Although out of it now, I spent a decent decade and a half working in the (male) prison system down here. This goes on a bit - and it's always women killers that want it. One has been trying for close to 20 years - and is still in a male jail, so that's something. For lack of a medical diagnosis - they are just fucked. Pure and simple. Luckily the powers that be are scared to make big decisions, or more so - scared of the consequences should they approve such a transition.