Over the past year, Florida’s sprawling slate of anti-transgender laws has most often come under scrutiny for targeting trans minors. But more than 20 incarcerated trans women say state prison officials are also using Republicans’ ban on gender-affirming care to deny them access to hormones, surgeries, and even getting a medical diagnosis at all.

As reported by journalistic nonprofit The Marshall Project and the Tampa Bay Times on Thursday, the process through which trans prisoners can access gender-affirming care has “fallen into disarray” since Florida Gov. Ron DeSantis signed SB 254 into law last May. That law banned minors from accessing gender-affirming medical care, but also more broadly prohibited “governmental entities” in Florida from using state funds for “sex-reassignment prescriptions and procedures.” Although the law doesn’t specifically mention prisons, nearly two dozen trans women in Florida state prisons say they have had their hormones improperly changed, been denied necessary surgeries, and prevented from obtaining a gender dysphoria diagnosis at all since SB 254 was passed.

“We’re often being told, ‘Because of the law, we can’t do anything,’ any time we raise a medical issue,” incarcerated trans woman Betty Bartee told interviewers. All of the trans women interviewed by the Marshall Project said that as of July 2023, they were unilaterally switched to estradiol pills, regardless of how they had previously received hormones. That’s of particular concern to Bartee, who had been wearing adhesive patches since suffering 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,” Bartee explained, “which at 51 years of age, and having two stents in my chest, is a very real concern.”

Part of the problem, the incarcerated interviewees said, is with the state Gender Dysphoria Review Team, a five-person panel created in 2017 to review prisoners’ dysphoria diagnoses before approving treatment. Some prisoners told the Marshall Project they’ve been informed the review board is no longer meeting at all, even though they’re still waiting for their diagnoses to be approved. Because Florida prisoners are segregated according to their sex assigned at birth, trans women without a diagnosis are not only denied medical care, but may even have their heads forcibly shaved or be locked in solitary confinement for attempting to appear more feminine.