Management of Inmates with Gender Dysphoria

PS 5260.01 (2/19/2026) · Official PDF on bop.gov →

This one is different from most program statements: it's actively being fought over in court. The cover memo attached to the policy admits that a federal judge has ordered the BOP to keep doing the opposite of what large parts of this policy say. So read the policy and the memo together. Nothing here is legal advice, I'm not a lawyer, and this is medical and mental-health territory that's outside my own lane as a camp/low guy. If this affects someone you love, get a lawyer who does BOP and civil-rights work, and check the current status of Kingdom v. Trump, because a court order can change what actually happens on the ground overnight.

OFFICE OF GENERAL COUNSEL MEMORANDUM (EXCERPT)

SUBJECT: New Policy on Management of Inmates with Gender Dysphoria and Ongoing Obligations under the Preliminary Injunction Issued in Kingdom, et al., v. Trump, et al., 25-cv-691 (D.D.C.)

Today the Director signed a new policy entitled Management of Inmates with Gender Dysphoria. However, BOP remains obligated to comply with the preliminary injunction issued on June 3, 2025, by the United States District Court for the District of Columbia in Kingdom v. Trump et al., 25-cv-691, which requires BOP to provide hormones and social accommodations to inmates diagnosed with gender dysphoria under the policy that existed before Executive Order 14168, Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government, issued on January 20, 2025. The policy and practice regarding hormones and social accommodations that was in effect immediately prior to January 20, 2025, is outlined in the attached guidance memo issued by the Reentry Services Division, Health Services Division, Correctional Programs Division and the Administration Division on July 16, 2025.

Please ensure all staff are reminded of these ongoing obligations under the preliminary injunction issued in Kingdom v. Trump. Thank you for your attention and cooperation.

SECTION 1: PURPOSE AND SCOPE (EXCERPT)

To establish professional guidelines for the mental health evaluation and treatment of inmates meeting the diagnostic criteria for Gender Dysphoria (GD) to assist their progress toward recovery, while reducing or eliminating the frequency and severity of symptoms and associated negative outcomes.

a. Program Objectives. Expected results of this program are:

To ensure inmates diagnosed with GD receive timely, appropriate mental health services and individualized treatment programming, as clinically indicated. Treatment shall target psychological distress/dysphoria as well as any co-occurring mental health disorders and be tailored to the unique needs of the inmate.

To allocate sufficient staff and resources to deliver appropriate services to such inmates.

To enhance staff’s understanding of the mental health issues associated with individuals diagnosed with GD and the appropriate treatment that accounts for the evolving scientific understanding.

b. Institution Supplement. None required.

SECTION 2: DEFINITIONS (EXCERPT)

Gender Dysphoria (GD): a mental health diagnosis currently defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5 TR), or its replacement. It is a psychological disorder caused by clinically significant distress or impairment due to the perceived discrepancy between a person’s expressed/experienced gender identity and his or her biological sex.

Gender Identity: a fully internal and subjective sense of self, disconnected from biological reality and sex and existing on an infinite continuum, that does not provide a meaningful basis for identification and cannot be recognized as a replacement for sex.

Multidisciplinary Review Team (MRT): a multidisciplinary group of staff representing different disciplines, which has the responsibility for ensuring access to necessary assessment, treatment, continuity of care, and services to inmates in accordance with their identified mental health needs, and which collaboratively develops, implements, reviews, and revises the treatment plan. Additionally, institutions may request a review by the MRT of individual inmates based on treatment concerns or clinical consultation needs. The MRT is coordinated by the Psychology Services Branch (PSB), which is responsible for scheduling meetings, maintaining records, and documenting official notes. The MRT will consist of the following members (or their designee): (1) Psychology Services Branch (PSB) Administrator; (2) PSB, Chief of Mental Health; (3) Health Services Division (HSD) Chief Psychiatrist; (4) HSD Chief of Health Programs; (5) HSD Chief Pharmacist; (6) HSD Chief Social Worker; and (7) Women and Special Populations Branch (WASP) Administrator.

