Filed
5:35 p.m. EDT
05.22.2025
A federal judge considers if the president’s executive order barring hormone treatment in the Bureau of Prisons is cruel and unusual punishment.
People demonstrate in support of gender-affirming care in Washington, DC, in March.
A federal judge heard arguments Thursday over whether the government can withhold gender-affirming care from people incarcerated by the Bureau of Prisons while a lawsuit against the Trump administration proceeds.
District Judge Royce Lamberth, who sits in Washington, D.C., must consider whether to temporarily stop the prison system from implementing an executive order from President Donald Trump. The order, which Trump signed shortly after his inauguration in January, directed the prisons to stop providing hormone therapy for people being treated for gender dysphoria, as had been the practice for years.
Trump’s executive order prohibited federal spending for “any medical procedure, treatment, or drug for the purpose of conforming an inmate’s appearance to that of the opposite sex.” The lawsuit, filed in March, argued that Trump’s order is unconstitutional because it “mandates an across-the-board ban on such gender-affirming health care for individuals in BOP custody, regardless of the impact on their health.” The suit was brought by the ACLU and the Transgender Law Center on behalf of one trans woman and two trans men, but the lawyers asked the judge to make the case a class action suit representing anyone in federal prison affected by the executive order.
In the suit, lawyers for transgender prisoners argued that Trump’s order directly conflicts with years of court rulings that held that prisons cannot issue blanket bans on any category of medical care without making individualized assessments. They also said that denying incarcerated people gender-affirming care violates the Eighth Amendment’s prohibition on cruel and unusual punishment. The lawyers have asked for the judge to stop the prison system from enforcing the order permanently.
The Bureau of Prisons declined to comment, citing the pending litigation, and a Justice Department lawyer representing the government did not immediately respond to requests for comment after the hearing. In court filings, lawyers for the bureau argued that the federal prison system “has not categorically banned the provision of hormone medication to inmates with gender dysphoria,” and said that there are no grounds for the lawsuit because the named plaintiffs are still on their medicines. The bureau “conducts individualized assessments to address the medical needs of inmates in its custody,” they wrote.
At Thursday’s hearing, an attorney for the Department of Justice argued that the bureau was not withholding hormone therapy from transgender people, but conceded that the government had stopped providing social accommodations such as undergarments.
For more than a month after Trump signed the order, bureau officials in Washington, D.C., issued no formal guidance about how to implement it for the more than 2,000 people incarcerated in federal facilities who self-identified to prison psychology services as transgender. As a result, there was chaos and confusion across the federal prison system, as wardens and other officials confiscated clothing, then gave them back, then confiscated them again.
In late February, bureau officials identified several long-standing accommodations for trans people that would no longer be provided. A Feb. 21 memo said, “Staff must refer to individuals by their legal name or pronouns corresponding to their biological sex.” Trans people could no longer have access to gender-affirming clothing and underwear. All support groups and programs for trans people “must also halt.” Across the country, people reported having bras and other undergarments confiscated in cell searches. Other accommodations, like pat-down searches of trans women by female correctional officers, were no longer available.
People on gender-affirming hormone therapy have received conflicting information about whether they would be able to stay on their medications, and for how long, according to declarations filed in the lawsuit and more than a dozen trans people who have spoken to The Marshall Project. Some were told they could finish whatever prescriptions they already had, but that the prison pharmacy wouldn’t order more. Some reported that their medication was stopped suddenly. Still others were denied their medication, only to have it resume again with no explanation. Alishea Kingdom, the lead plaintiff in the ACLU’s case, said in court filings that the prison stopped access to her hormone medication and then restarted it because, a prison doctor told her, her lawsuit “was causing problems.” More than 600 people are receiving gender-affirming hormone therapy in federal prisons, according to legal filings in the case.
The lawsuit is the latest to challenge Trump’s executive order, and judges have issued several other rulings restricting how it could be implemented in the federal prison system. Most of the previous court proceedings focused on a provision that demanded “that males are not detained in women’s prisons” or immigration detention facilities. A small group of trans women was initially moved from women’s facilities to men’s facilities and then back. Lamberth is overseeing two of those cases as well.
Phaedra McLaughlin arrived in the federal prison system in February to begin serving a 3 ½ year sentence for using a stolen credit card. She has been on hormone therapy for more than 20 years and had gender-confirmation surgery in 2018. At her sentencing in December, the judge recommended she go to a women’s minimum-security prison in Texas. But because of the executive order, she was ultimately sent to a men’s medical center in Minnesota, where she and four other trans women lived in an open dorm with 30 men, she said. While she was there, she lost access to her hormone therapy.
“I am a POST-OP trans woman,” she wrote in a recent email. “The executive order is placing persons with VAGINAS in MALE prisons.” She was only there for a few days before she joined a separate lawsuit challenging the housing policies and was sent to a women’s prison.
The vast majority of the 1,350 trans women in the system are housed in men’s facilities, according to bureau data obtained by The Marshall Project. They have long been able to access some accommodations, like women’s undergarments and women’s hygiene items, from the commissary. (There are about 750 trans men in the system, according to bureau data. All but one of them were housed in women’s prisons. For safety reasons, it’s very unusual for trans men to request placement in men’s facilities.)
Ayana Satyagrahi, who is incarcerated at a men’s prison in Texas, described having to shower in common areas alongside men now that her prison no longer provides a designated shower time for transgender women only. “We’ve had guys come in the shower area on us,” she said.
When it came to gender-affirming medications, the bureau’s Health Services Division sent prison administrators a memo that was only two sentences. It reiterated the language of the executive order barring medical procedures and medications without explaining what to do about the hundreds of people already on hormones, or how to proceed when prison psychologists think hormone treatment or surgery is needed. The memo concluded by saying that the policy “is to be implemented in a manner consistent with applicable law including the Eighth Amendment.”
One nurse at a federal prison in Texas said the memo was more confusing than clarifying. “They just kind of dance around everything,” said the nurse, who asked not to be named because she’s not authorized to speak to the press. “They give an answer, so they can say they gave one, but then they don’t give a clear enough answer to let you know what to do.”
In court documents, ACLU attorneys have argued that the bureau’s instructions were clearly contradictory.
In a declaration filed in the case, Rebecca-James Meskill, a transgender woman housed in a men’s prison in Alabama, said that after more than a year of hormone therapy, refills of her medication suddenly stopped in March. When she asked a prison doctor about it, “he said to take it up with the White House.”
