The Supreme Court declined on Wednesday to revive the Trump administration’s policy barring taxpayer money from going to pay for drugs or operations for prisoners seeking to switch genders.
President Trump had to let the policy remain in effect while the case moved through the courts.
The justices, without comment, denied his request to end the process.
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As a result, the Bureau of Prisons will continue to fund gender transitions for the foreseeable future.
Two members of the court, Justices Clarence Thomas and Samuel A. Alito Jr., noted their dissent from the ruling.
Federal prisons had covered surgeries, hormone treatments and other “social accommodations” for transitioning inmates until Mr. Trump took office in 2025 and declared a reversal.
He said the government would recognize only two sexes and would limit accommodations for those who tried to transition.
The BOP said it would still cover mental health treatments for those diagnosed with gender dysphoria, but not the other interventions.
“BOP’s decision to prioritize mental-health treatment, while discontinuing medically disputed and unproven sex-rejecting interventions, falls well within the bounds of reasoned decision-making,” Solicitor General D. John Sauer said in his petition asking the justices to step in.
U.S. District Judge Royce Lamberth, a Reagan appointee to the court in Washington, found Mr. Trump’s policy to be unreasonable and arbitrary, and put it on hold.
He said the prisoners had been getting hormone treatments, social accommodations and surgery before and that the government needed a better explanation if it wanted to stop them.
He approved a class action and applied his order to all current and future federal prisoners who had a diagnosis of gender dysphoria.
Judge Lamberth waved aside the administration’s arguments that the old policy was based on a now-crumbling consensus about the best treatments for gender dysphoria.
Mr. Sauer said opponents of the president were seeking to “run out the clock” by dragging the litigation on long enough to outlast the Trump administration.
He defended the BOP’s decisions, saying they took account of the evolving science and concluded that “the latest scientific information does not support providing sex-trait-modification surgeries, hormone interventions in general, and social accommodations as treatment for inmates with gender dysphoria.
“All agree that gender dysphoria is a mental-health disorder, so BOP will address it through mental-health treatment,” he said in a briefing to the justices.
Prison officials also said they had concerns over security and difficulty in administering prisons. That included the danger that those who underwent “sex-rejecting interventions” would become targets for other inmates.
Judge Lamberth saw those as misleading reasons.
The case came to the justices on the “emergency” docket, which is handled with limited briefing and no oral argument. Those are usually cases where the justices are being asked to step in and put lower court rulings on hold while the cases proceed.
Wednesday’s action wasn’t a final decision, and leaves room for the case to return to the high court later.
For now, though, lawyers for transgender inmates celebrated a win.
“Today’s ruling affirms that everyone, trans or not, deserves access to medically necessary health care and to be treated with dignity in federal custody,” said Shawn Thomas Meerkamper, managing attorney at the Transgender Law Center.
Before this case, the Supreme Court had been quite active in the fast-moving area of transgender rights.
In the past few years, it allowed states to block transgender medical treatments for juveniles, and ruled that states can restrict sports leagues to prevent biological boys and men from competing against girls and women.
Earlier this month, a high school wrestler in Washington asked the justices to intervene in her case, where she wanted to opt out of competing against biological males.
The girl said she was sexually assaulted in a previous match by a transgender wrestler who stuck fingers inside her vagina.
The justices have yet to rule on her petition.
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