The Trump administration must continue providing transition care to inmates with gender dysphoria, at least for now, the Supreme Court ruled on Wednesday.
The justices denied the government’s request to freeze a lower-court order that found the administration’s decision to end such care for prisoners was not backed by sufficient evidence. The lower court had ordered the treatment to continue.
The high court weighed in with a brief, unsigned order. Justices Clarence Thomas and Samuel A. Alito Jr. noted that they would have granted the administration’s request for a stay.
When President Donald Trump began his second presidential term last year, he signed an executive order directing the Federal Bureau of Prisons (BOP) to discontinue long-standing policies of providing transition care to federal prisoners experiencing gender dysphoria.
Gender dysphoria is a medical condition referring to the distress a person feels when their sex assigned at birth does not match their gender identity. Before Trump returned to office, federal prisons had provided treatments such as hormone therapy and sex-trait modification surgery. Prison officials also allowed inmates to dress in ways consistent with their gender identity.
But Trump’s sweeping order, issued on his first day in office, declared that the federal government would recognize only two sexes — male and female — and that the “biological reality” of those classifications left no room to consider a person’s gender identity. The order was far-reaching, affecting the federal government’s work in employment, housing and the federal prison system.
The BOP issued memorandums directing prisons to stop providing sex-trait modification surgeries, hormone therapy and social accommodations such as breast padding, chest binders, wigs and other items used to help an inmate align their appearance with their gender identity, according to court records.
In place of those treatments, the administration said it would offer psychotherapy and group counseling.
In a brief to the high court, Solicitor General D. John Sauer wrote that the administration did so because the latest medical science did not support the treatments. Sauer also wrote that the treatments risked making recipients targets of violence by other inmates, among other safety issues.
The treatments “raised security and prison-administration concerns that outweighed whatever limited benefits they had,” Sauer wrote.
In March 2025, a group of inmates filed a class-action lawsuit accusing the government of failing to follow the proper administrative processes before changing the prison policy. They disputed the government’s argument that the treatments are not supported by the most recent science. They also noted that prison officials in past administrations had not raised safety concerns regarding inmates receiving the care.
They further argued that cutting off the care could cause medical harm to those who have been receiving the treatment.
In August, a federal judge in D.C. sided with the plaintiffs and ruled the treatments should continue as the case’s merits are litigated in lower court. A month later, a panel on the D.C. appeals court declined to pause that decision, finding that the government had “not made a strong showing that they are likely to succeed on the merits.”
The administration asked the high court to weigh in on an emergency basis and allow it to implement its new policy as the case wends through lower courts. Attorneys for the prisoners urged the high court to allow the transition care to continue.
“Withdrawing care will cause significant changes to their bodies and put Respondents and Class members at serious risk of worsening gender dysphoria as well as other mental health symptoms including depression, anxiety, self-harm, and suicidality,” attorneys with the American Civil Liberties Union wrote in a brief.
“Respondents have already experienced some of these harms when BOP temporarily discontinued their treatment and they justifiably fear such harm will recur if this care is again taken away,” the attorneys added.
The high court in recent years has grappled with numerous cases involving the rights of transgender people. Just this summer, it upheld state bans on trans athletes playing on women’s and girls sports teams. The court has also held that states could ban transition care for minors.
Allison Schuster, a White House spokeswoman, said in a statement that Wednesday’s ruling was a “loss for common sense.”
“This administration will continue to fight for bold action to stop the waste of taxpayer dollars, restore Gold Standard Science as the guiding principle of all health policy, and protect countless Americans from these dangerous, life-altering medical practices, especially those funded on the taxpayer’s tab,” Schuster added.
LGBTQ+ advocates applauded the court’s ruling.
“This decision protects incarcerated trans people from the administration’s attempt to steamroll over constitutional rights for now, but the fight to uphold the dignity and respect our community deserves is far from over,” Human Rights Campaign President Kelley Robinson said in a statement.
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