Sex Trait Modification Surgeries: surgical procedures that seek to modify the person’s physical characteristics to appear to align with the person’s “gender identity” rather than the person’s sex. Examples of these surgeries include vaginoplasty, phalloplasty, orchiectomy, vulvoplasty, hysterectomy, oophorectomy, mastectomy, metoidioplasty, chest reconstruction, breast augmentation, hair removal, facial feminization surgery, and voice modification. These surgeries are also called “cross-sex,” “sex reassignment,” or “sex rejection” surgeries.

Social Accommodations: items, including cosmetics and clothing, used to alter the person’s appearance to align with the person’s “gender identity.” Examples of “social accommodations” include buttock padding, breast padding, binders, undergarments, makeup, and wigs.

SECTION 3: STAFF RESPONSIBILITIES (EXCERPT)

c. Wardens

Wardens will establish a local multi-disciplinary approach for the management of inmates diagnosed with GD. The Chief Psychologist is the primary point of contact in the institution for issues related to this population and will consult, as needed, with the Executive Team, Captain, Clinical Director, Unit Manager, or other individuals, as appropriate. Institutions will consult with the Region, Central Office, and the MRT as necessary to ensure inmates diagnosed with GD receive clinically necessary mental health programming and medical services.

SECTION 4: SCREENING AND EVALUATION (EXCERPT)

a. Screening

Diagnostic screening and evaluation of GD can occur at any time throughout an inmate’s incarceration. All diagnostic evaluations are documented in the electronic health record as a Diagnostic and Care Level Formulation note. If primary care medical providers are diagnosing GD, the diagnosis will be documented in the electronic health record as a Clinical Encounter note.

If an inmate reports or presents a documented history of GD before incarceration, Psychology staff will request the inmate to complete a BP-A0171 Record of Information Release form to authorize the Bureau to obtain the inmate’s prior mental health records from community providers who diagnosed or treated the inmate. Similarly, Health Services staff will request completion of a BP-A0621, Authorization for Release of Medical Information form, to obtain prior medical records relevant to the inmate’s care. Signed documents will be added to the electronic health record. These signed documents will be added to the electronic health record and Psychology staff will enter as a General Administrative Note. If the inmate refuses to sign the records release form, this refusal will also be documented in the electronic health record as a General Administrative Note.

As appropriate, a diagnosis of GD will be made by a mental health clinician or primary care medical provider. The diagnosis will be added to the electronic health record. At a minimum, the inmate will be classified and maintained as a Mental Health Care Level 2.

SECTION 5: TREATMENT (EXCERPT)

Executive Order 14,168, Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government, 90 Fed. Reg. 8,615 (Jan. 30, 2025), prohibits the Bureau from expending federal funds for “any medical procedure, treatment, or drug for the purpose of conforming an inmate’s appearance to that of the opposite sex” “to the extent consistent with applicable law.” Id. at 8,617-18. The Bureau will comply with this Executive Order unless compliance with the Executive Order is prohibited by a court injunction or court order. Though Executive Order 14,168 supports this policy, the Bureau also adopts this policy independently of Executive Order 14,168.

a. Individualized Treatment Plan

If treatment for GD is likely to be necessary based on the results of the foregoing evaluation, the following treatment protocol should be followed:

All clinicians will review available documentation in combination with clinical interview(s) to determine the appropriate treatments addressing all identified medical and psychiatric concerns. Because treatment is individualized, treatment plans are tailored to the specific clinical needs of the inmate.

In general, identified medical and psychiatric comorbidities should be addressed before treatment for GD proceeds. As appropriate, medical and psychiatric comorbidities should be addressed through psychotherapy, psychotropic medication, or other appropriate medically accepted interventions. When comorbidities are addressed before GD, further treatment for GD may be necessary and may proceed once these medical and psychiatric comorbidities are resolved or ruled out as the potential cause of GD.

b. Availability of Sex Trait Modification Surgeries to Address Gender Dysphoria

In instances when an inmate is diagnosed with GD, the Bureau will not provide sex trait modification surgeries to address GD and the inmate will not receive sex trait modification surgeries to address GD.

