A view of the U.S. Supreme Court in Washington, D.C., on Oct. 14. Saul Loeb/AFP via Getty Images The Supreme Court ruled Wednesday that the Trump administration must continue providing gender-affirming care to transgender inmates in federal prisons.

The decision, in an emergency appeal, maintains a lower court's injunction on a federal Bureau of Prisons' policy that would terminate hormone therapy and other treatments for trans inmates.

The unsigned order offered no explanation behind the decision. It simply read, "The application for stay presented to The Chief Justice and by him referred to the Court is denied." It also said Justices Clarence Thomas and Samuel Alito would side with the Trump administration and would grant the application for stay.

As the federal judge's injunction remains in place, the legal battle over the policy continues.

In January 2025, upon assuming office, Trump issued an executive order banning the use of federal funds that "promote" gender ideology. And prisoners brought a class action seeking reinstatement of the decades-long health policy. It contends that the Trump policy violates the Eighth Amendment's ban on cruel and unusual punishment.

A federal district judge barred the BOP from implementing its policy this summer. A second court, the U.S. Court of Appeals for the District of Columbia Circuit, also rejected the administration's request to pause U.S. District Judge Royce Lamberth's order.

That's when U.S. Solicitor General D. John Sauer asked the Supreme Court to intervene.

Li Nowlin-Sohl, senior staff attorney at the American Civil Liberties Union and a lawyer involved in this case, said the organization believes there are more than 2,000 people in BOP custody who identify as transgender. (The BOP stopped publishing data reflecting transgender inmates after Trump took office in 2025. It only records male or female individuals incarcerated in the federal system.)

Kingdom v. Trump represents 1,000 inmates who have a gender dysphoria diagnosis, Nowlin-Sohl explained. Of those, the ACLU believes there are about 800 who have been prescribed hormone therapy and many who are also receiving social transition accommodations, Nowlin-Sohl said.

its request for an emergency stay on the earlier rulings, the Trump administration argued that providing this care poses several risks, including for recipients of this specialized care, who it argued would become "targets for attacks." They also said that it raises "fairness concerns" as it would "breed resentment" with other inmates.

Access to gender-affirming care is considered medically necessary to treat gender dysphoria, a medical term used to describe the deep discomfort caused by a mismatch between a person's assigned sex at birth and their gender identity. Without it, individuals can struggle severely with mental health issues such as heightened anxiety and depression, with some turning to self-harm and suicide.

Gender-affirming care can include "...hormone therapy, and gender-affirming surgeries among others," according to the World Professional Association for Transgender Health Some people who are transgender may require hormone therapy and gender-affirming surgeries; others may not require any of these interventions.

The BOP has treated people diagnosed with gender dysphoria since at least 1992, the ACLU said in response to the government's filings to the Supreme Court.

"Had BOP's doctors found this treatment unhelpful or harmful to patients or had the agency found that the treatment compromised security, surely BOP would have mentioned it in the administrative record," the ACLU wrote. This is a "glaring omission" and appears to indicate that the government's arguments now are simply "contrived," the ACLU continued.

NPR previously covered the impact of the loss of hormone treatments on people who are incarcerated.

One woman said she experienced severe physical and mental anguish when she lost access to hormone treatments. The Supreme Court's decision is at odds with other rulings that support the Trump administration's anti-trans policy agenda.

Last June, the court ruled that states can ban transgender girls from participating in sports at publicly funded schools. And in 2025, the court upheld state laws that make it illegal for doctors and other health professionals to provide gender-affirming care for minors.

In one of his first executive orders of his second term, President Trump targeted the trans community with a declaration that his administration recognizes just two sexes, male and female This order has been the basis for a host of anti-trans policies throughout the administration.

But at least for now, the emergency request on the prison policy was to no avail.

Waiting in the wings at the Supreme Court are other cases on transgender rights. Most prominently, the Alliance Defending Freedom, an anti-trans group, has filed an emergency petition at the court on behalf of a mother and her teenage daughter who contend that the daughter was "unknowingly" forced to face a transgender opponent in girl's high school wrestling. Later this year, the court will hear oral arguments in a case testing whether a religious preschool can receive state funding while excluding LGBTQ families.

In a separate case, the justices will examine whether parents have the right to challenge a state law that allows runaway teens to receive gender-affirming care without parental consent.

NPR Legal Affairs Correspondent Nina Totenberg contributed reporting.