The US Supreme Court has refused to pause an order protecting gender-affirming care for a class of people in federal prisons. Its 21 October decision leaves those protections in place while the government’s appeal proceeds.

The Trump administration had asked the court to put the lower-court injunction on hold. The Supreme Court’s docket records the refusal without reasons. Justices Clarence Thomas and Samuel Alito would have granted the request.

For the people covered by the case, access to care remains governed by the Bureau of Prisons’ policy from before President Trump’s January 2025 executive order. The injunction blocks enforcement of the bureau’s February 2026 replacement policy and requires officials to provide or continue care under the earlier rules.

That protection covers people currently or prospectively held in Bureau of Prisons facilities who have, or develop, a gender-dysphoria diagnosis. State prisons fall outside this class.

The district court issued the injunction on 17 June. It renewed the injunction on 26 August, with the new order taking effect on 15 September.

ACLU attorney Aditi Shah said the decision would protect the prisoners from “serious and irreparable harm” as their challenge continues.