Trump just rolled out a cruel anti-trans prison policy doctors are calling ‘dangerous’

The Trump administration has ordered federal prisons to begin tapering hormone therapy for incarcerated transgender people. Physicians say that it could inflict immediate psychological distress and long-term medical harm on a vulnerable population.

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The guidance, issued February 19 by the Federal Bureau of Prisons, outlines how the federal prison system will treat incarcerated people diagnosed with gender dysphoria. It bars the agency from initiating hormone therapy for inmates who were not already receiving it and instructs clinicians to develop tapering plans that could ultimately discontinue treatment for prisoners who currently rely on hormones as part of their medical care.

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To physicians who treat transgender patients, the directive reads less like clinical guidance than a political decision overriding established medical practice.

“From a medical point of view, this is alarming because 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,” Dr. Carl Streed, a Boston primary care physician and one of the country’s leading researchers on transgender health, told The Advocate in an interview. “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.”

The policy follows a January 2025 executive order from President Donald Trump barring federal funds from being used for medical treatments intended to align a person’s physical characteristics with a gender identity different from their sex assigned at birth.

But hormone therapy is not cosmetic medicine, clinicians say. It is a core treatment for gender dysphoria, widely recognized by major medical organizations and incorporated into clinical standards of care.

Removing it can have immediate, destabilizing effects. “People are going to have changes in cognition. They’re going to experience mood changes. They're going to see brain fog issues, difficulty concentrating,” Streed said.

Such symptoms can arise quickly when hormone levels suddenly drop, because those hormones help regulate mood, cognition, metabolism, and cardiovascular health. Over time, the consequences may become more serious.

“We’re going to see an increase in the risk of cardiovascular disease events,” Streed said, as well as bone metabolism problems and metabolic illnesses such as diabetes if hormone therapy is withdrawn. The danger may be especially acute for incarcerated people who have undergone gender-confirmation surgeries affecting the body’s ability to produce hormones naturally.

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“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.”

For clinicians inside federal prisons, the policy also presents an ethical dilemma.

“This definitely poses a challenge for clinicians because it's taking away one of their treatment options for folks,” Streed said. The decision, he added, collides with one of medicine’s oldest principles. “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.”

The policy arrives amid a broader political push by the Trump administration and Republican lawmakers to restrict gender-affirming care nationwide.

Streed and colleagues recently warned in a New England Journal of Medicine perspective that transgender people are incarcerated at more than four times the rate of the general population and that denying medically indicated gender-affirming care in prison can violate the constitutional requirement that incarcerated people receive adequate health care. Courts have repeatedly held that deliberate indifference to serious medical needs violates the Eighth Amendment’s ban on cruel and unusual punishment.

Advocacy groups say the Bureau’s new guidance may also worsen conditions for transgender people already at heightened risk of violence behind bars.

“The devastating health effects of discontinuing hormone therapy for incarcerated transgender people are well-documented,” Jesse Lerner-Kinglake, communications director at Just Detention International, said in a statement to The Advocate. “People will suffer, just so that this administration can carry out its anti-trans agenda. The new BOP policies are an act of overt bigotry against the incarcerated transgender community, and place them directly in harm’s way.”

Removing gender-affirming care, Lerner-Kinglake added, could increase vulnerability to abuse in a prison system where transgender people already face disproportionate violence.

“By eliminating gender-affirming care, prison officials are sending a very clear signal that they don’t care about the safety and dignity of incarcerated transgender people,” they said. “They 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.”

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Legal advocates say the new policy may also conflict with ongoing federal litigation.

The case, Kingdom v. Trump, was filed in 2025 by three transgender people incarcerated in federal prisons who were diagnosed with gender dysphoria and had been prescribed hormone therapy by prison medical providers but were told their treatment would be stopped under the administration’s policy.

The lawsuit, brought by the American Civil Liberties Union and the Transgender Law Center, challenges the administration’s attempt to end gender-affirming medical care in federal custody. A federal judge later issued a preliminary injunction requiring the Bureau of Prisons to continue providing hormone therapy to incarcerated transgender people while the case proceeds.

“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,” said Shayna Medley, senior litigation staff attorney at Advocates for Trans Equality.

“Our view is that this guidance is currently enjoined by the existing injunction in the Kingdom v. Trump litigation,” Medley said. “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.”

The Federal Bureau of Prisons did not respond to The Advocate’s request for comment.

Federal prisons house roughly 150,000 people nationwide. Only a small fraction identify as transgender, but physicians and advocates say policies governing their medical care can have profound consequences.

For Streed, the stakes of the new guidance are difficult to overstate.

“Withdrawing hormone therapy,” he said, “is a dangerous thing to do.”