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Notes -
I should probably do an effort post on this at some point but the distribution of trans patients in general medical care (which aligns closeish with real life), primary psychiatric settings, and correctional/forensic settings are all wildly different.
This causes a number of headaches, since political leadership inside the prison system often has minimal experience with prison (to say nothing of more general political leadership). You might be a well meaning left leaning person, primarily interact with well meaning and convincing trans people, and assume that the prisoners are the same. They are not.
"Real" trans people exist. In say, a locked psychiatric inpatient unit (where everyone is by definition mentally ill) most of the trans people are psychotic patients or those with borderline personality disorder or some other process causing identity instability. Correctional settings has those, and also people malingering. And yes you have people malingering so hard they'll cut their dick off if given the option.
For the usual reasons of wokeism activists can't really admit these other types of trans people exist and causes all kinds of problems, although it can be darkly funny when physicians are involved.
Wokeism does not typically survive very long with day to day contact with the prison population, so you'll find staff (even doctors and social workers) are much more clear eyed about all this but they don't make the decisions. People with strong ego defenses can stay woke but they almost uniformly end up on therapy to do it, which is...worrying.
In my state (redacted) the "worst" prison doesn't have functional climate control in the high security unit because too much of the budget has been redirected towards gender affirming care.
Maybe that's a win, in a sense. If a male with sufficient propensity for violence or anti-social behavior chooses to castrate himself, I'd be happy if that procedure was paid for with taxes. I would be OK with the additional tax burden there.
Hard to research but - not necessarily a good outcome, once the identity instability clears or the secondary gain abates the patient may have increased rage at the system, violent urges, etc.
People in prison almost never have the ability to accurately assign blame "I can't believe specific person/the system let me do that, I need revenge on them specifically or people in general."
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