New directives from the Bureau of Prisons amount to government-mandated conversion therapy.
The Metropolitan Detention Center in New York City.(Angela Weiss / AFP via Getty Images)
In February, the Trump Justice Department issued a program statement titled “Management of Inmates with Gender Dysphoria,” its new internal directives regarding transgender people in federal prison. The policy classifies being transgender itself as a “mental health disorder” and outlines a “treatment plan” to ensure those afflicted “progress toward recovery.” What “recovery” means, in the eyes of the administration, is made obvious by the mandates of the plan: confiscation of trans inmates’ gender-affirming clothes, makeup and other personal items; denial of hormones and any other gender-affirming medication; and program of forced psychotherapy and psychotropic drugs. “It is, in every meaningful sense, a blueprint for a government-run conversion therapy program,” Shannon Minter, legal head of the National Center for LGBTQ Rights, writes in the Advocate, “one targeting thousands of incarcerated people who have nowhere to turn.”
In January 2017, the outgoing Obama administration issued federal prison guidelines that aimed to ensure “transgender inmates can access programs and services that meet their needs.” Since then, including during Trump’s first term, the Bureau of Prisons’ official policy held that trans prisoners should be given gender affirming care—including hormones, surgery and placement in facilities matching their gender identity. But as the Marshall Project notes, “across both Democratic and Republican administrations, gender-affirming housing was rare, and surgery rarer still.” And depending on the prison, provision of even the most basic gender-affirming care was always inconsistent.
“People’s experience in federal prisons varies widely from place to place. In some places, medical staff are more supportive and better trained. In others, people already often have to fight hard to get the medical care they need and are thwarted at every turn,” Minter told me. “It’s probably not news to anyone paying the least bit of attention that healthcare in prisons is generally abysmal. And people are denied all kinds of care that they need all the time.”
Of the 1,500 estimated trans women in federal custody, per NPR reporting, just 22 were in women’s prisons as of February 2025. (Of the estimated 750 trans men in custody, one was in a men’s facility.) That means that when Trump issued his day-one executive order declaring his administration would only “recognize two sexes” and requiring trans women to be put in men’s prisons, 99 percent of trans women were already being held in men’s facilities. That order also announced a new ban on using federal funds for gender-affirming care in prisons, providing the administration a pretext for ending numerous provisions—from hormones to gender-confirming commissary items such as breast and hip padding—for trans inmates.
On the heels of Trump’s order, the National Center for LGBTQ Rights and its partners immediately filed lawsuits, quickly securing injunctions in at least three federal courts. And yet, a BOP memo dated February 21, 2025, acknowledges the existence of a “nation-wide restraining order” blocking Trump’s EO—but nonetheless states the agency’s compliance with the president’s illegal order. BOP officials explicitly directed staff to both misgender and deadname trans inmates, according to court papers seen by The Guardian, and to reject requests for gender-affirming clothing. And a trans legal advocate who spoke with the outlet cited the case of a trans woman who had transitioned before being incarcerated in a men’s facility.
In June 2025, a DC federal judge issued a nation-wide injunction requiring the Bureau of Prisons to again start providing trans people with hormone therapy and prohibiting relocation of trans women to men’s prisons. And yet, all available evidence suggests the BOP is refusing to comply. Eight current and recently incarcerated trans-identifying people who spoke with Uncloseted Media this March confirmed they were denied legally mandated gender-affirming care, and the outlet uncovered court papers detailing “cases of noncompliance at 19 different prisons.” It seems that with its new policy, the administration has formalized what it was already doing illegally—and gone further.
Studies show transgender women incarcerated in men’s prisons are 13 times more likely than cisgender inmates to endure sexual violence. That is part of why Congress unanimously passed the Prison Rape Elimination Act in 2003, requiring officials to consider particular vulnerabilities to sexual abuse—including LGBTQ status—in making prison housing decisions. Despite the law, in December 2025 the Trump administration announced it was defunding the National PREA Resource Center, which provides prison staff training, certification and myriad other supports for PREA compliance.
“This administration has unlawfully thrown all that overboard and is busily trying to implement policies that they know are going to result in sexual violence against these vulnerable people—everyone knows that is what is going to happen. They are doing that with full knowledge,” Minter told me. “That is not just unlawful. It’s a gross human rights violation. We don’t expect to see the federal government knowingly subjecting people who have no choice—who are captive—to sexual violence. It is pretty shocking.”
As journalist Aleksandra Vaca points out, the BOP’s policy rewrite cribs heavily from Florida’s 2024 policy paper rolling back the rights of transgender inmates, which claimed gender dysphoria results from “unaddressed psychiatric issues and unaddressed childhood trauma,” and treats transgender identity as “short-termed delusions or beliefs which may later be changed and reversed.” It also borrows from a 400-page 2025 report on transgender youth issued by Trump’s Health and Human Services Department, headed by Robert F. Kennedy Jr. That paper promotes “exploratory therapy,” recognized as conversion therapy in all but name by Kaiser Family Services and the Trevor Project. Among the many other scholars, researchers, scientists and clinicians who assailed its contents was the American Academy of Pediatrics, which criticized it for “bypassing medical expertise and scientific evidence.”
