Imminent Supreme Court Ruling May Signal Future of Hormone Therapy in Federal Prisons

The Bureau of Prisons said in 2025 that it was giving hormone therapy to more than 600 inmates at taxpayer expense. The Trump administration is asking the Supreme Court to let it halt the practice. Justice Department figures put the bureau’s spending on that therapy at about $1.25 million under Biden-era practices.The justices are not being asked to rule on whether a new policy ending the treatments is lawful. The administration wants the court to freeze a federal judge’s order blocking it from enforcing the policy while a legal challenge to its new rules works its way through the courts.On that narrower question, one legal scholar says the government has the edge.“I think the government will win at the Supreme Court because of the broad deference prisons usually get,” the professor of law and Centennial Chair of Constitutional Law at the South Texas College of Law in Houston, Josh Blackman, tells The New York Sun.What the Policy Would DoThe administration asked on September 28 for a pause on an injunction from Judge Royce Lamberth of the Federal District Court at Washington, D.C., that has blocked the bureau from enforcing the new policy, which it issued February 19. In a response filed on Thursday — the deadline set by Chief Justice John Roberts — the prisoners’ lawyers urged the justices to leave Judge Lamberth’s order in place, arguing that the bureau had offered no reasoned explanation for its new policy and that the administration is asking the high court “to overturn a three decades-long status quo.” The lawyers also said that withdrawing the care would put the prisoners at serious risk of worsening dysphoria, depression, self-harm and suicidality.The policy, titled “Management of Inmates with Gender Dysphoria,” reverses years of bureau guidance that treated hormone therapy as an option for inmates diagnosed with the condition. It replaces hormone treatment and surgery with psychotherapy, counseling, psychiatric services and psychiatric medications. It bars new hormone prescriptions for gender dysphoria, and directs clinicians to taper existing ones, accounting for each inmate’s treatment history, response to medication and whether the person has had surgery.Gender-affirming surgery would be prohibited, though care for complications from past operations would continue. Officials are told, when practicable, to remove or confiscate items such as binders, wigs, makeup and breast padding. The administration’s application acknowledges that some inmates who have had surgery, or who suffer severe withdrawal effects, might initially continue receiving hormones.The policy follows President Trump’s January 2025 order, which directed the bureau to ensure no federal funds are spent on treatment “for the purpose of conforming an inmate’s appearance to that of the opposite sex.”Solicitor General D. John Sauer argues the bureau independently reconsidered its approach based on medical evidence and security concerns. The filing says the bureau determined that surgeries, hormone interventions in general and social accommodations “could no longer be justified as treatment for gender dysphoria.” Mr. Sauer writes that the policy is necessary “to maintain institutional security,” and objects that the lower court’s decision “nullifies” that determination.Mr. Blackman stresses the government’s position is that there are only two sexes and no medical reason to provide the therapy.The stakes are immediate. If the justices grant the request, tapering could begin for the hundreds of inmates now receiving hormones. If they refuse, the injunction stays in place while the case moves toward a fuller hearing on the merits.A Small Program, a Big FightThe legal dispute affects only a small slice of the federal prison population. Bureau data reported at the start of 2025 put the number of transgender persons under its care at about 2,000, roughly 1.5 percent of the more than 140,000 individuals held in federal prisons and jails. In March 2025, the Associated Press quoted the bureau saying it had nearly 2,200 transgender persons in custody. Against either count, the 600-plus inmates receiving hormones make up well under 1 percent of the federal prison population.The Justice Department says the bureau’s total spending on gender-affirming care under those practices came to about $1.65 million, with roughly $1.25 million going to hormone therapy.Critics of the practice argue the relatively low figures hide real problems inside prisons.“Male inmates who receive cross-sex hormones often do so as a means of securing transfer to a women’s prison; although medical interventions are not necessary to qualify, they can bolster transfer requests,” a research associate at the Manhattan Institute, Forest Romm, tells the Sun.Mr. Romm underscores that giving inmates the drugs “introduces serious security risks for prison staff and other inmates, exacerbates mental illness and behavioral problems in those receiving hormones, wastes taxpayer money, and lacks a strong evidentiary basis for its psychological benefits.”He also points to the science the bureau once relied on.