The US Supreme Court rejected on Wednesday a bid by US President Donald Trump's administration to immediately enforce a policy restricting gender-affirming care for transgender inmates in federal prisons in a rare win for transgender rights at the nation's top judicial body.
The court denied the Justice Department's emergency request to lift a federal judge's order blocking the Federal Bureau of Prisons from implementing the policy, while a legal challenge to the measure plays out.
The policy, issued in February, prohibits medical and surgical treatments as well as any "social accommodations" such as clothing and hair-removal devices that could be used to alter a person's appearance to align with their gender identity. The policy would still allow for psychiatric services to be provided.
Three transgender inmates incarcerated at federal correctional institutions in New Jersey, Florida, and Minnesota filed a class action lawsuit challenging the policy.
The Supreme Court's brief order gave no explanation for its action, as is common when the justices handle emergency requests. Conservative Justices Clarence Thomas and Samuel Alito publicly dissented from the decision.
"This ruling will prevent serious and irreparable harm to plaintiffs and the class while we continue to challenge the government's unlawful efforts to deny medically necessary healthcare for political reasons," said Aditi Shah, an attorney at the American Civil Liberties Union, which helps represent the inmates challenging the policy.
The Bureau of Prisons declined to comment on the decision.
Over 2,000 transgender inmates in the US face risk of restrictions
There are more than 2,000 transgender inmates in federal facilities and halfway houses, according to a government figure from 2025.
The new restrictions would reverse the government's prior procedures. The federal prison system has treated people with gender dysphoria with hormones since at least 1992, according to the plaintiffs.
Gender dysphoria is a term for the clinical diagnosis of significant distress that can result from an incongruence between a person's gender identity and sex at birth.
Trump has taken a hard line on transgender rights since returning to office in January 2025.
The president issued an executive order on his first day back in office recognizing only two genders - male and female - and casting transgender identity as a lie. The directive ordered changes across numerous federal agencies, including that "males are not detained in women's prisons" and halting funding for treatments "for the purpose of conforming an inmate's appearance to that of the opposite sex."
In the litigation, the administration has called medical care provided for gender transition "unproven sex-rejecting interventions."
Siding with the administration would cause "immediate and catastrophic" harm, the plaintiffs said in a court filing, noting that "patients who are denied hormone therapy can suffer from increased depression, anxiety, suicidal ideation and self-harm."
The Supreme Court, which has a 6-3 conservative majority, has ruled against transgender rights in key cases since last year.
It backed state laws banning transgender athletes from participating on female sports teams at public schools, including universities. It also allowed the administration to ban transgender people from the military and bar passport applicants from designating their gender identities for the document. In addition, it let states ban gender-affirming medical care for transgender youths.
Washington judge blocks administration's restrictions on federal prisoners
Washington, DC-based US District Judge Royce Lamberth blocked the restrictions on federal prisoners in June, concluding that the policy is likely "arbitrary and capricious" and violates a federal law governing agency procedures.
The judge found that the Federal Bureau of Prisons disregarded its own evidence and experience and "reverse engineered" the measure in order to implement Trump's executive order.
"With this opinion, the court has no intention of wading into the culture war being waged against transgender individuals," Lamberth wrote.
On September 18, the US Court of Appeals for the District of Columbia Circuit refused the administration's request to lift Lamberth's ruling.
The Justice Department in its filing urged the Supreme Court to allow the Federal Bureau of Prisons to enforce its "decision to prioritize mental-health treatment, while discontinuing medically disputed and unproven sex-rejecting interventions."
The Bureau of Prisons, the filing said, "reasonably considered its prior experience both in determining that such interventions are not medically necessary and in determining that security and prison-administration concerns independently justified a change in policy."