When the U.S. Court of Appeals for the Ninth Circuit on Friday ruled that prison officials in Idaho must provide a transgender inmate with gender confirmation surgery, the three-judge panel set up a stark split with the Fifth Circuit—and offered a withering critique of their sister circuit's recent holding.

The two cases had similar facts: male-to-female transgender prisoners who suffer from severe gender dysphoria, where their sex assigned at birth (male) differs from their gender identity (female).

The Idaho inmate, Adree Edmo, twice attempted self-castration. The Texas inmate, Scott Gibson, also known as Vanessa Gibson, said she copes by tying a string around her testicles "until they turn purple.… I do this to stop the testosterone from entering my body."