Supreme Court keeps hormone treatment for transgender federal inmates, blocking Trump policy

The ruling

The Supreme Court on Wednesday, 21 October 2026, refused the Trump administration's request to enforce immediately a Bureau of Prisons policy that would have cut off gender-transition medical care for transgender inmates. The order was unsigned and gave no reasoning. It leaves in place a lower-court block on the policy while the litigation continues. Justices Clarence Thomas and Samuel Alito said they would have granted the administration's request for a stay. The outcome is unusual for a court with a conservative majority, which sided, at least for now, with the rights of transgender people.

What the policy would have changed

The policy followed a January 2025 executive order from President Donald Trump that barred prison officials from spending federal funds on medical procedures, treatments or drugs for gender dysphoria. Under the revised rules, prisons would halt surgeries, taper off hormones and end social accommodations such as makeup and wigs. Prisons would keep offering mental health services, including psychotherapy, group counseling and medications such as antidepressants. Solicitor General D. John Sauer wrote in a brief that the administration acted because the latest medical science did not support the treatments. He also argued that the treatments risked making recipients targets of violence by other inmates.

The lower court and the appeal

District Judge Royce Lamberth, nominated to the bench by Ronald Reagan, ruled in June 2025 that the administration had offered neither evidence nor valid reasons for changing a policy long applied to these inmates. He relied on the Administrative Procedure Act, which bars federal agencies from making sudden and arbitrary changes. Lamberth also noted that untreated gender dysphoria can cause severe side effects such as depression, anxiety and suicidal thoughts. The administration appealed, and a divided appeals court panel left his order in place. Lawyers for the inmates said withdrawing care would significantly affect their clients' bodies and mental health. They added that the government had not detailed evidence of security problems linked to hormone therapy over the 30 years it has been provided.

Who is affected

The agency said in court records that about 600 inmates were receiving hormone therapy in 2025. The New York Times and Bloomberg put the number of transgender people in federal custody affected by the policy at about 1,000. The challenge was brought by three transgender people in federal custody, all of whom had previously been diagnosed with gender dysphoria by prison medical officials and prescribed treatment. Their lawsuit argued that the change violated Eighth Amendment protections against cruel and unusual punishment.

Wider context and next steps

The Supreme Court has previously allowed other policies on transgender people to proceed for now, including restrictions on military service and passport sex markers. In June the justices upheld state laws banning certain medical treatments for transgender youth. The administration has also asked the Supreme Court to let the U.S. military fully enforce its ban on transgender service members, and that case is pending. Wednesday's order does not decide the merits of the dispute over federal prison care. The block stays in place while the case proceeds in the lower courts.