In a succinct unsigned opinion, the US Supreme Court on Wednesday denied the Trump administration’s request to stay an injunction that would bar implementation of the Federal Bureau of Prisons (BOP) policy denying gender-affirming care to transgender inmates in federal prisons. Justices Thomas and Alito would have granted the administration’s call for a stay.

This rare move by a conservative-dominated Supreme Court permits over 1,000 incarcerated individuals diagnosed with gender dysphoria to receive gender-affirming care, including hormone therapy and social accommodations, while the long-term legality of the BOP’s policy is worked out in the lower courts.

Li Nowlin-Sohl, senior staff attorney with the ACLU’s LGBTQ & HIV Project, praised the decision:

This is a critical ruling for our clients and all transgender people in Bureau of Prisons custody. The denial of medically necessary health care, including gender-affirming health care, to people in prison is a violation of their fundamental constitutional rights. We will continue to defend the rights of our clients and all incarcerated people.

The legal action and subsequent court intervention challenging the BOP’s policy stems from a January 2025 executive order (EO) directing the BOP to revise its policies to “ensure that no Federal funds are expended for any medical procedure, treatment, or drug for the purpose of conforming an inmate’s appearance to that of the opposite sex.”

The EO, entitled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government,” indicates that its purpose is to protect women from fundamental attacks on their “dignity, safety, and well-being” by preventing anyone other than a federally-defined biological woman from accessing “intimate spaces” such as detention centers. This EO came despite the studies and information indicating that transgender individuals in carceral settings experience sexual violence, harassment, and harm at extreme levels.

In February 2026, the BOP issued a policy implementing the directives of the EO and conveying its compliance by ceasing the use of federal funds for the provision of hormone therapy and social accommodations for incarcerated individuals.

Three transgender inmates then filed a class action lawsuit in the US District Court for the District of Columbia seeking to block the enforcement of the policy. The court granted an injunction, and the BOP appealed to the US Court of Appeals for the District of Columbia, which denied the request to stay the injunction. This prompted the BOP to petition the Supreme Court for emergency review of the action.

The high court’s ruling confirms and permits what the plaintiffs call a “decades-long” status quo of access to adequate health care and medical treatment, including gender-affirming care.

Aditi Shah, an ACLU-DC staff attorney, indicated that “[t]his ruling will prevent serious and irreparable harm to the Plaintiffs and the class while we continue to challenge the government’s unlawful efforts to deny medically necessary health care for political reasons.”