WASHINGTON — The U.S. Supreme Court on Wednesday rejected the Trump administration’s emergency request to reinstate restrictions on gender-affirming medical care for transgender people incarcerated in federal prisons, leaving in place a lower court order requiring the Bureau of Prisons to continue providing treatment while litigation proceeds.
In a brief, unsigned order issued Oct. 21, the justices denied the administration’s application for a stay in Trump v. Kingdom, allowing an injunction blocking the administration’s revised medical policies to remain in effect.
Justices Clarence Thomas and Samuel Alito indicated they would have granted the government’s request. The court provided no explanation for its decision, which does not resolve the underlying legal challenges to the administration’s policies.
The ruling represents a setback for President Donald Trump’s efforts to eliminate gender-affirming medical treatment in federal prisons, where incarcerated transgender people have previously received hormone therapy, mental health services and, in some circumstances, gender-affirming surgery.
The dispute began after Trump signed an executive order on Jan. 20, 2025, directing federal agencies to recognize only two sexes and requiring the Bureau of Prisons to revise policies governing medical treatment and accommodations for transgender people.
The order instructed federal officials to ensure that government funds were not used for medical procedures, treatments or medications intended to conform an incarcerated person’s appearance to that of the opposite sex.
Federal prison officials subsequently issued directives restricting hormone therapy, gender-affirming surgery and accommodations such as clothing, wigs, breast padding and chest binders.
The administration argued that the changes reflected medical considerations and concerns about institutional security. Transgender people incarcerated in federal facilities challenged the restrictions, arguing that the government had abruptly reversed established medical policies without adequate justification and placed them at risk of serious harm.
The lawsuit, Kingdom v. Trump, was brought by Alishea Sophia Kingdom, Solo Nichols and Jas Kapule on behalf of themselves and other similarly situated people, with representation from the American Civil Liberties Union and Transgender Law Center.
The plaintiffs argued that withdrawing previously prescribed hormone therapy could produce physical and psychological consequences, particularly for people who had relied on the treatment for years.
Their challenge also questioned whether federal prison officials could substitute categorical restrictions for individualized medical assessments of people diagnosed with gender dysphoria.
Gender dysphoria refers to clinically significant distress associated with an incongruence between a person’s experienced gender and sex assigned at birth.
Before Trump’s return to office, the Bureau of Prisons maintained clinical guidance permitting treatment plans that could include psychotherapy, psychiatric services, hormone therapy and surgery, depending on an individual’s medical needs.
The earlier policies also permitted certain social accommodations intended to help transgender people express their gender identity while incarcerated.
In June 2025, U.S. District Judge Royce Lamberth issued preliminary relief preventing the government from enforcing its initial restrictions.
The administration subsequently developed a new policy in February 2026, supported by a 43-page explanatory memorandum and an administrative record containing approximately 3,200 pages of materials.
Under that policy, the Bureau of Prisons would no longer initiate hormone therapy for people diagnosed with gender dysphoria and would develop individualized plans to taper treatment for those already receiving hormones.
The policy also prohibited gender-affirming surgeries and directed prison officials to discontinue or remove certain social accommodations when practicable.
Instead, the agency proposed treating gender dysphoria primarily through psychotherapy, group counseling, psychiatric services and medications addressing psychological symptoms.
In its Sept. 28 emergency application, Solicitor General D. John Sauer argued that the new policy reflected an independent assessment of medical evidence and the operational responsibilities of federal prison administrators.
The government maintained that existing standards supporting hormone therapy and surgical interventions were insufficiently supported by scientific evidence and that such treatment could create security concerns within correctional facilities.
Sauer argued that prison administrators deserved substantial judicial deference when determining how to provide medical services while maintaining institutional security.
The administration also contended that the district court had improperly substituted its judgment for that of federal prison officials.
The plaintiffs disputed those arguments in their Oct. 8 opposition, maintaining that the Bureau of Prisons had failed to meaningfully consider its own experience providing gender-affirming treatment before adopting the restrictions.
Their attorneys argued that the agency’s administrative record did not adequately support its conclusions about the medical effectiveness of treatment or the security consequences of allowing transgender people to continue receiving care.
They also challenged the government’s reliance on psychotherapy as an alternative to hormone treatment, arguing that psychological counseling could not necessarily replace medical interventions prescribed for gender dysphoria.
The plaintiffs warned that withdrawing treatment could worsen depression, anxiety and other mental health conditions, particularly among people whose treatment had already been interrupted following the administration’s initial directives.
The litigation also raised questions about whether prison officials could discontinue established medical care based on broad policy determinations rather than individualized clinical evaluations.
In June 2026, Lamberth issued an updated preliminary injunction against the revised Bureau of Prisons policy, concluding that the plaintiffs were likely to succeed on their claim that the agency had acted arbitrarily and capriciously under the Administrative Procedure Act.
That federal law requires agencies to provide reasoned explanations for their decisions, including when changing established policies.
The district court found deficiencies in the agency’s consideration of its previous experience, the justification for its new restrictions and the relationship between the policy and Trump’s executive order.
The administration appealed and sought to suspend the injunction while the litigation continued.
In September, the U.S. Court of Appeals for the District of Columbia Circuit declined to stay the district court’s order, concluding that the government had not demonstrated a sufficiently strong likelihood of prevailing on appeal.
The administration then turned to the Supreme Court, arguing that the injunction improperly prevented prison administrators from implementing a policy they considered medically appropriate and necessary for institutional security.
The government also invoked the Prison Litigation Reform Act, which imposes limitations on federal court orders governing prison conditions.
In its Oct. 9 reply, the Justice Department maintained that the district court had exceeded those limitations by imposing relief extending beyond the plaintiffs’ individual circumstances.
The plaintiffs countered that broader relief was necessary because the challenged restrictions applied across the federal prison system to people diagnosed with gender dysphoria.
Wednesday’s Supreme Court order leaves the injunction intact without deciding whether the revised policy ultimately violates federal law or the Constitution.
The decision does not independently establish a constitutional entitlement to every form of gender-affirming treatment, nor does it constitute a final judgment on the legality of the administration’s policy.
Rather, it preserves the lower court’s restrictions on implementing that policy while the case continues through the federal courts.
The ruling comes amid broader Supreme Court litigation concerning transgender rights, including decisions allowing states to restrict gender-affirming medical treatment for minors and addressing participation by transgender athletes in school sports.
Unlike those cases, the immediate question before the justices concerned whether the administration could implement its revised prison medical policy before appellate review was completed.
The underlying lawsuit remains pending, with the government continuing to defend its authority to change federal prison medical policies and the plaintiffs challenging the legality of withdrawing previously available care.
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