For inmates who have had sex trait modification surgery, medical care will be provided as necessary to address any complications or resulting conditions, such as urethral stricture and pelvic infections.

c. Availability of Hormones to Address Gender Dysphoria

i. Inmates Not Currently Receiving Hormones to Address Gender Dysphoria

In instances when an inmate is diagnosed with GD but is not currently receiving hormones to address GD, the Bureau will not provide hormones to address GD and the inmate will not receive hormones to address GD. Such inmates will continue to have an individualized treatment plan to meet the inmate’s needs. The individualized treatment plan may include psychotherapy, group counseling, psychiatric services, and psychotropic medications.

ii. Inmates Currently Receiving Hormones to Address Gender Dysphoria

In instances when an inmate is previously and currently diagnosed with GD and is currently receiving hormones to address GD, the MRT shall review and approve or disapprove the tapering plan submitted by the Primary Care Provider for all such inmates. Each tapering plan shall consider the appropriate factors, such as the duration the inmate has been receiving hormones to address GD, the initial rationale for receiving the hormone intervention, the response by the inmate to the intervention, and whether the inmate has undergone sex trait modification surgery.

For inmates that have recently begun receiving hormones to address GD, the Primary Care Provider shall develop a tapering plan that includes a rapid discontinuation of the hormone intervention.

For inmates that have been receiving hormones to address GD for an extended period of time, the Primary Care Provider shall develop a tapering plan that includes an appropriately paced discontinuation of the hormone intervention.

For inmates who (1) are post sex trait modification surgery or (2) have been receiving hormones to address GD for an extended period of time and develop severe physiological and psychological withdrawal effects from tapering, it may not be appropriate in all cases for the initial tapering plan to include cessation of hormones. But tapering plans should be reevaluated regularly with respect to cessation of hormones, including during the inmate’s chronic care clinic appointments.

d. Social Accommodations

The Bureau will not provide social accommodations, including to inmates diagnosed with GD, and the inmate will not receive social accommodations. If the inmate currently has social accommodations, the Bureau shall no longer provide the social accommodations and, when practicable, remove or confiscate the social accommodations. When appropriate, and in accordance with standard procedure, inmates may still have access to purchase items on the standardized list of Commissary items available to inmates in their facility.

SECTION 8: SEVERABILITY, APPLICATION OF THIS POLICY AND NO PRIVATE RIGHT OF ACTION (EXCERPT)

If any provision of this policy, or the application of any provision of this policy to any individual or circumstance, is held to be invalid, the remainder of this policy and the application of its provisions to any other individuals or circumstances shall not be affected. The intent of this policy is for federal funds to not be expended for any medical procedure, treatment, or drug for the purpose of conforming an inmate’s appearance to that of the opposite sex to the maximum extent permitted by law, including the Eighth Amendment to the U.S. Constitution.

Nothing in this policy shall prevent a prison official from providing care required by federal law, including the Eighth Amendment to the U.S. Constitution. The Bureau shall ensure that all inmates diagnosed with GD receive care in accordance with federal law, including the Eighth Amendment to the U.S. Constitution.

Nothing in this policy is intended, nor shall it be construed, to create a private cause of action.

Source: PS 5260.01 (2/19/2026), bop.gov/policy/progstat/5260_001.pdf. U.S. government work, public domain. Excerpts only; the official PDF controls.

Read this first, before anything else in the document. The BOP just signed a new policy that says it won't provide hormones or social accommodations and will taper people off. But this same cover memo admits a federal court has ordered them, as of June 3, 2025, to keep doing exactly that under the OLD rules. So the new policy and a court order point in opposite directions. When a policy and an injunction conflict, the injunction controls while it's in force. The BOP's own lawyer is telling every warden this in writing. Practically: what's supposed to happen and what a given facility actually does may not match, and it can shift with the next court ruling.

The General Counsel is directly telling every warden: remind your staff they still have to follow the old rules because of the court order. If someone inside is being told 'new policy, hormones are gone,' this line is the paper that says staff were instructed otherwise. Worth knowing exists if you're documenting a problem.

The framing here treats gender dysphoria as a condition to move away from ('recovery,' 'eliminating symptoms'), and the whole policy is built around mental-health treatment rather than the medical transition care the prior policy allowed. Notice what's not here: no mention of hormones or accommodations as treatment. That's the shift the document is making.

