BOSTON (AP) – Wearing lipstick, a scooped-neck sweater and nearly waist-length hair, the witness cried while describing what it feels like to be a woman trapped inside a man’s body.

“The greatest loss is the dying I do inside a little bit every day,” said Michelle Kosilek, an inmate who is serving a life sentence for murder.

Kosilek was Robert Kosilek when she was convicted in the killing of his wife. In 1993, while in prison, she legally changed her name to Michelle.

Since then, Kosilek has been fighting for the state Department of Correction to pay for sex-change surgery, which can cost from $10,000 to $20,000. After two lawsuits and two trials, the decision now rests with a federal judge.

Kosilek’s case has become fodder for radio talk shows, often provoking outrage among callers on topic of whether the state should pay for a convicted murderer’s sex-change operation.

The case is also being closely watched by attorneys and advocates across the country who say Kosilek is an example of the poor treatment transgender inmates receive in prison.

Courts in several other states have ordered prison systems to allow transgender inmates to receive psychotherapy and, in some cases, hormone shots. But no inmate in the country has ever succeeded in getting a court to order a sex-change operation, according to advocates.

“If people are not treated, they suffer tremendously,” said Shannon Minter, a board member of the Transgender Law and Policy Institute. “It’s just as cruel to withhold treatment for gender-identity disorder as it is to withhold treatment for any other medical issue.”

In Massachusetts, four of the 12 inmates diagnosed with gender-identity disorder are receiving hormone shots, including Kosilek. Prison officials also allowed Kosilek to receive laser hair removal, female undergarments and some makeup.

Some states allow inmates to continue hormone treatments if they are already on hormones when they begin their sentences, but most do not allow inmates to initiate hormone therapy while in prison. Many states do not have any written policy for the treatment of transgender inmates, said Cole Thaler, a transgender-rights attorney for Lambda Legal, a national advocacy group for gay, lesbian, bisexual and transgender people.

Inmates in several other states have sued prison officials for sex-change operations. Like Kosilek, they argued that gender-identity disorder is a serious illness that can lead to severe anxiety, depression, suicide attempts and self-castration. They argue that treatment for their condition is a “medical necessity” and denying it would violate the constitutional prohibition against cruel and unusual punishment.

“It’s the most absurd thing I’ve ever heard of,” said Wisconsin state lawmaker Mark Gundrum, who helped write a state law that bars the Department of Correction from using tax dollars for hormone therapy or sex-reassignment surgery.

He said the framers of the Constitution “were envisioning preventing people from being burned in oil or burned at the stake,” not simply refusing to use taxpayer dollars for inmate sex changes or breast implants.

The law was introduced after Wisconsin inmate Scott Konitzer filed a lawsuit seeking a sex-change operation. The law took effect in January, but is being challenged by the American Civil Liberties Union and Lambda Legal.