim of a 

preoperative transsexual who had taken estrogen before entering 

prison, the United States District Court for the Western District 

of Michigan has issued a preliminary injunction ordering prison 

officials to provide female hormones to the prisoner. Phillips v. 

Michigan Dep't of Corrections, 731 F. Supp. 792, 794 (W.D. Mich. 

1990), aff'd, 932 F.2d 969 (6th Cir. 1991). The court reasoned 

that the plaintiff "suffer[ed] from a serious medical need," id. 

at 800, and that the denial of hormone treatment constituted cruel 

and unusual punishment. 

Unlike the plaintiff in Phillips, however, Mr. Brown has not 

alleged that he received hormone treatment for gender dysphoria 

prior to his incarceration. Phillips is therefore inapplicable to 

this case. 

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Appellate Case: 94-1537 Document: 01019279619 Date Filed: 08/18/1995 Page: 6 
(lOth Cir. 1992) (remanding case to district court for factual 

development of issues raised in pro se supplemental brief) .3 

We therefore remand to the district court to properly 

determine whether Mr. Brown is being offered medical care 

consistent with Supre. 

C. Equal Protection 

Mr. Brown also asserts that he is being denied the equal 

protection of the laws because some prisoners receive estrogen 

treatment.4 In this case, the district court observed that 

transsexuals are not a protected class and dismissed Mr. Brown's 

equal protection claim. 

The Ninth Circuit has held that transsexuals are not a 

protected class. Holloway v. Arthur Andersen & Co., 566 F.2d 659, 

663 (9th Cir. 1977). In Holloway, the court reasoned that 

transsexuality did not meet the traditional indicia of a suspect 

classification because transsexuals are not a discrete and insular 

minority, and because the plaintiff did not establish that 

"'transsexuality is an immutable characteristic determined solely 

by the accident of birth' like race, or national origin." Id. 

3 Although the documents defendants attached to their motion to 

dismiss suggest that it is the policy of the Colorado Department 

of Corrections to provide preoperative transsexual prisoners who 

have not taken hormones with counseling rather than hormones, we 

review Mr. Brown's claim under the Rule 12 standard, referring 

only to his complaint. 

4 The documents that defendants attached to their motion to 

dismiss suggest that Colorado provides hormones to prisoners with 

low hormone levels and that the state will therefore give estrogen 

to postoperative transsexuals who suffer from a hormone imbalance. 

However, as we have noted, we review Mr. Brown's claim under the 

Rule 12 standard, referring only to his complaint. 

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(quoting Frontiero v. Richardson, 411 u.s. 677, 686 (1973)). A 

number of courts have adopted the Holloway court's holding. See, 

e.g., Doe v. Alexander, 510 F. Supp. 900, 904 (D. Minn. 1981); 

Russell J. Davis, Annotation, Refusal to Hire, or Dismissal from 

Employment, on Account of Plaintiff's Sexual Lifestyle or Sexual 

Preference as Violation of Federal Constitution or Federal Civil 

Rights Statutes, 42 A.L.R. Fed. 189, § 5 (1979) (collecting 

transsexual prisoner cases) . 

Recent research concluding that sexual identity may be 

biological suggests reevaluating Holloway. See Equality Found. v. 

City of Cincinnati, 860 F. Supp. 417, 437 (S.D. Ohio 1994) 

(concluding that sexual orientation is an issue beyond individual 

control), aff'd in part and vacated in part, 54 F.3d 261 (6th Cir. 

1995); Dahl v. Secretary of the United States Navy, 830 F. Supp. 

1319, 1324 n.S (E.D. Cal. 1993) (collecting research suggesting 

that sexual identity is biological). However, we decline to make 

such an evaluation in this case because Mr. Brown's allegations 

are too conclusory to allow proper analysis of this legal 

question. We therefore follow Holloway and hold that Mr. Brown is 

not a member of a protected class in this case. When the 

plaintiff is not a member of a protected class and does not assert 

a fundamental right, we determine only whether government 

classifications have a rational basis. See Stephens v. Thomas, 19 

F.3d 498, 501 (lOth Cir.), cert. denied, 115 S. Ct. 516 (1994). 