Heads up: this definition is written like an argument, not a neutral dictionary entry. Most program statement definitions just tell you what a term means. This one takes a position. I'm pointing that out so you read the rest of the document knowing the drafters had a point of view baked in from the start. The DSM (the actual psychiatric manual it cites) does not define the term this way.

The MRT is a national committee, not people at your facility. They're the ones who sign off on decisions like tapering someone off hormones. It's central-office staff in Washington, which means these calls get made way above the level of the psychologist you'd actually talk to inside.

'Social accommodations' is the policy's term for things like binders, makeup, and wigs. Remember this term, because later the policy says these get taken away, and that's one of the exact things the court injunction says the BOP still has to provide. The scare quotes around 'gender identity' throughout are the drafters' choice, not standard BOP style.

At the facility level, the person to go to is the Chief Psychologist. If you're a family member trying to figure out who's handling a loved one's care, this is the title that owns it inside the walls.

If someone was diagnosed or treated on the outside before coming in, the BOP wants a signed release (form BP-A0171 for mental health, BP-A0621 for medical) so they can pull those old records. Practical takeaway: having your outside diagnosis and treatment history documented and gettable matters, because the policy leans hard on what's in the paper trail. Refusing to sign is allowed but gets logged.

A GD diagnosis automatically bumps you to at least Mental Health Care Level 2. Care Level is the BOP's system for how much mental-health attention you're flagged to need. Level 2 means routine ongoing mental-health care, not the lowest tier. This classification can affect which facility you can be housed at.

Two things packed in here. First: the BOP admits again that a court order overrides this, which is the Kingdom injunction from the cover memo. Second, that last sentence ('adopts this policy independently') is lawyer-armor: they're saying even if the executive order gets struck down, they'd keep this policy anyway. That's written to survive the executive order being challenged in court.

The policy says: treat other conditions first (anxiety, depression, PTSD, etc.), on the theory that they might be causing the dysphoria. Critics would read this as a built-in way to defer or avoid GD treatment indefinitely by always pointing at something else to treat first. Either way, the effect is that GD-specific treatment comes last in line.

No surgeries for gender dysphoria. If someone already had surgery before coming in, they'll still get treated for complications from it. This surgery ban is the part least affected by the court fight; the bigger live dispute is over hormones and accommodations, below.

If you weren't already on hormones, this policy says you don't start. BUT: this is precisely one of the things the Kingdom injunction ordered the BOP to keep providing under the old rules. So this sentence and the court order directly collide. Which one wins in practice depends on the state of the litigation, and that's exactly why you check current status rather than trusting the policy text alone.

For people already on hormones, the policy's plan is to taper them off, not continue them, with the national committee (MRT) signing off. Someone newer to hormones gets a 'rapid' taper; someone on them a long time gets a slower one. This is the other head-on collision with the court order, which says keep providing hormones. If a taper is happening to someone despite the injunction, that's the kind of thing you'd want documented and in front of a lawyer fast.

There's a narrow carve-out: if stopping hormones would cause severe medical/psychological harm (or the person is post-surgery and needs them), they don't have to fully stop right away. But note the follow-up sentence keeps pushing toward cessation over time. The direction of travel in the policy is off the hormones; the exceptions just slow it down.

The binders, makeup, wigs, etc. defined earlier: the policy says stop providing them and take away what someone already has. Again, this is a direct hit against the Kingdom injunction, which ordered social accommodations to continue. The one thing left open is buying whatever's on the normal commissary list everyone can access. Confiscation of items a court said to keep providing is exactly the kind of conflict that ends up back in front of the judge.

Three pieces of legal self-defense. 'Severability': if a court strikes down one part, the rest stands. The Eighth Amendment line: they're reserving that they'll still provide whatever the Constitution's ban on cruel and unusual punishment requires (denial of serious medical care can violate it). And 'no private right of action': this policy by itself is not a thing you can sue over. That doesn't mean nobody can sue about the underlying care, people clearly have, that's what Kingdom is, it just means the lawsuit hangs on the Constitution and other law, not on this document. I'm not a lawyer and this is the part where you genuinely need one.

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