A convicted murderer who claims he is a woman trapped inside a man's body testified Thursday that he feels distressed "every waking moment" because prison officials refuse to pay for a sex-change operation.

Michelle Kosilek, who was Robert Kosilek when he was convicted of killing his wife in 1990, is suing to force the state to pay for the surgery.

Kosilek, who wore makeup and a feminine sweater with jeans to court, cried while describing to a judge how he grew up feeling like a "circus freak."

If state prison officials refuse to allow the procedure, "I would not want to continue existing like this," said Kosilek, who has twice attempted suicide. "The greatest loss is the dying I do inside a little bit every day."

Kosilek, 57, is serving a life sentence at an all-male prison in Norfolk.

Kosilek sued the state in 2000, claiming that its refusal to provide the surgery violated the Eighth Amendment right against cruel and unusual punishment.

In 2002, federal Judge Mark Wolf ruled that Kosilek was entitled to receive medical treatment for gender-identity disorder, but stopped short of ordering a sex-change operation.

Since then, Kosilek has received female hormone treatments, laser hair removal and psychotherapy. Kosilek has also been given some access to female undergarments and makeup

But Kosilek said those treatments have not been enough and asked Wolf to hear the case instead of a jury.

Prison officials have said allowing the operation would create security concerns if Kosilek returns as a woman to the all-male prison and is targeted for assault by the male inmates. If transferred to a women's prison, Kosilek could pose a risk to female inmates, officials said.

Neither side has given an estimate for how much the surgery would cost.