Recent guidance from the Trump administration requires federal prisons to begin reducing transgender inmates’ hormone therapy treatments.

Medical experts warn that the move will have dangerous medical and psychological consequences for incarcerated trans people, while legal experts say the guidance violates a federal judge’s preliminary injunction in a case challenging the administration’s anti-trans prison policies.

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As Advocate reports, the Federal Bureau of Prisons (BOP) issued the new guidance in February. It not only bans prisons from providing hormone therapy to inmates who were not receiving it prior to incarceration, but also orders prisons to develop plans for tapering off treatment for those already receiving it.

Dr. Carl Streed, a Boston-based researcher specializing in transgender health, describes the guidance as “alarming.”

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“It’s essentially saying that a form of evidence-based care will no longer be provided to people under the purview of the Bureau of Prisons,” Streed told Advocate. “That means the policy runs counter to best practices and arguably probably the law in terms of providing care to inmates because it’s setting up a different standard for them versus the standard out in the community.”

According to Streed, trans inmates receiving hormone therapy to treat gender dysphoria will experience a range of adverse health effects stemming from the drop in hormone levels if their treatment is decreased, including changes in cognition and mood, increased risk of cardiovascular disease, and metabolic issues. For those who have already undergone surgeries as part of their gender-affirming care, the risks are even more serious.

“They no longer produce adequate endogenous hormones to a level that would be good for their health if we were to take away their exogenous hormones,” Streed said. “Now we’re going to take away hormone therapy for them — they are put at much greater risk than anybody else.”

As Just Detention International communications director Jesse Lerner-Kinglake said in a statement, the new policy will almost certainly exacerbate the already dangerous conditions for trans inmates. Data from the Department of Justice indicates transgender inmates are 10 times more likely to be sexually assaulted than straight prisoners, and multiple court cases have found that housing transgender women in men’s facilities and denying gender-related healthcare are violations of the Eighth Amendment, which bans cruel and unusual punishment.

But on January 20, 2025, President Donald Trump signed a sweeping anti-trans executive order, which, among other directives, instructed Attorney General Pam Bondi to ensure that trans women are housed in men’s detention centers and that “no Federal funds are expended for any medical procedure, treatment, or drug for the purpose of conforming an inmate’s appearance to that of the opposite sex.”

Trans inmates, Lerner-Kinglake said, “already had a bullseye on their back — and the federal government knows it. The rates of sexual abuse facing the transgender community were astronomical before these new policies. It’s hard to imagine this already abysmal situation getting worse. And yet it will.”

The administration has already been blocked from implementing its ban on gender-affirming care in prisons. Last year, three transgender people currently incarcerated in federal custody filed a class action suit against the administration and the Federal Bureau of Prisons challenging those policies. In June 2025, a federal judge granted a temporary injunction requiring the BOP to continue providing gender-affirming care to trans inmates as the case proceeds.

It’s unclear whether the administration believes that merely weaning trans inmates off hormone therapy represents a legitimate workaround. But Shayna Medley, senior litigation staff attorney at Advocates for Trans Equality, told Advocate that the new BOP guidance violates that injunction.

“The February 19 guidance from the Bureau of Prisons directing tapering of hormone therapy for transgender people in custody is a direct violation of the injunction in Kingdom v. Trump, which requires the BOP to continue providing hormones to people in custody with a gender dysphoria diagnosis,” Medley said. Advocates for Trans Equality’s position, she said, is that the guidance “is currently enjoined by the existing injunction in the Kingdom v. Trump litigation.”

“Implementation would be in direct violation of the federal court’s order to continue providing hormone therapy to transgender people in BOP custody with a gender dysphoria diagnosis.”

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