What Trump’s Transgender Prison Policy Proposed, and Why a Federal Judge Blocked It

The U.S. Supreme Court on Wednesday rejected the Trump administration’s emergency request to reinstate restrictions on gender-affirming medical care for transgender federal prisoners, leaving a lower court injunction in place while the legal battle wages on.

The legal battle stems from the Federal Bureau of Prisons’ efforts to implement President Trump’s earlier January 2025 executive order, restricting federal fundings on gender dysphoria treatment. In February 2026, the BOP issued a revised policy supported by a 43-page memo and 3,200 pages of supporting materials. This includes medical research and prison security considerations.

After a federal judge blocked the restrictions, the Trump administration filed an emergency application with the Supreme Court on September 28, 2026, asking the judges to allow the policy to take effect while litigation continued. That application was separate from the BOP’s earlier policy review.

The October 21 decision, issued without an explanation, means the Federal Bureau of Prisons (BOP) cannot enforce its revised February 2026 policy, which would have restricted certain medical treatments and accommodations for inmates diagnosed with gender dysphoria.

Justices Clarence Thomas and Samuel Alito indicated they would have granted the administration’s request. But what exactly was the Trump administration proposing?

According to the 40-page emergency application filed with the Supreme Court in September, the revised policy would have continued individualized medical evaluations, psychotherapy, group counseling, psychiatric services and psychiatric medications for inmates with gender dysphoria.

However, BOP would no longer provide gender-transition surgeries or initiate hormone therapy specifically to treat gender dysphoria. For inmates already receiving hormones, prison medical officials would develop individualized plans to gradually discontinue treatment after considering their medical histories, treatment duration, responses to therapy and previous surgeries. The policy also called for discontinuing certain gender-related accommodations, including makeup, wigs, chest binders and padding. Medical care for complications from previous surgeries would remain available. The administration argued that the changes were justified by its review of medical evidence and concerns about prison safety and operations, through the BOP.

But U.S. District Judge Royce Lamberth, appointed by President Ronald Reagan, found that the agency had likely failed to adequately justify its policy reversal under federal administrative law.

In his opinion, Lamberth cited evidence that discontinuing hormone treatment could worsen gender dysphoria and contribute to depression, anxiety, self-harm and suicidal thoughts, even when treatment was gradually tapered and mental health counseling remained available. The judge also questioned whether BOP had sufficiently considered its experience under earlier policies or supported its claims about security risks.

Under the previous framework, transgender inmates could receive hormone therapy, certain personal accommodations and gender-affirming surgeries when deemed clinically appropriate.

There was also a lawsuit, Kingdom v. Trump, brought by federal prisoners Alishea Sophia Kingdom, Solo Nichols and Jas Kapule, who challenged the restrictions on behalf of themselves and similar inmates. Kingdom, formerly known as Joshua Mueller, legally changed her name in 2025 and is currently serving a federal prison sentence for robbery and discharging a firearm during a crime of violence.

Credit: Eastern District of Wisconsin

Kingdom’s federal lawsuit (cited in the judge’s opinion) also highlights an important difference between the administration’s original January 2025 executive order and the revised Bureau of Prisons policy issued in February 2026. Plaintiff Kingdom, who court filings indicate was diagnosed with gender dysphoria in 2016 and had been receiving hormone therapy for years, alleged that prison officials denied her a regularly scheduled hormone injection on January 26, 2025, telling her that treatment was no longer available because of Trump’s executive order. She also alleged that gender-related commissary items were removed.

Those events occurred more than a year before BOP issued its revised February 2026 policy, which called for individualized medical reviews and gradual tapering plans for certain inmates already receiving hormone therapy. The earlier denial should not be attributed to the procedures outlined in the later policy. Kingdom once described losing access to treatment. “The distress of losing my care has caused me to experience anxiety, panic attacks, and mood swings, and I have been unable to sleep,” she said in a statement. “I frequently find myself thinking, I would rather not live than be forced to live as a man.”

The revised policy does seek to discontinue certain hormone treatments specifically for gender dysphoria, with individual reviews to determine how and if that treatment would be tapered, rather than whether it would continue indefinitely.

The cost of gender-affirming care in federal prisons remains difficult to determine. Although the BOP reported $9.13 billion in total spending during fiscal year 2025, including substantial expenditures on inmate medical care, publicly available budget records do not identify how much was spent on hormone therapy, gender-transition surgeries or related accommodations for transgender inmates. An earlier memo points to a prior internal Justice Department estimate: the BOP spent approximately $60,000 to $95,000 annually on hormone therapy during President Trump’s first term.

One California case illustrates the difference between state and federal prison policies, however. Skylar Sophia Deleon, sentenced to death in 2009 for murdering Newport Beach yacht owners Thomas and Jackie Hawks and a third victim, John Jarvi, began receiving hormone therapy while incarcerated at San Quentin. In a January 2024 letter attributed to Deleon, she said she underwent gender-affirming surgery and breast augmentation in April 2023 and was awaiting a possible transfer to a women’s prison. A separate report citing California prison health records estimated that the state spent more than $4 million on approximately 117 gender-related procedures between fiscal 2016 and 2023, although that figure was not specific to Deleon. Unlike the federal prisoners involved in Wednesday’s Supreme Court decision, Deleon is in California state custody, where medical treatment is governed by a separate correctional system.

Wednesday’s Supreme Court order does not resolve whether the administration’s policy is ultimately lawful. It denies the government’s request to enforce the restrictions while the case proceeds through the courts. For now, the lower court’s injunction remains in effect.

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