For nearly 15 years, child rapist Erika Hood has wanted medical treatment for her transition from a man to a woman.

Assigned a male at birth — named Ronald Hood Jr. — Hood has fought since 2000 to get hormone therapy while she’s held in civil commitment for being a sexually violent predator. So far, the Florida Department of Children and Families, the state agency responsible for housing the 42-year-old, has denied her requests for taxpayer-funded treatment.

Now, the battle has reached the federal courts, with the potential to reshape how Florida’s most dangerous deviants — many of whom suffer from sexual disorders — are cared for while incarcerated.

Hood, who has been held at the Arcadia center since 2000, argues that DCF is neglecting the medical needs of transgender men and women by refusing to treat, or create a policy for treatment of, gender dysphoria. The diagnosis is a widely acknowledged medical condition in which individuals identity with a different gender than their physical gender.

READ: Erika Hood's federal civil rights complaint

Fort Myers-based U.S. District Court Judge John Steele denied DCF’s request to toss Hood’s complaint of cruel and unusual punishment last week. In a written opinion, Steele said DCF might be violating the rights of people held in the Florida Civil Commitment Center if it is ignoring treatment for gender disorders.

“Since (gender dysphoria) is a recognized psychiatric disorder, a complete refusal by FCCC officials to provide any type of treatment at all could constitute an Eighth Amendment violation,” Steele wrote last week.

READ: U.S. District Court Judge John Steele's opinion in Hood case

DCF has acknowledged it has no policy regarding treatment of gender dysphoria or transgender individuals, and a DCF spokeswoman said the state has never administered hormone therapy to a civilly committed person. But the agency hasn’t outright said it refuses to provide hormone therapy to civilly committed individuals.

“The staff at the facilities work with individuals on a case-by-case basis to treat each individual’s specific mental health needs,” DCF spokeswoman Michelle Glady said in a statement.

Steele said the limited evidence available to him suggests DCF has “a de facto policy” against offering gender dysphoria treatment. A definitive ruling would likely be made at a trial.

Hood’s case comes at a time when more members of the transgender community, including convicted prisoners, are gaining additional rights.

Last month, the U.S. military approved hormone therapy treatment for Chelsea Manning, a transgender Army soldier convicted of leaking a trove of national security secrets.

In 2011, a federal appeals court ruled that a Wisconsin law banning the use of tax dollars for hormone therapy and sex reassignment surgery for inmates is unconstitutional. In that case, judges ruled gender dysphoria is a “serious medical need,” and that the state showed a “deliberate indifference” to that need by refusing to provide treatment. The cost for hormone therapy, lawyers on both sides of the case agreed, is about $300 to $1,000 per year.

A Florida Department of Corrections spokeswoman said hormone therapy is available to prison inmates diagnosed with gender dysphoria, if it’s deemed appropriate.

“There’s a growing recognition around the country — and several different circuit courts have recognized — that transition-related health care is medically necessary,” said Jael Humphrey, staff attorney for Lambda Legal, which represented inmates in the Wisconsin case.

Hood’s case, however, is littered with land mines that could derail her claim.

Hood was first diagnosed with gender dysphoria — then called “gender identity disorder” — by two doctors in 2000. At the time, she was finishing a three-year prison stint for a child sexual assault conviction out of Seminole County, north of Orlando.

READ: A history of Erika Hood's medical diagnoses and treatment

But according to court records, Hood hasn’t been diagnosed since then. In fact, DCF points to notes written in 2010 by a doctor, who said Hood “reports sometimes feeling like a man and sometimes like a woman, rather than like a woman all the time.”

“This difference of opinion did not lead the defendants to believe (Hood) suffered from (gender dysphoria),” lawyers for DCF wrote in a motion in June.

Even if Hood is shown to have gender dysphoria, she likely won’t be able to dictate what type of treatment she receives. In the past, judges have generally ruled that incarcerated people aren’t entitled to select their treatment or detainment conditions. Steele, the Fort Myers federal judge, has already acknowledged as much.

Hood also faces the challenge of making legal arguments on her own against members of Florida Attorney General Pam Bondi’s office, which represents DCF. Because her lawsuit falls in civil court, she’s not entitled to a lawyer and has been denied a request for court-appointed representation. She has made coherent and well-researched arguments in court, but could struggle more at trial.

John Knight, a senior staff attorney at the American Civil Liberties Union’s LGBT and HIV Project, said it’s “fairly common” that departments like Florida’s DCF frequently don’t have policies for handling cases like Hood’s. Convincing legislators and government administrators to spend tax dollars on transgender treatment — especially for perpetrators of heinous crimes — can be difficult, he said.

“There’s clearly an institutional desire not to provide it, and I think it’s a political concern,” Knight said. “But politics should not trump medical need, and I do think we’re seeing prisons that are understanding that.”