Supreme Court Leaves Gender-Affirming Care in Federal Prisons Intact

The Supreme Court on October 21, 2026 refused to disturb a preliminary injunction that requires the Federal Bureau of Prisons to keep providing gender-affirming care to transgender people in its custody. The Court issued no opinion explaining the denial. Justices Clarence Thomas and Samuel Alito indicated they would have granted the government's application.

The policy at issue traces to Executive Order 14168, which directs that federal money not be spent to conform an incarcerated person's appearance to that of the opposite sex. The Bureau first implemented that directive through memoranda and then, in February 2026, through Program Statement 5260.01, which barred funding for hormone therapy and surgical care and suspended social accommodations — clothing, commissary items, and pat-search protocols — along with name and pronoun practices. Mental health services and medications such as antidepressants would have remained.

Senior U.S. District Judge Royce Lamberth enjoined the program statement on June 17, 2026, finding that the Bureau had not reckoned with its own three-decade practice of providing hormone therapy, had offered no evidence that the treatment was ineffective or dangerous, and had advanced justifications that looked like pretext for implementing the executive order. The D.C. Circuit declined to stay that order; the Supreme Court has now done the same.

Roughly 1,000 transgender people in Bureau custody are covered by the certified class. Because this is an order on an emergency application rather than a merits decision, the underlying litigation continues in the district court — but the operative rule for now is the Bureau's pre-executive-order standard of care.