Competing standards for resolving a plaintiff's equal 

protection claim under Rule 12 complicate our analysis when we 

review a plaintiff's claim under the rational basis standard. In 

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Wroblewski v. City of Washburn, 965 F.2d 452 (7th Cir. 1992), the 

Seventh Circuit identified and considered this issue: 

A perplexing situation is presented when the 

rational basis standard meets the standard applied 

to a dismissal under Fed R. Civ. P. 12(b) (6). The 

rational basis standard requires the government to 

win if any set of facts reasonably may be conceived 

to justify its classification; the Rule 12(b) (6) 

standard requires the plaintiff to prevail if 11 relief could be granted under any set of facts 

that could be proved consistent with the 

allegations ... Hishon v. King & Spalding, 467 U.S. 

69, 73, 104 S. Ct. 2229, 2232-33, 81 L.Ed.2d 59 

(1984). The rational basis standard, of course, 

cannot defeat the plaintiff's benefit of the broad 

Rule 12(b) (6) standard. The latter standard is 

procedural, and simply allows the plaintiff to 

progress beyond the pleadings and obtain discovery, 

while the rational basis standard is the 

substantive burden that the plaintiff will 

ultimately have to meet to prevail on an equal 

protection claim. 

Id. at 459-60. The court then adopted a hybrid approach to 

reconcile the standards, holding that a plaintiff pursuing an 

equal protection claim must allege facts sufficient to overcome a 

presumption of government rationality. 

While we therefore must take as true all of 

the complaint's allegations and reasonable 

inferences that follow, we apply the resulting 11 facts 11 in light of the deferential rational basis 

standard. To survive a motion to dismiss for 

failure to state a claim, a plaintiff must allege 

facts sufficient to overcome the presumption of 

rationality that applies to government 

classifications. 

Id. at 460. Finally, the Wroblewski court reviewed possible 

government rationales for the actions at issue, noted that a court 

must presume that government actions are rational, and held that 

the plaintiff's 11 Conclusionary assertions 11 were insufficient to 

state a claim under that standard. Id.; see also Shanks v. 

Forsyth County Park Auth .. Inc., 869 F. Supp. 1231, 1236 (M.D.N.C. 

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Appellate Case: 94-1537 Document: 01019279619 Date Filed: 08/18/1995 Page: 9 
1994) (applying Wroblewski). We find the Seventh Circuit's 

analysis sound and apply Wroblewski here. 

It is a close question as to whether Mr. Brown's complaint 

raises an equal protection claim under the Wroblewski standard. 

See Wroblewski, 965 F.2d at 460 (affirming dismissal, but noting 

that an allegation that the city acted out of personal animosity 

towards the plaintiff creates a closer question). However, Mr. 

Brown's allegations are merely conclusory in that they do not 

allege the factual basis for an equal protection claim, and even 

pro se litigants must do more than make mere conclusory statements 

regarding constitutional claims. See United States v. Fisher, 38 

F.3d 1144, 1147 (lOth Cir. 1994) (holding that conclusory 

allegations are insufficient to support a claim for relief); 

Petrick v. Maynard, 11 F.3d 991, 995 (lOth Cir. 1993) (holding 

that a pro se prisoner must do more than make conclusory 

allegations regarding access to a law library). Thus, even 

assuming the truth of Mr. Brown's allegation that some prisoners 

are given hormones and others are not, we hold that his conclusory 

allegations simply do not state a cause of action for which relief 

can be granted under an equal protection theory. 

We REVERSE and REMAND this matter to the district court for 

proceedings consistent with this opinion regarding Mr. Brown's 

Eighth Amendment claim, but AFFIRM the decision of the district 

court regarding Mr. Brown's equal protection claim. 

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