The U.S. Supreme Court on Wednesday rejected an emergency request from the Trump administration to immediately enforce restrictions on gender-affirming medical care for transgender inmates in federal prisons. The order, issued without explanation, leaves in place a lower court ruling that blocks the administration’s attempt to end hormone treatments and other transition-related care while ongoing litigation proceeds.
The dispute centers on an executive order signed by President Donald Trump early in his second term, directing the Federal Bureau of Prisons (BOP) to discontinue long-standing policies that provided hormone therapy, sex-reassignment surgeries, and social accommodations such as wigs and clothing consistent with inmates’ gender identities. The administration argued that its new policy, which allows psychotherapy but prohibits medical interventions aimed at aligning a person’s appearance with their gender identity, is grounded in “biological reality” and concerns over prison security and administration.
Solicitor General D. John Sauer, representing the government, asserted in emergency court filings that the treatments carry security risks and that recent medical science does not support their use in correctional settings. The administration also described the treatments as costly and suggested that their cessation was in accordance with evolving scientific standards.
Opponents, including the American Civil Liberties Union (ACLU), have challenged the policy on constitutional grounds, arguing that the sudden change violates inmates’ Eighth Amendment protections against cruel and unusual punishment and Administrative Procedure Act (APA) requirements, which prohibit arbitrary regulatory changes without sufficient evidence. They contend that gender-affirming care is medically necessary and effective for treating gender dysphoria, a condition characterized by significant distress related to the incongruence of gender identity and sex assigned at birth.
A federal judge in Washington, D.C., Royce Lamberth, appointed by President Ronald Reagan, blocked the administration’s policy in June, citing a lack of evidence supporting the change and warning that denying care risks exacerbating mental health conditions such as depression, anxiety, and suicidal ideation among transgender inmates. The D.C. Circuit Court of Appeals upheld that injunction last month by a 2-1 vote. The Supreme Court’s refusal to grant a stay preserves the lower court’s ruling while the underlying case is resolved.
Justices Clarence Thomas and Samuel A. Alito dissented from the denial, indicating they would have allowed the administration to implement its policy pending further review. The remaining justices, however, declined to intervene at this stage.
Advocacy groups hailed the Supreme Court’s decision as a temporary protection for transgender inmates’ access to health care, emphasizing the risks posed by abrupt withdrawal of treatment. The Human Rights Campaign stated the ruling safeguards constitutional rights for now, though it acknowledged ongoing challenges ahead.
White House spokeswoman Allison Schuster criticized the ruling as dismissive of scientific standards and taxpayer concerns, affirming the administration’s intention to continue pursuing policies aligned with its views on gender and health care.
The high court’s action highlights the continuing legal and policy battles over transgender rights within the justice system and beyond. In recent years, the Supreme Court has taken up related issues involving transgender athletes' participation in sports and access to medical care for transgender youth, with rulings often reflecting deep divisions along ideological lines.