BOP Program Statement 5260.01 § 5

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

5260.01 02/19/2026 PROPERTY OF US GOVERNMENT 5

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.

Psychotherapy should be prioritized. Treatment should include, at a minimum, therapy in

accordance with their mental health care level as outlined in Program Statement PS 5310.16,

Treatment and Care of Inmates with Mental Illness. Additionally, other treatments, such as

psychoeducational group interventions, may be added as clinically indicated. Treatment

interventions will focus on managing the psychological distress/dysphoria, assisting with

adjustment to incarceration, community re-entry, and strengthening resilience. Follow-up mental

health care should target any associated emotional or behavioral problems and should emphasize

supportive treatment modalities.

All clinicians will ensure individuals with GD are not experiencing acute distress during any

clinical contact. If the individual is experiencing suicidal ideation, a suicide risk assessment and

appropriate protocols related to decreasing distress will be prioritized (in accordance with

Program Statement PS 5324.08, Suicide Prevention Program). The psychologist may deem it

appropriate to refer the individual for trauma treatment, if clinically indicated. Additional areas

of focus may include adjustment to incarceration, other mental health diagnoses, community re-entry, and strengthening resilience. Follow-up mental health care should target any associated

emotional or behavioral problems and should emphasize supportive treatment modalities.

5260.01 02/19/2026 PROPERTY OF US GOVERNMENT 6

Psychotropic medication should be considered to determine if its use may alleviate the symptoms

of GD.

Diagnosis and treatment of GD will be discontinued if it is determined by a mental or medical

health professional that the inmate no longer meets the criteria for the diagnosis based on clinical

outcomes. The treatment plan will be updated, and a Diagnostic Care Level Formulation note

will be entered into the electronic health record to reflect the diagnosis as “Resolved.”

All clinicians shall ensure that individuals with GD receive informed care. The medical provider

is responsible for ensuring that the inmate understands and signs the informed consent form,

before any medication orders. Consent must be voluntary, and the inmate must be able to

understand and appreciate the risks and potential side effects of the prescription. If the required

documented evidence is insufficient, or if the inmate fails to sign the consent form, the clinician

shall not prescribe medication or provide the procedure.

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

5260.01 02/19/2026 PROPERTY OF US GOVERNMENT 7

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.

Medical and mental health professionals shall evaluate the inmate before beginning tapering.

Based on that evaluation and patient-specific needs, medical and mental health professionals

shall develop a monitoring and follow-up evaluation plan. All inmates who are tapering and were

receiving mental health treatment before tapering shall continue to receive counseling and

pharmacological treatment as appropriate as part of the inmate’s individualized treatment plan.

Tapering plans may be adjusted as necessary based on monitoring and follow-up evaluations, but

the adjusted tapering plans must still be consistent with the purpose of this policy and based on

all relevant factors, including security and prison-administration concerns.

Patients may submit a request for additional medical or mental health care or evaluation if they

have acute concerns during the tapering process. All requests shall be considered in a reasonable

amount of time in accordance with standard procedure, and decisions concerning such requests

shall be based on all relevant factors, including security and prison-administration concerns.

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.

5260.01 02/19/2026 PROPERTY OF US GOVERNMENT 8