“Their position is pretty clearly that there’s no such thing as a genuinely transgender person—and that identifying as transgender is always a manifestation of some other underlying mental illness or pathology or disorder,” Minter told me. “So, when this Bureau of Prisons policy says that transgender people who are incarcerated will receive psychiatric medications and therapy, it’s very clear that they’re talking about therapy designed to ‘cure’ transgender people of the delusion that they’re transgender.”
Indeed, the BOP’s new policy explicitly claims that, “like many DSM-V psychiatric conditions, [gender dysphoria] is complex and often accompanied by other psychiatric comorbidities.” It promises “individualized treatment plans,” yet universally mandates that “treatment should include, at a minimum, therapy” administered under a Bureau policy titled Treatment and Care of Inmates with Mental Illness. The stated goal of that treatment is to help trans inmates “progress toward recovery” by “reducing or eliminating the frequency and severity of symptoms and associated negative outcomes.” If there is any doubt that trans identity itself is here framed as the symptom, the memo’s glossary declares “gender identity” is “disconnected from biological reality and sex” (my emphasis), claiming it does “not provide a meaningful basis for identification and cannot be recognized as a replacement for sex.” As Vaca notes, transition is thus cast as the “negative outcome.” The treatment will only be “discontinued if it is determined by a mental or medical health professional that the inmate no longer meets the criteria for” gender dysphoria, the policy notes, at which point their medical records will be updated to show the condition has been “resolved.”
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Tellingly, the BOP report contends that gender dysphoria is the source of increased suicidality. In fact, trans people’s suicidality is driven by the stigmatization of their identities as defective, disordered or abnormal, and intense societal pressure to conform to cis-normative standards. Nowhere is that pressure more explicit than in conversion therapy, a widely discredited pseudoscience whose efficacy has been thoroughly debunked through decades of scientific research and mountains of scholarly studies. Pretty much every medical and mental health professional organization in the US—American Medical Association, American Psychiatric Association, American Psychological Association, and American Academy of Pediatrics—supports legal efforts to ban the practice. (The United Nations, which labels conversion therapy a form of torture, has called for a global ban.) The American Psychological Association and scholars at Stanford link is use to increased “depression, anxiety, suicidal thoughts and behaviors, substance abuse, and post-traumatic stress.” Among trans and nonbinary youth—who are more likely than their cisgender LGBQ peers to be subject to conversion therapy—nearly 60 percent, or three in five of those who underwent it in the last year, attempted suicide. Studies similarly indicate that transgender American adults who experienced gender identity conversion are significantly more likely to suffer “severe psychological distress” and “lifetime suicide attempts.”
Peer-reviewed science proves that the best way to “cure” or mitigate gender dysphoria is with gender-affirming care. The aforementioned Stanford study found that when given access to hormone treatments, “Odds of severe psychological distress were reduced by 222 percent, 153 percent and 81 percent for those who began hormones in early adolescence, late adolescence and adulthood, respectively. Odds of previous-year suicidal ideation were 135 percent lower in people who began hormones in early adolescence, 62 percent lower in those who began in late adolescence and 21 percent lower in those who began as adults.”
If psychological coercion could change a person’s sexuality or gender identity, the trauma wreaked by homophobia and transphobia would almost certainly do the trick. However, there’s plenty of evidence proving it does succeed in shaming folks into denying who they are. And for the Trump administration—the most anti-science, anti-LGBTQ and, in particular, anti-trans presidency in recent decades—that’s good enough.
None of this is, of course, a departure from American history. Homosexuality was only declassified as a mental illness in the DSM in 1973, and it’s clear that’s a past this administration wants to return to. The state’s coercive power is maximized in federal prisons, and the Trump administration is using that power—with full knowledge of the laws it is breaking and the harm it will cause—against some of the most vulnerable people in the country. But of course, this is all par for the course.
“This is very dangerous, irresponsible and disrespectful of the court system and the judicial process,” Minter told me. “But it is of a piece with the way this administration is operating—with very little, if any, respect for the rule of law. Or norms of basic decency. Or respect for human dignity and human rights. They are engaged in full-on, open scapegoating of many vulnerable minorities. Including transgender people.”
Kali HollowayKali Holloway is a columnist for The Nation and the former director of the Make It Right Project, a national campaign to take down Confederate monuments and tell the truth about history. Her writing has appeared in Salon, The Guardian, The Daily Beast, Time, AlterNet, Truthdig, The Huffington Post, The National Memo, Jezebel, Raw Story, and numerous other outlets.