Transgender prisoners ask U.S. Supreme Court to stop Trump from taking their medical care

Attorneys representing transgender people in federal prisons urged the U.S. Supreme Court to preserve their access to gender-affirming care, including hormone therapy.

In a 41-page brief filed October 8, attorney Li Nowlin-Sohl and other lawyers representing the prisoners argued that the justices should uphold an updated preliminary injunction issued this year by U.S. District Judge Royce C. Lamberth. The order followed an injunction issued last year and blocked the Bureau of Prisons from enforcing a policy implementing President Donald Trump’s executive order denying gender-affirming care to transgender people in federal prisons.

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“The district court issued a fact-bound, preliminary order based on its determination that BOP’s sudden reversal of its own longstanding policy of providing hormone therapy and social transition accommodations based on individual assessments of clinical need was arbitrary and capricious,” the attorneys wrote.

The brief follows a request from the Trump administration last month to allow federal prisons to withdraw gender-affirming care from people in their custody. In an emergency application in the case Trump v. Kingdom, administration attorneys asked the court to allow enforcement of a policy that would deny hormone therapy for gender dysphoria and require prison medical providers to taper patients off the treatment.

Those policies implement an executive order Trump issued on the first day of his second term. In addition to directing that transgender people be housed in prisons according to their sex assigned at birth rather than their gender identity, a matter being fought in separate court battles, the order directs federal officials to “ensure 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.”

But the prisoners’ attorneys argue in the new brief that denying care is unreasonable and ignores the agency’s decades of experience providing it.

Related: Trump begs Supreme Court to let feds withdraw medical care for trans prisoners: ‘A dangerous thing to do’

“For over three decades, BOP has treated people diagnosed with gender dysphoria with hormone therapy,” the brief reads.

The brief traces the bureau’s policy of continuing hormone therapy for people already receiving it when they entered custody to at least 1992. In 2010, the bureau began allowing people to start hormone therapy in custody if an individual evaluation determined it was “medically indicated.” In 2017, the bureau released its Transgender Offender Manual, further formalizing those policies.

The restrictions also extend beyond medical treatment, the brief noted, prohibiting requests for clothing that did not “align with an inmate’s biological sex.”

The attorneys argued that the district court’s findings support keeping the injunction in place while the litigation proceeds. Allowing the policy to take effect, they warned, would put incarcerated people at risk.

Related: The Federal Bureau of Prisons is running a conversion therapy program. We must not let it stand

Dr. Carl Streed, a Boston primary care physician and transgender health researcher, previously told The Advocate that withdrawing hormone therapy could cause mood changes and difficulty concentrating, along with longer-term cardiovascular and bone health risks. He warned that patients whose bodies no longer produce sufficient hormones after surgery could be especially vulnerable. “One of our main tenets in medical ethics is non-maleficence — do no harm,” Streed said. “And this is going to have direct harm on people.”

In their brief, the prisoners’ lawyers explained that, “The most concrete assertion that the government’s Application can muster from the administrative record is the statement that BOP staff have to spend time to protect incarcerated people ‘who appear more feminine, including due to hormones or social transition accommodations’ from sexual predators.

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“But, as BOP’s statement implicitly acknowledges, transgender women in BOP custody face a risk of being targeted regardless of whether they are receiving hormone therapy or social transition accommodations. The reality is that ‘transgender people are vulnerable to being targeted whether or not they are receiving gender-affirming care’; even before such care was consistently available, transgender people in BOP custody were subject to assault.”