Transgender Inmates Challenge Federal Prison Policy on Healthcare Access

Why it matters locally: This Supreme Court case challenging federal prison healthcare policy could have implications for transgender individuals incarcerated in federal facilities located within Tennessee, potentially affecting their access to hormone therapy and other accommodations.

WASHINGTON – Lawyers for a group of transgender inmates on Thursday asked the Supreme Court to keep in place a federal judge's order that prevents the Federal Bureau of Prisons (BOP) from enforcing new healthcare policies for transgender inmates. The Trump administration's policy, adopted earlier this year, restricts access to hormone therapy and social accommodations such as makeup, wigs, and padding. Attorney Li Nowlin-Sohl, representing the inmates, stated to the justices that the administration seeks to reverse a three-decade-long existing practice. This policy followed a February 2025 executive order from President Donald Trump. That order directed the attorney general to ensure no federal funds would be spent on medical procedures, treatments, or drugs intended to conform an inmate's appearance to that of the opposite sex. When the BOP adopted its February 2026 policy, it stated the decision was independent of Trump’s executive order. The bureau cited an extensive administrative record and a 43-page memorandum. In this document, the BOP attributed the policy change to "the latest scientific information," stating that prior policies relied on recommendations from the World Professional Association for Transgender Health, which prison administrators deemed "unreliable" and "unpersuasive." The BOP also raised concerns that providing gender-transition surgeries could lead to "attacks," "raise fairness concerns," and "breed resentment among other inmates." Three transgender inmates filed a class-action lawsuit in federal court in Washington, D.C., to block the policy's enforcement. On August 26, Senior U.S. District Judge Royce Lamberth issued an order barring the BOP from implementing its 2026 policy. On September 18, a divided panel of the U.S. Court of Appeals for the District of Columbia Circuit rejected the government's request to pause Lamberth's order. The Trump administration subsequently appealed to the Supreme Court on September 28, requesting the justices block Lamberth's order. U.S. Solicitor General D. John Sauer informed the Supreme Court that the district court had "substitut[ed] its own policy judgment for that of the" BOP, "rel[ied] on evidence outside the administrative record, and fault[ed] the agency for following presidential directions." Sauer also added that the district court "denied prison administrators the substantial deference they are due." In their Thursday filing, the inmates argued the new policy failed to meet federal administrative agency laws. They asserted the BOP did not provide a "reasoned explanation" for its decision. Nowlin-Sohl wrote that the BOP's extensive record was "silent about BOP’s extensive experience providing" hormone therapy and social accommodations "and whether it supports" the BOP’s conclusions that "this care is not medically necessary and poses security and administrative issues." The brief further stated the record was "devoid of any evidence indicating whether BOP healthcare providers found this care effective, ineffective, or harmful to patients." The inmates also contended that the BOP had "cut off treatment that its healthcare providers had recommended for decades and replaced it with psychotherapy" and "psychotropic medications." They noted that "BOP’s Medical Director recognizes... [these] treat co-existing conditions such as depression and anxiety, not gender dysphoria itself." The inmates concluded that the BOP's failure to include "key evidence" in the record "make[s] it clear that the rationales were contrived to support the demand President Trump made in the EO." Finally, the inmates told the justices that pausing the district court’s order would cause them permanent harm. They stated that "Withdrawing care will cause significant changes to their bodies and put [them] and class members at serious risk of worsening gender dysphoria as well as other mental health symptoms including depression, anxiety, self-harm, and suicidality."