A view of the United States Supreme Court in Washington, DC on October 14, 2026.
Saul Loeb/AFP via Getty Images/AFP
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Saul Loeb/AFP via Getty Images/AFP
The Supreme Court ruled on Wednesday that the Trump administration must continue to provide gender-affirming care to transgender inmates in federal prisons.
The ruling, issued on an emergency appeal, upholds a lower court’s injunction against a Federal Bureau of Prisons policy that would end hormone therapy and other treatments for trans inmates.
The order offered no explanation behind the decision. It simply read: “The request for suspension presented to the Chief Justice and referred by him to the Court is denied.”
He also said Justices Clarence Thomas and Samuel Alito would side with the Trump administration and grant the stay request.
A federal judge barred the BOP from implementing its policy this summer.
A second court, the U.S. Court of Appeals for the District of Columbia Circuit, also rejected the administration’s request to stay U.S. District Judge Royce Lamberth’s order.
That’s when U.S. Solicitor General D. John Sauer asked the Supreme Court to intervene.
While the federal judge’s injunction remains in effect, the legal battle over the policy continues.
Li Nowlin-Sohl, senior counsel for the American Civil Liberties Union and an attorney involved in the case, said the organization estimates there are more than 2,000 people in BOP custody who identify as transgender. (The B.O.P. stopped publishing data reflecting transgender inmates after Trump takes office in 2025. It only records male or female individuals incarcerated in the federal system.)
Kingdom against Trump That’s 1,000 inmates diagnosed with gender dysphoria, Nowlin-Sohl said. Of those, the ACLU estimates that about 800 have been prescribed hormone treatment and many are also receiving social transition accommodations, Nowlin-Sohl said.
In his request for emergency stay Regarding previous decisions, the Trump administration argued that providing this care posed several risks, including to the recipients of this specialized care, who it said would become “targets of attack.” They also said it raised “fairness concerns” because it would “breed resentment” toward other inmates.
Access to gender-affirming care is considered medically necessary to treat gender dysphoria, a medical term used to describe the profound discomfort caused by a mismatch between a person’s sex assigned at birth and their gender identity. Without it, individuals can suffer serious mental health problems such as increased anxiety and depression, with some turning to self-harm and suicide.
Gender-affirming care may include “…hormone therapy and gender-affirming surgeries, among others,” according to the World Professional Association for Transgender Health. (In its filings, the Trump administration questioned WPATH’s standards of care, which were developed by transgender health experts and used by organizations around the world.)
Some transgender people may need hormone treatment and gender-affirming surgeries; others may not require any of these interventions.
The BOP has been treating people with gender dysphoria since at least 1992, the ACLU said in response to government filings with the Supreme Court.
“If BOP physicians had deemed this treatment unnecessary or harmful to patients or if the agency had found that the treatment compromised safety, the BOP surely would have mentioned this in the administrative record,” wrote the ACLU.
This is a “glaring omission” that appears to indicate that the government’s arguments are now simply “artificial,” the ACLU continued.
NPR has previously covered the impact of the loss of hormone treatments on incarcerated people. A woman said she had lived severe physical and mental anguish when she lost access to hormonal treatments.
The Supreme Court’s decision is at odds with other rulings that support the Trump administration’s anti-trans policy agenda.
Last June, court ruled states can ban transgender girls to participate in sports at publicly funded schools. And in 2025, court upheld state laws which prohibit doctors and other health professionals from providing gender-affirming care to minors.
In one of his first executive orders of his second term, President Trump targeted the trans community by declaring that his administration recognized only two genders, male and female. This order has been the basis for a host of anti-trans policies across the administration.
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