The Supreme Court refused Wednesday to let the Trump administration immediately end surgeries, hormones, and cross-sex accommodations for transgender inmates, leaving a lower-court order in force.
In a brief emergency docket action out of Washington, the justices declined to lift an injunction that stops the Bureau of Prisons from enforcing new medical restrictions while the case proceeds. Only Justices Clarence Thomas and Samuel Alito noted they would have allowed the policy to take effect now.
The unsigned order gave no written explanation. It is not a final ruling on the merits. It simply leaves U.S. District Judge Royce Lamberth’s block in place for the time being, as Just the News reported.
President Donald Trump’s executive order directed the Bureau of Prisons to revise medical policies so federal funds are not spent “for the purpose of conforming an inmate’s appearance to that of the opposite sex.” The revised approach would halt surgeries, taper hormone therapy, and end social accommodations such as makeup and wigs. Mental health services would continue.
About 600 federal inmates were receiving hormone therapy in 2025, the agency said in court records. The administration argued the treatments raised security concerns and “could no longer be justified.”
Judge Lamberth, nominated by President Ronald Reagan, ordered the treatments to continue. He pointed to risks of untreated gender dysphoria, including depression, anxiety, and suicidal thoughts. Attorneys for the inmates challenged the policy and said withdrawing care would have major effects on bodies and mental health.
Those lawyers also argued the government has not detailed evidence of security problems tied to hormone therapy across the roughly 30 years it has been provided. A divided appeals court panel left Lamberth’s order standing, and the administration sought emergency relief at the high court.
The Associated Press reported the Supreme Court’s refusal to clear the path for immediate enforcement, keeping the lower-court block intact.
Readers tracking the Court’s current term will note other active matters, including when the Supreme Court takes Maryland magnet-school fight over race in admissions.
The New York Post detailed Lamberth’s critique of the government’s filing. He found the Bureau of Prisons memo restricted funding for transgender medications and for clothing that did not match biological sex, and he concluded the government had not assessed impacts with enough care.
Lamberth wrote that the government cited “zero evidence from its own medical or mental health professionals to support its conclusions,” despite years of providing the care.
"Despite providing gender-affirming care to inmates in its custody for years, the government cites in the Program Statement zero evidence from its own medical or mental health professionals to support its conclusions."
He added that officials “provided no evidence that the previous plan was ineffective or harmful.” Inmates and the ACLU had raised Eighth Amendment claims, and Lamberth treated those concerns as serious enough to keep the prior care regime in place while the fight continues.
That reading puts a Reagan-appointed judge at odds with an administration trying to stop prison budgets from underwriting appearance-altering interventions. The high court, for now, has left his injunction undisturbed.
Separately, the justices are also set to weigh a long federal ban on making liquor at home, another case about the reach of federal rules.
The Washington Examiner reported the Court ruled 7-2 against the Justice Department’s emergency petition. Thomas and Alito would have granted the stay and lifted the injunction. The majority offered no further reasoning in the short order.
That posture differs from other recent transgender-related actions. The same Court has allowed certain administration policies to move ahead for now, including limits on military service and on passport sex markers. It has also upheld state laws barring some medical treatments for transgender youth and restricting sports participation by transgender athletes in women’s sports.
Here, emergency relief was denied. The injunction stays. Litigation on the underlying policy continues in the lower courts. Taxpayers, prison wardens, and medical staff remain under the old care framework until a fuller ruling arrives.
National-security and capital docket watchers have also seen the Court leave the 9/11 mastermind facing a capital trial after rejecting a plea-deal appeal, another high-stakes order with limited public explanation.
The administration’s stated aim is straightforward: stop using federal prison dollars to reshape an inmate’s appearance to the opposite sex. Surgeries would stop. Hormones would be tapered. Makeup and wigs used as social accommodations would end. Counseling and mental health care would remain available.
Critics of the old approach see a basic fairness problem. Law-abiding Americans face rising costs and long waits for ordinary care, while a small inmate population, roughly 600 on hormones in the latest agency figure, receives specialized cross-sex interventions behind bars. Security staff must also manage housing, searches, and interpersonal risk when biological sex and claimed identity diverge.
Inmates’ lawyers counter that abrupt withdrawal risks physical and mental harm, and they say the government has not produced a clear security record against hormone therapy over decades of use. Lamberth credited the absence of detailed medical evidence in the program statement and kept treatments on.
Debates over the Court’s size and role continue in Congress as well, including when Collins rejects Supreme Court packing after a Democrat opened the door to expansion.
Wednesday’s action freezes the status quo. It does not bless permanent taxpayer funding for inmate surgeries or hormones. It does not strike down the executive order. It does not adopt the inmates’ constitutional theory as final law. It holds only that the administration may not enforce the new restrictions immediately while appeals run.
Thomas and Alito would have let the Bureau of Prisons implement the limits now. Seven justices declined. The public is left with a short order, a live injunction, and a policy fight that still has to be won on a fuller record.
In a different regulatory fight, the Court recently handed the Trump FCC a 7-2 stay in a political-ad discount dispute, a reminder that emergency outcomes can cut either way depending on the record and the equities.
For now, federal prisons remain under a court order to keep providing the contested treatments. The administration’s security and funding arguments will have to be developed further in the lower courts. Biological sex, prison safety, and the proper use of public money are still on the table. They have not been taken off it by a one-line refusal to lift a stay.
When judges keep inmate gender medicine on the taxpayer tab without a full airing of prison security evidence, voters are right to ask who the system is built to serve.
