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Trans People in Florida Prisons Say Gender-Affirming Care Ban Upended Their Health Care

Nearly two dozen transgender women in prison said their access to treatment suddenly changed following the “anti-woke” law championed by Gov. DeSantis.

Florida Gov. Ron DeSantis, a White man, points a finger while giving a speech.
Florida Gov. Ron DeSantis signed four bills into law in 2023 targeting the LGBTQ+ community, including one that states that governmental entities in Florida may not expend state funds for “sex-reassignment prescriptions and procedures.”

Transgender women incarcerated in Florida say that the prison system’s already cumbersome process for providing gender-affirming care has fallen into disarray following the passage of a bill last year championed by Gov. Ron DeSantis. The law, SB 254, prohibits gender-affirming care for most young people, but transgender people in the state’s prisons say a clause that prohibits the use of state funds for “sex-reassignment prescriptions or procedures” is also affecting them.

They say medications and other accommodations have been abruptly changed or delayed with little or no explanation. In 2017, a five-person panel, the Gender Dysphoria Review Team, was created to approve gender dysphoria diagnoses before incarcerated people could begin treatment. Since the law’s passage last May, those whose treatment depends on the team say they have waited for months. Some have been told the team isn’t meeting at all now, leaving them in what they describe as a “twilight zone.”

The director of communications for the Florida Department of Corrections did not respond to more than a dozen emails, phone calls and texts over several months. Nor did she provide answers after a reporter’s visit to the agency’s offices, inquiring about the status of the Gender Dysphoria Review Team and asking about the prison agency’s policies on care for transgender people. Another spokesperson, approached at the state Capitol building, said she would pass along questions to the department, but that did not garner any answers.

In her only response, in June, Communications Director Kayla McLaughlin said in an email that the agency “provides medical services in compliance with state law. As such, no state funds will be used to provide services outlined in SB 254.”

This article was published in partnership with the Tampa Bay Times.

More than 20 transgender women in Florida prisons said that changes to their care began suddenly over the summer, shortly after the law went into effect.

“We’re often being told, ‘Because of the law, we can’t do anything,’ any time we raise a medical issue,” said Betty Bartee, a transgender woman incarcerated in Avon Park Correctional Institution in central Florida for a 1997 murder conviction. Bartee and others report that hormone prescriptions that used to be refilled routinely are now delayed, sometimes for weeks, resulting in the women being cycled on and off their medications.

Since 2021, almost half the states in the country passed laws to prevent transgender young people from receiving medical care to aid their transitions. Before dropping out of the race for the Republican nomination for president this week, DeSantis positioned Florida as a laboratory for ultraconservative “anti-woke” laws, including several limiting the rights of transgender people. On one day in May, DeSantis signed four bills into law targeting the LGBTQ+ community, including SB 254, which, in addition to prohibiting gender-affirming care for most people under 18, also says any “governmental entity” in Florida “may not expend state funds … for sex-reassignment prescriptions and procedures.”

The law does not specifically mention prisons. But Simone Chriss, an attorney with Southern Legal Counsel, a nonprofit civil rights law firm based in Gainesville, Florida, that has been fighting the law in court, said that prisons would logically fall under the law. “But it also doesn’t define what it means by expending state funds. In my opinion, the goal is to get [state agencies] to … err on the side of caution to avoid liability for violating these difficult-to-understand rules and laws,” Chriss said.

Another bill DeSantis signed that day limited which restrooms people could use, and in the initial state House and Senate versions of the bill, the legislation sought to ensure that prisons house “females and males in its custody separately, based on their sex.” That language was later scrapped, but attorneys and transgender prisoners in Florida report that this is already the corrections department’s practice: transgender women are held in men’s facilities, and transgender men in women’s facilities.

The corrections department did not respond to requests for information about the transgender population in the state’s prisons. But state officials told NBC News in 2020 that 235 transgender people were housed in Florida prisons at that time.

For transgender people, life in prison can be treacherous and difficult. Access to basic medical and social supports, such as gender-appropriate clothing or hormones, are only available because of years-long legal battles. In those cases, federal court rulings have consistently said that for prisons to withhold hormones and other transition-related care constitutes cruel and unusual punishment.

Florida’s new law “would absolutely conflict” with those rulings, said Jen Orthwein, a California civil rights attorney who has represented transgender prisoners in several landmark cases. “Any blanket ban on medically necessary treatment is a violation” of the Constitution, Orthwein said.

In Florida’s prisons, a diagnosis of gender dysphoria can unlock a host of basic accommodations and medical care, including hormone therapy, state-issued bras and permission to wear long hair in a men’s facility. However, a diagnosis made by a mental health professional requires additional approval from the Gender Dysphoria Review Team, composed of three medical and mental health supervisors and two correctional administrators, including the chief of security for the prison system. According to department policy, the review team is supposed to meet at least once every three months. Transgender women across the state’s prison system say they have been told that the team hasn’t met since May. None of the team’s five members responded to phone calls or questions sent via email asking whether the meetings had been suspended and when the group planned to meet again.

Several transgender women say they’ve been in limbo for months, waiting for final approval from the team. Without it, they risk having corrections officers shave their heads or throw them in solitary confinement for wearing makeup or women’s undergarments. “I was crying for over a week,” said Jada Edwards, after she said officers handcuffed her and forcibly shaved her hair when she arrived in prison in 2022. Serving time in a men’s prison outside Tallahassee on robbery and burglary and related charges, Edwards fears that officers will do it again while she doesn’t have the team’s approval.

Other women describe arriving in prison with breasts they developed from taking hormones prescribed by outside doctors, but not being allowed to wear bras because the team has not approved their diagnosis.

All the women we spoke with said that those who had been receiving hormones via injection or patch were suddenly notified in July that they would begin taking pills, regardless of their individual medical needs. The women say they have been told by medical staff that this change stems from a provision in SB 254 that a doctor must administer gender-affirming medications. Previously, nurses or other medical staff administered hormone injections and patches. It’s unclear whether state funds are still being spent on what the law describes as “sex-reassignment prescriptions.” Because the department has not answered repeated questions, the women are left wondering whether the state is trying to comply with the conflicting law and court rulings at the same time.

Bartee had been using patches, she said, since she had a heart attack in 2020. “Now, I’m being forced to take estradiol pills that are not only not as effective as the patches, but carry the [inherent] risk of blood clots, which at 51 years of age, and having two stents in my chest, is a very real concern.”

The women also report that their prescription refills have been routinely delayed. Beyond physical health implications, fluctuating hormone levels can lead to “mental agitation, mood swings, snappish — flying off the handle on petty things,” said Linda Steele, a transgender woman incarcerated on 1979 murder and weapons convictions in a men’s prison outside Tallahassee. She and the other trans women on her yard live in constant fear that these mood swings will lead to confrontations with officers or time in solitary confinement, Steele said.

“We have all been in a state of complete mess,” said Sara Maatsch, a transgender woman incarcerated for burglary and attempted murder. Maatsch said the women in her unit watch the news closely and are hoping a judge overturns the law. “We’re tired. We shouldn’t have to fight just for basic little medicines.”

Beth Schwartzapfel Twitter Email is a staff writer who often covers addiction and health, probation and parole, and LGBTQ+ issues. She is the reporter and host of Violation, a podcast examining an unthinkable crime, second chances, and who pulls the levers of power in the justice system.