Earlier this fall, in a move that has since sparked a federal lawsuit and ignited alarm among advocates, Florida’s Department of Corrections (FDC) enacted a new policy that severely restricts access to gender-affirming care for incarcerated transgender individuals. In a series of mandatory prison meetings held at the end of September, transgender women—most of whom have been previously diagnosed with gender dysphoria by the prison system’s own healthcare providers—were informed that their medical treatments and accommodations would undergo stringent reevaluation. Since then, numerous reports have surfaced detailing invasive physical examinations, confiscation of clothing and personal items traditionally associated with women, and forced changes to personal appearance.
The FDC’s new rules effectively ban hormone therapy and other medical interventions for gender dysphoria, except in exceedingly rare circumstances. The changes follow a broader climate of anti-trans legislation in Florida, most prominently championed by Governor Ron DeSantis. Already, transgender people behind bars say these policy shifts have led to anxiety, depression, and a sense of personal violation. Many fear that what had been slow but steady progress in accessing gender-affirming healthcare is now being rolled back to a pre-2017 era, when care and accommodations were far less accessible.
From Hormone Therapy to Forced Exams
The crux of the new policy requires prison clinicians to treat gender dysphoria primarily through psychotherapy, rather than through cross-gender hormone therapy or other affirming medical care. According to prison medical staff, this stance is meant to ensure that underlying psychiatric issues or past trauma are properly addressed before or instead of prescribing hormones. But incarcerated transgender women say this approach echoes the discredited logic of “conversion therapy”—an attempt to alter their gender identity rather than affirm it.
Shortly after the September meetings, multiple women reported being ordered to submit to breast examinations. Medical staff used the Tanner scale—a tool typically employed by pediatricians to measure adolescent pubertal development—to assess breast size. Women who did not meet a certain, undisclosed standard had their bras confiscated. Some also lost access to other “feminine” items, such as underwear and hygiene products traditionally marketed to women. According to interviews and declarations filed in court, many of those affected described the exams as degrading and performed under threat of silence.
“It felt like I was being treated less than human,” said one incarcerated trans woman, who described the experience of having her breasts inspected by a male doctor who recorded notes without explanation. She recounted how a nurse told her to “shut up and do what I’m told” when she attempted to ask questions.
In another facility, multiple women reported being forced to cut their hair—a deeply personal part of their gender expression. One woman, who had previously been allowed to wear her hair long, said she was given a disciplinary infraction and even spent time in solitary confinement for initially refusing to submit to the haircut. Eventually, correctional officers placed her in handcuffs and took her to the prison barber, where her hair was reduced to a buzz cut.
“I’m very sad and depressed. I feel like they’re taking away my identity,” said Jada Edwards, incarcerated in Dade Correctional Institution. “Before this, I had my hair long enough for a ponytail. Now, I’m left feeling exposed and humiliated.”
A Retreat From Gender-Affirming Care
Florida’s prison system, one of the largest in the United States with more than 87,000 individuals incarcerated, had until recently been making gradual strides in offering gender-affirming care. In 2017, a groundbreaking lawsuit (filed by a transgender inmate) paved the way for state prisons to recognize the medical necessity of hormone therapy and certain social accommodations, like access to women’s clothing and grooming items. This shift followed mounting legal precedent holding that prisons must meet incarcerated individuals’ serious medical needs—including those related to gender dysphoria—under the Eighth Amendment to the U.S. Constitution.
However, the new policy enacted this fall appears to effectively reverse these gains. Under the updated guidelines, transgender inmates diagnosed with gender dysphoria will be limited to psychotherapy, with hormone therapy offered only under extraordinary circumstances, such as a direct court order. The official stance, as stated in court papers, is that many individuals may be “misdiagnosed” and that hormone therapy could be requested by those experiencing “short-termed delusions or beliefs.”
These assertions run counter to the established medical consensus. Major medical organizations, including the American Medical Association and the American Psychiatric Association, consider gender-affirming healthcare—such as hormone therapy—both safe and effective. Multiple federal courts have ruled that denying necessary gender-affirming care to incarcerated people constitutes cruel and unusual punishment.
Legal Showdown in the Courts
The American Civil Liberties Union of Florida (ACLU of Florida) quickly filed suit in late October, calling the policy “draconian” and arguing that it amounts to an unconstitutional ban on medically necessary care. In a preliminary hearing held this week in Tallahassee, the state asked the judge to dismiss the suit entirely, while the ACLU pressed for a preliminary injunction to halt enforcement of the new rules. The judge’s ruling is expected in the coming weeks.
