The US supreme court went against Donald Trump’s administration on Wednesday, refusing to allow the immediate enforcement of sweeping restrictions on gender-affirming care for transgender individuals held in prisons and federal facilities.

The decision marks an unusual victory for transgender rights before the nation’s highest court, which has largely sided with the administration and other opponents of transgender rights in several major cases.

In its latest action, the supreme court turned away an emergency appeal from the justice department seeking to overturn a federal judge’s order that prevents the Federal Bureau of Prisons from putting the controversial restrictions into effect while a lawsuit challenging them moves forward.

Two conservative members of the court, Clarence Thomas and Samuel Alito, publicly opposed the decision.

At the center of the legal battle is a policy introduced earlier this year that would sharply limit medical care and other accommodations available to transgender people in federal custody.

Under the measure, medical and surgical treatments related to gender transition would be prohibited. The restrictions would also extend to “social accommodations”, including access to clothing and hair-removal devices intended to help prisoners present themselves in a way that matches their gender identity. Psychiatric care would remain available under the policy.

The restrictions prompted three transgender people incarcerated at federal correctional facilities in New Jersey, Florida and Minnesota to bring a class-action lawsuit challenging the government’s actions.

The proposed changes represent a big departure from longstanding federal prison practices. According to the plaintiffs, the federal prison system has provided hormone treatment to prisoners experiencing gender dysphoria since at least 1992.

The dispute comes amid Trump’s broader campaign to roll back transgender rights since beginning his second presidential term.

On his first day back in the White House, Trump signed an executive order declaring that the federal government would recognize only two genders, male and female, while portraying transgender identity as false.

The order directed multiple federal agencies to revise their practices, including requirements ensuring that “males are not detained in women’s prisons” and ending government funding for medical procedures provided “for the purpose of conforming an inmate’s appearance to that of the opposite sex”.

In defending the prison restrictions in court, government lawyers have characterized gender-transition medical treatment as “unproven sex-rejecting interventions”.

But the plaintiffs challenging the policy have warned that allowing the restrictions to take effect could have devastating consequences. In their legal filing, the plaintiffs argued that a decision favoring the administration would result in “immediate and catastrophic” harm.

They pointed to serious mental health concerns, warning: “Patients who are denied hormone therapy can suffer from increased depression, anxiety, suicidal ideation and self-harm.”

Wednesday’s decision stands in contrast to several recent supreme court actions involving transgender rights. The court, which holds a 6-3 conservative majority, has issued multiple decisions since last year that have favored restrictions affecting transgender Americans.

Among those decisions, the justices supported state laws preventing transgender athletes from competing on female sports teams at public schools, including colleges and universities.

The court also permitted the Trump administration to enforce its ban on transgender people in the military. In another decision, the justices allowed the administration to prevent passport applicants from selecting gender designations reflecting their gender identities.

The legal fight carries potential consequences for thousands of people within the federal correctional system. More than 2,000 transgender prisoners were housed in federal prisons and halfway houses in 2025, according to reporting from NPR.