The Supreme Court on Wednesday refused to allow the Trump administration to immediately enforce new medical restrictions for transgender people in prison. The decision leaves in place a lower-court block on the policy, which was adopted following an executive order from President Donald Trump as part of his efforts to roll back transgender rights during his second term.
Justices Samuel Alito and Clarence Thomas indicated they would have allowed the policy to be enforced. The Supreme Court has previously permitted other policies regarding transgender individuals to proceed, including restrictions on military service and passport sex markers.
The executive order directed the Bureau of Prisons to revise medical care policies to ensure federal funds are not used “for the purpose of conforming an inmate’s appearance to that of the opposite sex.” Under the proposed policy, surgeries would be halted, hormones would be tapered off, and social accommodations such as makeup and wigs would be ended, though prisons would continue to provide mental health services.
Attorneys representing transgender inmates challenged the policy, leading U.S. District Judge Royce Lamberth to order that treatments continue. Lamberth, a nominee of President Ronald Reagan, noted that untreated gender dysphoria can lead to severe side effects, including depression, anxiety and suicidal thoughts.
The Trump administration appealed the ruling, arguing that the medical treatments raised security concerns and “could no longer be justified.” A divided appeals court panel previously left the lower court’s order in place.
According to court records, approximately 600 inmates were receiving hormone therapy in 2025. Lawyers for the inmates argued that withdrawing care would have significant effects on their physical and mental health. They further stated that the government has not provided evidence of security issues linked to hormone therapy, which has been provided to inmates for 30 years.
The conservative-majority Supreme Court has previously upheld state laws that ban certain medical treatments for transgender youth and restrict the participation of transgender athletes in women’s sports.