Lawyers for the Florida Department of Corrections insist that the policy is a “carefully crafted” approach rooted in scientific evidence. Yet, in their legal filings, they rely heavily on a 2022 state Medicaid report that purportedly found “insufficient evidence” of the safety and efficacy of gender-affirming care. This same report was previously criticized by a federal judge who concluded it was “a biased effort to justify a predetermined outcome” and not representative of widely accepted medical standards.
Experts like Dr. Dan Karasic, a psychiatrist at the University of California, San Francisco, who helped shape international guidelines for transgender care, have dismissed Florida’s new prison policy as a transparent attempt to sidestep legal obligations. “This is a fig leaf on their efforts to ban gender-affirming care,” Karasic said. “They are really trying to skirt the law, as determined by multiple courts, that gender-affirming medical and surgical care must be provided when medically necessary.”
Fear, Uncertainty, and the Threat of Losing Hormones
The looming threat of losing hormone therapy has caused widespread distress among those who have come to rely on these treatments for their mental and physical well-being. Several incarcerated trans women have reported intense anxiety, with some even disclosing thoughts of self-harm should their hormones be discontinued.
“If they took away my hormone therapy treatment, I would be ready to end my life,” said one woman in a declaration filed in the ACLU case. “I’m halfway through my transition, and now they’re making me stop. It’s like having the rug pulled out from under you. It’s not just medication—it’s my identity, my stability, my hope.”
Those who once took small comfort in the ability to wear bras or maintain long hair say these seemingly minor allowances were important forms of self-expression that helped mitigate the constant stress of life in a men’s prison. Now that those symbolic anchors have been removed, despair runs deep.
Others have tried to improvise: sewing makeshift undergarments or tucking away contraband clothing to regain a semblance of their authentic selves. But such acts risk disciplinary action, and the emotional toll grows heavier by the day.
Conversion Therapy by Another Name?
Critics of the policy argue that it effectively tries to force trans women to present and behave in ways incongruent with their gender identity. By reducing treatment to psychotherapy and focusing on the notion that gender dysphoria might be a byproduct of other psychiatric conditions or trauma, Florida prisons are, in essence, attempting to “treat away” a person’s core identity.
“This comes off like conversion therapy,” said Daniel Tilley, an attorney for the ACLU of Florida. “We’re trying to change your fundamental nature to get you to stop being who you are. That’s both unethical and unconstitutional.”
Lawsuits like the one now unfolding in Florida are reminders that incarcerated individuals—no matter their crimes—retain a constitutional right to be free from cruel and unusual punishment. Courts have consistently found that denying necessary care, including gender-affirming treatment, violates the Eighth Amendment. As the ACLU’s case progresses, many hope that legal precedent and established medical expertise will prevail over political ideology and bureaucratic stonewalling.
Florida’s policy shift is not happening in a vacuum. It follows a raft of anti-trans initiatives in the state and nationwide, including laws restricting transgender minors’ access to gender-affirming care and attempts to curtail the rights of transgender athletes and students. Florida’s governor has emerged as one of the most vocal proponents of such measures, framing them as efforts to protect children and maintain traditional values.
Meanwhile, the incarcerated population—already a marginalized group—bears the brunt of these ideological battles. Within the confines of prison walls, transgender individuals struggle daily for basic respect, bodily autonomy, and affirmation. Losing their access to hormones or being forced to undergo humiliating examinations intensifies their vulnerability.
The Bottom Line
The federal judge hearing the ACLU of Florida’s case will soon decide whether the lawsuit can proceed, and whether the new policy should be suspended while the case unfolds. If the court rules in favor of the incarcerated transgender women, it could restore their access to necessary medical care and personal items. If not, the stakes remain high: without legal intervention, the FDC’s policies may stand, effectively denying transgender prisoners access to care recognized as medically necessary by every major medical authority.
To be sure, no one is arguing that transgender inmates should avoid accountability for their convictions. Rather, the core issue is whether they should be denied fundamental healthcare and dignity simply because they are behind bars. For transgender individuals and their allies, the question is urgent and deeply personal: Will prisons honor established medical standards and constitutional protections, or will trans people continue to face policies that strip them of their identity and well-being?
As the legal battle continues, the eyes of the transgender community and its allies are fixed on Florida. The decision in this case will likely echo far beyond state lines, influencing how other systems approach care for transgender inmates. Amid the uncertainty, one fact remains clear: every individual, regardless of gender identity, deserves healthcare that affirms their humanity—not policies that undermine it.
