The Trump Administration is Preparing to Attempt a Nationwide Ban on Gender-Affirming Care for Adults

The Trump admin is now defending its anti-trans prison policies by arguing care for trans adults can be banned because it isn’t healthcare. The consequences will extend far beyond prisons.

The Washington D.C. Federal Courthouse | Image: Wikimedia Commons

Just over two months ago, as Transitics has previously covered, the Trump administration released its new policy outlining how it will treat transgender people in federal prisons. The policy, Program Statement 5260.01, will deny trans people access to medically necessary healthcare and ban them from receiving any “social accommodations”—which is defined to encompass proper name and pronoun usage as well as gender-affirming items like clothing, binders, and makeup. Instead, the policy will attempt to help them “recover” through psychotherapy and psychotropic medications like antidepressants.

Because trans people in prisons will have no say in being subjected to this policy and its treatment plan, this essentially amounts to state-mandated conversion therapy. A lawsuit, Kingdom v. Trump, is currently challenging this policy—along with the executive order that sparked it—on 8th Amendment grounds and has resulted in a preliminary injunction covering ~800 of the 2,200 trans people in BOP custody.

As part of that case, last month, the agency that oversees federal prisons, the Bureau of Prisons (BOP), was forced to release an administrative record for PS 5260.01—essentially a list of the documents it evaluated when creating the policy. There, the BOP admitted to deliberately disregarding the medical consensus surrounding gender-affirming care and implied that it’s expecting to collect more self-harm data among trans people in prisons. Following the release of the record, in early April, the Trump administration began moving to dissolve the injunction blocking the policy.

For some context, up until this point, BOP lawyers had defended the denial of healthcare to trans prisoners by arguing that it wasn’t in violation of the 8th Amendment because 1) the plaintiffs were still receiving gender-affirming care when they challenged the policy, 2) the plaintiffs must prove individualized harm, not generalized, and 3) the plaintiffs’ reliance on “WPATH guidelines at best reflects a ‘simple difference in medical opinion’” and that WPATH standards “are not accepted as medical consensus.”

The main argument here rested on the final point and is reminiscent of the Supreme Court’s ruling in United States v. Skrmetti, which held that “states have wide discretion to pass legislation in areas where there is medical and scientific uncertainty.” But notably, the Trump administration wasn’t outright rejecting the existing consensus—just that it wasn’t enough of a consensus to be required treatment under the 8th Amendment, which has a relatively high threshold.

However, one year after taking this approach, the Trump administration has opted for a much more aggressive strategy, and the argument it’s now making is highly concerning. Here, there are two main documents: a 51-page declaration by Kristopher Kaliebe and a BOP memorandum on PS 5260.01.

First, the Kaliebe declaration. For some background, Kristopher Kaliebe is a psychiatrist who works at the University of South Florida and a known opponent of gender-affirming care. Aside from having ties to SPLC-designated hate group SEGM, he was also one of the nine authors of the ‘comprehensive’ HHS review that denounced gender-affirming care for minors. It’s also worth noting that Kaliebe was the only anti-trans expert consulted during the creation of PS 5260.01. In the document itself, he provides a succinct summary of his main argument towards the beginning, writing:

“Hormone therapy is unproven and experimental treatment for Gender Dysphoria that generally should not be available to those in the custody of the Federal Bureau of Prisons (“BOP”). Though it is not medically necessary to provide hormone therapy to inmates who are diagnosed with Gender Dysphoria but not currently receiving hormone therapy, inmates currently receiving hormone therapy may be a more complex situation. In most circumstances, it is appropriate, after individual assessment, to discontinue hormone therapy for inmates currently receiving hormone therapy through an appropriate withdrawal process. In a limited set of circumstances, it may be appropriate, after individual assessment, to continue hormone therapy for inmates already being treated with hormones.”

There are a lot of things happening here. First, there’s the claim that “hormone therapy is unproven and experimental,” which entirely replicates the rhetoric Republicans have employed when banning gender-affirming care for minors. This argument is a major claim, and it goes against the consensus that gender-affirming care is evidence-based and medically necessary—a consensus supported by virtually all major American medical organizations, including the AMA, APA, and Endocrine Society. And yet, Kaliebe spends a large chunk of the declaration supporting this assertion, and he begins this section by writing that the “affirmative model has many weaknesses and risks.”

He argues that “within the affirmation model, hormones or surgical interventions are provided despite that these treatments would not meet the usual clinical standards”; that gender dysphoria is “a temporary disorder like bulimia or depression”; and that “much of the justification for affirmative treatment, such as cross-sex hormones and surgical treatments, comes from surveys indicating patient satisfaction”—which he claims is unreliable.

Following this, he shifts to characterizing psychotherapy as “the preferred treatment approach for gender dysphoria,” and this is where it begins to get concerning. He writes that “the affirmation model carries significant risks because humans have immense powers to deceive themselves and because patients may be susceptible to clinicians’ suggestions of affirmative treatment…a major target of [psychotherapy] treatment is helping patients identify how they deceive themselves.”

The way this is written, it carries the implication that many trans people are pressured into being trans by their therapists and by their own minds. A few paragraphs later, Kaliebe cites a 1993 study in order to assert that “cross-sex identification can arise after trauma,” another nod to the idea that transgender identity is artificial and not inherent.

After devoting some time to denouncing the World Professional Association for Transgender Health’s (WPATH) recommendations while mentioning the Cass Review, Kaliebe finally makes his big claim: “cross-sex hormones generally are not medically necessary.”

