Federal Prisons Tried to Cut Off Hormones for Trans Prisoners. A Judge Said No
The ruling keeps gender-affirming care in place while the court weighs whether the Bureau of Prisons built a medical excuse around Trump’s anti-trans order.
A federal judge has ordered the Bureau of Prisons to keep providing hormone medication to transgender prisoners, blocking for now a Trump administration policy that would have pushed incarcerated trans adults off gender-affirming medical care and toward psychotherapy and psychotropic drugs instead.
The ruling matters because federal prisoners cannot simply find another doctor, another pharmacy, another clinic, or another way to receive care. When the government incarcerates someone, it controls access to treatment. For trans prisoners with gender dysphoria, that control becomes dangerous when prison policy is rewritten around anti-trans politics instead of medical need.
Judge Royce C. Lamberth, a federal judge in Washington, issued the preliminary injunction on Wednesday. He found that the Bureau of Prisons was unlikely to satisfy the legal requirement that agencies give a reasoned explanation when reversing existing policy.
The case centers on a Bureau of Prisons policy announced earlier this year called “Management of Inmates with Gender Dysphoria.” The policy called for prisoners to be tapered off hormone therapy and treated instead with psychotherapy and psychotropic drugs. It also barred access to social accommodations such as bras, cosmetics, and other items associated with a gender different from the one assigned to a prisoner at birth.
That policy came as the Trump administration has moved across the federal government to narrow recognition of trans people, restrict access to gender-affirming care, and force official systems back toward sex-assigned-at-birth classifications. Passports, military service, bathrooms, youth healthcare, research grants, school policy, and prison housing have all become sites of federal anti-trans action.
Inside prisons, the stakes are sharper because the people targeted have fewer ways to protect themselves.
About 1,028 federal prisoners have been diagnosed with gender dysphoria, according to the Bureau of Prisons. Of that group, 628 receive cross-sex hormone therapy. For those prisoners, the policy was not an abstract fight over agency language. It threatened treatment their own prison doctors had previously deemed necessary.
Lawyers for the prisoners, represented by the Transgender Law Center and the A.C.L.U. Foundation, argued that the Bureau of Prisons had manufactured a medical rationale to carry out President Trump’s policies. They said the agency understood the risks of withholding hormone treatment because its own doctors had previously provided the care.
Those risks include worsened depression, anxiety, suicidal thoughts, and self-harm, according to the prisoners’ lawyers. They also argued that psychotherapy and psychotropic drugs do not substitute for hormone therapy when hormone therapy is the medically necessary treatment for gender dysphoria.
One plaintiff, Solo Nichols, said in a sworn declaration that he had tried many psychotropic medications before hormone therapy and found them ineffective. That detail cuts against the government’s replacement framework, which treats psychiatric drugs and therapy as if they can stand in for transition-related medical care.
Judge Lamberth rejected, at least for now, the Bureau of Prisons’ attempt to justify that reversal. In his opinion, he found that the policy was likely “arbitrary and capricious” under the Administrative Procedure Act, the federal law requiring agencies to give reasoned explanations for policy changes.
The judge said the Bureau of Prisons failed to account for its own history of providing hormone therapy and social accommodations to prisoners with gender dysphoria. He also criticized the agency for relying on a doctor with limited experience treating gender dysphoria who promoted psychotherapy as a treatment that the doctor himself acknowledged was not evidence-based.
Most sharply, Lamberth said the Bureau of Prisons appeared to have “reverse-engineered” its rationale to fit President Trump’s executive order. That is the core accountability point in the ruling: the government cannot take a political command, dress it up as medical judgment, and use that as the basis for cutting off care it previously recognized as necessary.
The administration’s argument depended heavily on the claim that medical consensus had shifted. A government lawyer told the court that “the pendulum has swung” on support for hormone treatment. The Bureau of Prisons said it had concluded after a monthslong assessment that evidence supporting hormone therapy for adults with gender dysphoria was weak.
The prisoners’ lawyers pointed to the long-standing acceptance of transition-related care for adults and to support from major medical and mental health organizations in the United States. They also emphasized that the government had not shown evidence that psychotherapy or psychotropic medication would relieve gender dysphoria in the way the agency claimed.
For trans prisoners, this is the difference between care and control. A person outside prison may be able to seek another provider, challenge insurance, travel to another clinic, or rely on community support. A prisoner cannot do that. The prison system becomes the gatekeeper for nearly every condition of survival.
That is why denying gender-affirming care in custody is not the same as denying care in an ordinary medical setting. In prison, the state creates the dependency and then controls whether the person receives treatment. When the state uses that control to withdraw care from trans prisoners, the harm is imposed through confinement itself.
The ruling also follows another recent decision from Judge Lamberth involving transgender prisoners. Earlier this month, he found that a Bureau of Prisons plan to transfer 14 transgender women from women’s facilities to men’s facilities was likely to violate the Eighth Amendment’s prohibition on cruel and unusual punishment. Together, the cases show how federal anti-trans policy is being tested inside prisons, where housing, safety, medical care, and identity are all under state control.
The Justice Department defended the Bureau of Prisons policy by saying it ensures inmates with gender dysphoria are treated consistent with best medical practices. But the court’s ruling points to the gap between that claim and the record before the judge. According to the opinion, the agency had not shown that it considered the relevant evidence and reached a reasonable conclusion from that evidence.
For trans prisoners, the immediate result is protection from forced withdrawal while the case continues. The deeper issue is whether the federal government can use prison policy to turn gender-affirming care into something optional, suspect, or replaceable by psychiatric drugs.
That question reaches beyond one medication policy. It asks whether trans people lose medical recognition when the state gains control over their care. It asks whether prisons can become laboratories for anti-trans policy. It asks whether medical treatment can be rewritten around executive politics after the government has already accepted that care as necessary.
Lamberth’s ruling does not end the case. It does not settle every future fight over trans healthcare in federal custody. But it blocks, for now, a policy that would have forced trans prisoners off hormone treatment while the government leaned on a rationale the judge found likely unreasonable.
Trans prisoners should not have to depend on litigation to keep medically necessary care from being stripped away. This ruling makes one thing clear: the Bureau of Prisons cannot simply recast anti-trans policy as medicine and expect the court to treat that as a reasoned agency decision.
When the government controls a trans person’s access to medicine, safety, and daily survival, care is not symbolic. It can be the difference between treatment and state-imposed deterioration.
Federal prison policy is being used as another front in the campaign to control trans bodies, restrict medical care, and treat survival needs as political choices.
When the government controls a trans person’s housing, movement, safety, and access to medicine, denying gender-affirming care becomes state harm.
Trans United documents these cruelty because trans people deserve protection, healthcare, housing, and survival support before institutions turn their bodies into policy battlegrounds.
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