Trans Organization’s ‘Unreliable’ Standards Don’t Justify Prison Medical Interventions, DOJ Tells Supreme Court

The Trump administration is asking the Supreme Court to allow the Bureau of Prisons to restrict sex-rejecting procedures for federal inmates, citing an exhaustive BOP report rejecting the recommendations of the World Professional Association for Transgender Health as “unreliable” and based on “insufficient evidence.”

Solicitor General D. John Sauer asked the Supreme Court to lift a lower-court injunction Monday after the Court of Appeals for the Washington, D.C., Circuit let the injunction stand on Sept. 18.

A district court judge had ruled that the Bureau of Prisons had not adequately considered “its own experience providing gender-affirming care under its prior policy,” that the policy is “objectively unreasonable,” and that the policy is “pretextual and reverse engineered to implement” President Donald Trump’s executive orders.

Yet Sauer’s brief states that the Bureau of Prisons adopted the policy independent of the executive order after an exhaustive review, including a 3,200-page administrative record, explained in a 43-page memorandum. The review explained why the Trump administration rejected the authority of WPATH, the very authority that President Barack Obama’s administration had relied on to approve sex-rejecting procedures for inmates.

In developing the new policy, “BOP determined that sex-trait-modification surgeries, hormone interventions in general, and social accommodations could no longer be justified as treatment for gender dysphoria,” the brief notes.

The bureau repeatedly cited Justice Clarence Thomas’ concurrence in U.S. v. Skrmetti (2025), the 6-3 decision allowing states to ban these procedures for minors. The bureau found that “those interventions did not reflect the latest scientific information, which had undermined BOP’s prior reliance on the recommendations of the World Professional Association for Transgender Health—an organization whose standards had recently been called into serious question by medical professionals.”

Independent of the medical debate, BOP also concluded that the interventions raised security and administration concerns. Access to such procedures would risk turning inmates who received them into “targets for attacks,” “raise fairness concerns,” and “breed resentment among other inmates.” Some interventions would enable inmates to “hide contraband” or “obfuscate or conceal” their identity. The new policy restricts “breast padding,” chest “binders,” makeup, and wigs.

As for the claim that BOP failed to consider its previous guidance, Sauer quoted at length from the BOP memorandum.

“WPATH openly engages in ideologically based political advocacy, systematically misrepresents evidence, and often bases its recommendations, no matter how impactful for the patient, on low-quality supporting evidence,” the memo noted.

The Department of Health and Human Services previously published a peer-reviewed report finding “extremely weak evidence” for any benefits from sex-rejecting procedures for minors.

Internal WPATH files revealed that WPATH members expressed concerns about minors’ inability to consent to interventions with potentially lifelong impacts.

In 2022, WPATH left age recommendations for specific treatments out of its Standards of Care for transgender medicine, following political pressure from then-Assistant Secretary of Health Rachel Levine.

The new policy still offers mental-health treatment but will reject inmates’ requests to begin sex-rejecting medical procedures. If an inmate had previously been receiving hormones, however, BOP will develop a tapering plan for each inmate after considering appropriate factors.

Three anonymous inmates brought the case, Kingdom v. Trump, last year, represented by the American Civil Liberties Foundation of Washington, D.C., and the Transgender Law Center. The inmates claimed that the policy violates the cruel and unusual punishments clause of the Eighth Amendment, the equal protection component of the Due Process Clause of the Fifth Amendment, the Rehabilitation Act, and the Administrative Procedures Act.

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