A California inmate serving a life sentence has become the first prisoner to receive state-funded sex-reassignment surgery.

According to the AP, Shiloh Heavenly Quine, a 57-year-old convicted murderer, had the procedure performed at a hospital in San Francisco, her attorneys confirmed on Friday.

Quine, who has been on hormone therapy since 2009 and has attempted suicide multiple times, sued the state for the right to undergo the procedure. Her case, settled last year, led to California becoming the first state in the nation to allow transgender inmates to obtain gender affirmation surgery.

Quine said in court documents that she identified as female as early as age 9 and tried to castrate herself when she was about 19, three years before she entered the prison system.

Kris Hayashi, executive director of the Transgender Law Center, represents Quine and other transgender inmates.

“For too long, institutions have ignored doctors and casually dismissed medically necessary and lifesaving care for transgender people just because of who we are,” Hayashi told the AP.

California officials have approved four additional requests for sex-reassignment surgeries.

(Related: Tony Perkins: Transgender people will “sign up” to go to prison for “free surgery.”)