“Systematic reviews of cross-sex hormone interventions in adults have also found a weak evidence base, including a shortage of controlled studies and serious risks of bias in the observational research,” Mr. Romm continues.Not everyone sees it that way. “Prison officials generally have a lot of leeway when it comes to medical care and security. But they still need to make sure it is minimally adequate; inmates have a constitutional right against cruel and unusual punishment,” the federal policy director at the Williams Institute, Elana Redfield, tells the Sun.The effects would not fall only on transgender women. Two of the three original plaintiffs are transgender men who were born female. Court filings show that, as of early 2025, all but one of the roughly 710 transgender men in bureau custody were housed in women’s prisons, so the policy would not send them anywhere new. The question for them is what happens inside women’s facilities as the drug is tapered.“People in prison are completely dependent upon the facilities for their medical care, which means that cases like this one have very high stakes,” Ms. Redfield says.Mr. Romm sees the risk running the other way, though he stresses his research covers state prisons rather than the federal system.“There is also a growing problem with trans-identified female inmates receiving testosterone and becoming physically aggressive and sexually violent,” he says.What the Courts Have Said and What Comes NextThe lawsuit, Kingdom v. Trump, began in March 2025 as a class action filed at Washington, D.C., on behalf of the roughly 2,000 transgender persons in federal custody. It started with three prisoners held in New Jersey, Minnesota and Florida — two transgender men and one transgender woman — whose prison medical providers had diagnosed gender dysphoria and prescribed hormones. The American Civil Liberties Union, its Washington affiliate and the Transgender Law Center brought the case.Judge Lamberth, a Reagan appointee, issued an injunction in June 2025 and certified a class of current and future federal prisoners diagnosed with gender dysphoria. After the bureau issued its new policy, he blocked it in June and later renewed the order, finding the prisoners likely to succeed under the Administrative Procedure Act because the government “cites zero evidence” from medical professionals to support its conclusion that the care is not medically necessary. Writing that the court had no interest in “wading into the culture war” over transgender people, the judge rested the ruling on administrative law. A divided federal appeals court panel declined to suspend the renewed order on September 18, prompting the government to go to the Supreme Court. The conservative-majority justices have upheld state laws on medical treatments for transgender minors and transgender athletes, and they have allowed the administration to proceed, for now, on policies covering military service and passports. With the prisoners’ response now filed, a ruling could come at any time, and the interim decision may signal where the case ends up.Ms. Redfield questions why the justices are being asked to act now.“I don’t know whether the Court will take this up. It is hard to understand what the ‘emergency’ is here,” Ms. Redfield says, adding that she doesn’t see how the government would be harmed by preserving the status quo, in which inmates have been receiving gender-affirming treatments and accommodations for more than a decade.Ms. Redfield says the most recent federal orders on gender-affirming care instruct agencies to set aside decades of research.“If the evidence were given proper consideration, it might change the outcomes,” Ms. Redfield says. “For example, in the largest U.S. study of transgender people, 98 percent of respondents who were currently undergoing hormone therapy said it made them more satisfied with their lives. Facts matter.”Skeptics counter that the question isn’t only medical. Mr. Romm, whose research covers state rather than federal prisons, says female inmates have told him they are denied Rogaine and breast-reduction surgery. In contrast, transgender inmates can receive taxpayer-funded wigs, laser hair removal and mastectomies.“There are numerous other examples of this disparity, which is terrible for morale and raises questions about what constitutes a ‘medically necessary’ intervention,” Mr. Romm says.

Imminent Supreme Court Ruling May Signal Future of Hormone Therapy in Federal Prisons

Imminent Supreme Court Ruling May Signal Future of Hormone Therapy in Federal Prisons

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