He begins this section by arguing that “hormone therapy for Gender Dysphoria is not based on guidelines using best practice or systematic reviews of evidence” before repeating that “cross-sex hormones remain an experimental treatment that has been pursued at the expense of more cautious, holistic, and measured approaches.” To support that, he cites the work of Evgenia Abbruzzese, one of the other authors of the HHS review and a co-founder of SEGM.

Following this, he then writes that “sex-trait modification through hormone therapy has substantial health risks and is one of the few instances, and the only psychiatric disorder, in which doctors intentionally harm healthy tissue”—again taking a right-wing talking point that was used against trans youth care and applying it to trans adults. To conclude this section, Kaliebe ties it back to the Bureau of Prisons, asserting that:

“It could be reasonable for prison officials to adopt a strong presumption in favor of ending hormone therapy for all inmates (through the appropriate method of withdrawal), given the unproven medical benefits of continued hormone therapy and the potential negative effects of hormone therapy. This strong presumption would only be rebutted by exceptional cases.”

It’s worth noting that Kaliebe’s point here is disingenuous at best. After all, he wrote this declaration in support of a policy that makes no exceptions for “exceptional cases”—a policy that he had a hand in crafting, as per the administrative record. Clearly, although he emphasizes ‘caution’ and ‘risk’ when supporting mandatory detransition, he’s not willing to extend that same courtesy to gender-affirming care. This is a telling indicator of the true intent behind Kaliebe’s ‘evidence-based’ façade.

After this section, he repeats similar rhetoric to argue that ‘cross-sex surgeries’ and ‘social accommodations’ are not medically necessary under any circumstances for anyone, entirely ignoring the fact that gender-affirming surgeries are pretty much the only thing that doctors have been able to agree on about trans healthcare for at least the past half-century.

The BOP leans heavily on Kaliebe’s declaration in its memorandum, explicitly using it as evidence to support its claims that ‘sex trait modification surgeries,’ ‘social accommodations,’ and ‘hormones’ are not medically necessary, writing that “an expert [Kaliebe] has persuasively explained” these facts to them—an expert that they themselves sought out and hired for that exact purpose.

The bureau supports its policy further by claiming it keeps prisoners safe in three separate ways. First, it writes that PS 5260.01’s “handling of hormones to address gender dysphoria reduces rewarding threats of self-harm and may reduce overall self-harm” because “providing more access to hormones, especially in response to threats of self-harm or suicide, could increase self-harm.” Secondly, the BOP expresses baseless ‘fairness’ concerns, saying that “when inmates receive special treatment within a correctional environment, other inmates may begin to resent those receiving special treatment”—ignoring the fact that adequate medical care has not ever been considered to be ‘special treatment.’

Lastly, the memorandum argues that “limiting the availability of hormonal interventions to address gender dysphoria reduces the chance of an inmate being targeted by other inmates” as “the inmate would inevitably become a target for abuse in the male facility.” Which is actually true: trans women in prisons face astronomically higher rates of sexual violence. But taking away their healthcare is not the solution to this problem; removing them from male facilities is, and that’s something Trump has also moved to block.

Simply put, weaponizing the rampant abuse of trans people in prisons to justify taking away their healthcare is a new low, even for the Trump administration.

All of that said, because of the way the case is being argued, this won’t only have repercussions for federal prisons. Unlike before, the Trump administration has shifted to claiming that gender-affirming care isn’t healthcare at all—and that it’s harmful to trans people. These are the exact same justifications Trump used when he signed Executive Order 14187, which aims to strip federal funding from any providers that offer gender-affirming care (in its words, ‘chemical and surgical mutilation’) to minors. Already, dozens of providers nationwide have capitulated to these funding threats, creating a chilling effect on care for trans youth in states where it’s both legal and protected.

Unfortunately, precedent for banning adult care already exists. Notably, EO 14187’s definition of ‘children’ extends to anyone between the ages of 18 and 19, who are considered adults under federal law and in all but 3 states. Legally speaking, there’s no tangible difference between a minimum age of 19 and a minimum age of 21, 26, or even 60. Like EO 14187, the federal government is using trans prisoners as a test case for expanding these restrictions onto all trans adults.

Trump isn’t the only one pushing for a nationwide ban, either. Already, many right-wing groups and individuals, like the Heritage Foundation (the authors of Project 2025), Elon Musk, and Matt Walsh, have spoken out in support of total bans on transgender healthcare. At the same time, Republicans in Oklahoma and Texas have even introduced bills that aim to ban gender-affirming care for all ages. Meanwhile, Tennessee recently passed a bill that attempts to intimidate trans patients away from their care by forcing providers to report trans people’s private medical information to the state.

So far, Republicans have not been able to get the ruling they want to be able to justify a nationwide ban. Even a 4th circuit ruling last month upholding West Virginia’s exclusion of gender-affirming surgery from its Medicaid policy, despite calling those surgeries ‘experimental procedures,’ was fairly limited to questions of funding and discrimination. But here, they’re trying to force courts to answer on the medical necessity of gender-affirming care not just in prisons but for all trans Americans.

And they hope that by tying a nationwide ban to a case surrounding prisons—an area that’s typically far removed from the public conscience—fewer people will take notice. As such, now more than ever, the LGBTQ+ community as a whole must stand up and fight for the trans people in federal prisons and their access to healthcare. Our right to access care depends on it.