Earlier this fall, Florida officials mandated that transgender women in the state’s prisons undergo breast exams. Under a new policy for individuals with gender dysphoria, prison medical staff assessed the women’s breast size using a scale intended for adolescents. Those meeting the required size were permitted to retain their bras, while others were instructed to surrender theirs, along with other items deemed “female,” like women’s underwear and toiletries, as reported by The Marshall Project. This directive followed meetings held in late September with individuals diagnosed with gender dysphoria by the prison system’s own providers, where they were informed of the prisons’ restrictive new policy that would severely limit access to hormone therapy and other gender-affirming medical care. Numerous transgender women who attended these meetings shared accounts of the examinations.
One incarcerated individual, Josie Takach, recounted an experience at a men’s facility in southern Tallahassee, where a male doctor silently noted her breast size after asking her to lift her shirt. When she sought clarification, a nurse admonished her not to ask questions and simply comply with instructions. Feeling dehumanized, Takach expressed her distress over the treatment she received.
The ACLU’s Florida chapter filed a lawsuit against the state’s Department of Corrections in late October, condemning the policy as draconian and asserting that it violates transgender individuals’ rights to gender-affirming care. This policy shift is the latest development in Florida’s ongoing culture war surrounding transgender civil rights, with Governor Ron DeSantis championing anti-trans legislation, such as a law prohibiting gender dysphoric children from accessing treatments like puberty blockers and hormone therapy. A similar law in Tennessee recently faced scrutiny in a case before the U.S. Supreme Court.
In Tallahassee, a federal judge presided over a preliminary hearing on the ACLU’s lawsuit. While the state sought to dismiss the case entirely, the ACLU requested an injunction against enforcing the new regulations. A ruling on these matters is expected in the following weeks.
Despite repeated attempts to seek clarification from the Florida Department of Corrections’ media office, no responses were received. In court filings responding to the ACLU’s lawsuit, the department’s legal team defended the new policy as a meticulously crafted approach providing tailored treatment based on scientific evidence and clinical judgment.
Under this policy, the Department of Corrections outlined that individuals with gender dysphoria would only receive psychotherapy, not cross-gender hormones, except in rare circumstances where constitutional compliance or court orders necessitate it. The policy asserts that unaddressed psychiatric issues and untreated childhood trauma could result in misdiagnoses of gender dysphoria, and that cross-gender hormones might be requested by individuals experiencing transient delusions or beliefs that could later be revised.
Florida boasts the nation’s third-largest state prison system, with over 87,000 incarcerated individuals as of September’s end. Of these, 181 have been identified as transgender by the department, with around 100 having received hormone therapy, according to state records.
The ACLU case documents were filed with the courts regarding the new policy introduced in late September during meetings held in various state prisons. Transgender women who participated in these meetings were informed by officials that they would undergo a “re-evaluation” to determine their ongoing access to care and accommodations, such as the ability to grow their hair long. However, the officials have not clarified whether these women will be allowed to continue receiving hormone treatments.
Following this announcement, over a dozen transgender individuals reported that correctional officers instructed them to cut their hair. Mariko Sundwall shared her experience with The Marshall Project, revealing that she faced disciplinary action and solitary confinement for refusing to comply with the hair-cutting directive. Similarly, Jada Edwards, incarcerated at Dade Correctional Institution, expressed feeling saddened and deprived of her identity after having her hair forcefully cropped short.
Moreover, numerous women had their breasts examined, and each transgender woman was assessed using the Tanner scale by a medical provider to determine their stage of development. Despite not being informed about the specific requirements, many women had their bras confiscated, leaving them feeling exposed and vulnerable. Some resorted to hiding or creating makeshift undergarments, risking disciplinary charges as women’s undergarments were deemed contraband.
The new policy mandates psychotherapy for treating underlying issues instead of addressing gender dysphoria directly, raising concerns of resembling conversion therapy, according to Daniel Tilley, the leading attorney from the ACLU of Florida. Sarah Maatsch, an inmate in a men’s prison, shared her distress at being informed that her gender dysphoria diagnosis was now classified as a severe psychiatric condition. To continue treatment, she was informed that she would need to relocate to a more restrictive prison with limited opportunities for work and programming.
These changes in healthcare for transgender individuals in Florida stem from a 2023 law restricting the use of state funds for sex-reassignment prescriptions or procedures. Although prisons are constitutionally required to provide gender-affirming care, recent reports indicate abrupt medication changes or delays in response to anti-trans legislation. The impacted individuals express devastation and anxiety over their uncertain future within the prison system.
Dr. Sic, a psychiatrist at the University of California, San Francisco, has played a pivotal role in establishing international standards for the treatment of transgender individuals. He has also been actively involved in advocating against restrictions on gender-affirming care, notably in Florida and other jurisdictions. In response to a request from The Marshall Project, Dr. Sic reviewed Florida’s recent guidelines and criticized them as a mere facade to disguise their true intention of prohibiting gender-affirming care. He emphasized that such efforts were a clear attempt to circumvent established legal rulings mandating the provision of gender-affirming medical and surgical interventions when deemed medically necessary.
The initiative to address gender dysphoria within the Florida prison system was initiated in 2017 following a lawsuit filed by Reiyn Keohane against the state. A federal judge presiding over the case highlighted the Department of Corrections’ failure to provide Keohane with essential treatments such as hormones and social accommodations, which resulted in unnecessary suffering and posed significant health risks. Subsequently, the state began implementing gender-affirming hormone therapy, along with access to makeup, women’s clothing, and other social adjustments within its correctional facilities.
Dr. Danny Martinez, the medical director of the state prison system, revealed that he commenced revising the gender-affirming care program in 2020 in response to a lawsuit filed by the ACLU. According to Martinez, a considerable portion of individuals receiving hormone therapy in Florida’s prisons were not actively engaging in therapy sessions, indicating limited success with hormone therapy alone. Despite attempts to contact Martinez for further comments, no response was received.
Martinez justified the modifications to the program based on a 2022 report from Florida’s Medicaid organization, which questioned the safety and efficacy of medical interventions for gender dysphoria. This report led to the state’s Medicaid program discontinuing coverage for gender-affirming medical care. However, a federal judge invalidated the Medicaid ban, deeming the report biased and unsupported by credible medical standards.
Although there have been no reports of transgender women in Florida’s prisons having their hormone therapy discontinued, the looming possibility has sparked widespread anxiety among the incarcerated population. Sasha Mendoza, an inmate at a men’s prison near Miami, expressed profound distress at the thought of losing access to hormone therapy, stating that such an occurrence would push her to contemplate ending her life. Mendoza highlighted the progress she had made with her transition and the detrimental impact of abruptly halting her treatment.
This article was published in collaboration with the Tampa Bay Times and was produced by The Marshall Project, a nonprofit news organization dedicated to raising awareness about issues within the U.S. criminal justice system. Additionally, the content was reviewed and distributed by Stacker, adhering to journalistic ethics and standards.
