Supreme Court blocks Trump restrictions on gender-affirming care for transgender federal inmates

WASHINGTON, DC: The Supreme Court on Wednesday, October 21, rejected the Trump administration's emergency request to enforce restrictions on gender-affirming healthcare for transgender people held in federal prisons.

The decision left in place a lower-court order blocking a Bureau of Prisons policy that would prohibit gender-transition surgery, phase out hormone treatments and end certain social accommodations. The ruling allowed existing protections to remain in effect while legal challenges continued in lower courts.

Supreme Court rejects Trump administration's emergency appeal

In a brief order, the justices declined to overturn the lower court's injunction against the policy without providing an explanation for their decision. However, conservative Justices Clarence Thomas and Samuel Alito indicated that they would have granted the administration's request.

The policy was introduced as part of President Donald Trump’s broader effort to reverse federal policies recognising gender identity. It followed his January 2025 executive order directing federal agencies to recognise only the "immutable biological classification" of male or female.

Under the Bureau of Prisons' proposed restrictions, federal facilities would stop providing gender-transition surgery, gradually discontinue hormone treatments and end social accommodations such as wigs, makeup and padding. Mental health services would remain available, and some inmates could potentially receive medications such as antidepressants.

Transgender inmates challenged the policy, arguing that the government had not adequately explained its departure from previous practices and that denying medically necessary care violated the Constitution's Eighth Amendment prohibition on cruel and unusual punishment.

The American Civil Liberties Union, which represents the plaintiffs, welcomed the Supreme Court's decision. "This is a critical ruling for our clients and all transgender people in Bureau of Prisons custody," Li Nowlin-Sohl, an ACLU lawyer representing the plaintiffs, said.

"The denial of medically necessary health care, including gender-affirming health care, to people in prison is a violation of their fundamental constitutional rights," she added.

White House spokeswoman Allison Schuster criticised the ruling, calling it "a loss for common sense." Schuster said the administration would continue its efforts to "protect countless Americans from these dangerous, life-altering medical practices."

Lower courts questioned the justification for ending prison treatments

District Judge Royce Lamberth also blocked the policy earlier this year, finding that the Bureau of Prisons had failed to adequately assess its previous approach to treating transgender inmates. Lamberth, who was appointed by former Republican President Ronald Reagan, said the government had not demonstrated that the existing policy was ineffective or harmful.

"Despite providing gender-affirming care to inmates in its custody for years, the government cites in the Program Statement zero evidence from its own medical or mental health professionals to support its conclusions," Lamberth wrote.

The judge also concluded that the administration's stated justifications appeared to be pretexts for implementing Trump's executive order. The US Court of Appeals for the District of Columbia Circuit subsequently rejected the administration's request to suspend the ruling, with the panel divided 2-1.

The Supreme Court's decision marked a setback for the administration's broader efforts to restrict transgender rights. The court has previously upheld state restrictions on certain medical treatments for transgender minors and transgender participation in women's and girls' sports. It has also allowed the administration's military policy to proceed.