Trump Asks Supreme Court to Allow Transgender Health Care Restrictions in Federal Prisons

The Trump administration asked the Supreme Court on Monday to let federal prisons restrict hormone therapy and gender-affirming surgery for transgender inmates, seeking to enforce the policy after two lower courts refused to clear the way.

The Justice Department filed an emergency request asking the justices to lift an injunction from U.S. District Judge Royce Lamberth in Kingdom v. Trump, a class action covering federal inmates diagnosed with gender dysphoria. The U.S. Court of Appeals for the D.C. Circuit refused to suspend Lamberth’s order earlier this month.

The Bureau of Prisons policy, issued in February, bars gender-affirming surgeries, generally prohibits new hormone therapy and calls for gradually tapering hormones for inmates already receiving them. It also ends accommodations including makeup, wigs, and certain clothing and hair-removal items. Psychotherapy and psychiatric medication remain available.

The restrictions reversed an earlier approach that allowed treatment for gender dysphoria when clinicians determined it was medically appropriate. Gender dysphoria is a recognized clinical diagnosis involving significant distress associated with an incongruence between a person's gender identity and sex at birth.

Three transgender inmates held in federal prisons in New Jersey, Florida and Minnesota challenged the restrictions, arguing that the government unlawfully denied access to medically necessary care.

Lamberth blocked the restrictions after finding the challengers were likely to show that the Bureau of Prisons acted unlawfully when it changed its treatment rules. His ruling focused on the Administrative Procedure Act, which allows courts to set aside federal agency actions found to be arbitrary and capricious.

The judge found that prison officials failed to adequately account for the agency’s experience providing gender-affirming care before reversing course. He also concluded that the bureau effectively worked backward from Trump’s January 2025 executive order directing it to stop using federal funds for treatments intended to align an inmate’s appearance with a gender different from the person's sex as defined by the administration.

The D.C. Circuit refused to put Lamberth’s injunction on hold on Sept. 18, finding that the government had failed to show a strong likelihood of succeeding in its appeal. The divided panel also questioned the bureau’s reliance on prison security concerns and its consideration of the agency’s record under the earlier treatment rules. Circuit Judge Justin Walker dissented and would have allowed the restrictions to take effect during the appeal.

Solicitor General D. John Sauer is now asking the Supreme Court to intervene, arguing that federal prison officials reasonably concluded the disputed treatments are medically unnecessary and that security and prison administration concerns support the restrictions. The inmates maintain that the government is withholding medically necessary treatment because they are transgender.

The inmates also argue the restrictions violate the Eighth Amendment’s prohibition on cruel and unusual punishmentEighth Amendment and Cruel and Unusual PunishmentThe Eighth Amendment to the U.S. Constitution prohibits excessive bail, excessive fines, and cruel and unusual punishments. Its Cruel and Unusual Punishments Clause limits the types and severity of punishment the government may impose, including conditions of confinement and methods of execution.Read more →. Under Supreme Court precedent, prison officials can violate that protection through deliberate indifference to an inmate’s serious medical needs. The challengers say their diagnosed gender dysphoria requires individualized treatment, while the government maintains that hormones and surgery are unnecessary and may be restricted by prison officials.

The justices are being asked to decide whether the Bureau of Prisons can begin enforcing the restrictions before the courts resolve whether the policy itself is lawful. The Supreme Court has previously allowed other Trump administration policies affecting transgender people to take effect during litigation, including restrictions involving military service and gender markers on passports.

Until the Supreme Court acts, the injunction keeps the Bureau of Prisons from enforcing the restrictions against the affected class of transgender inmates.