US Federal Judge Questions Ban on Testosterone for Trans Troops

A federal judge in the United States has openly questioned why transgender soldiers are denied testosterone treatment, while cisgender soldiers can receive the same medication for other health reasons. The question came during a hearing on the Pentagon's policy under Defense Secretary Pete Hegseth. The case could shape how far the US military may go in restricting medical care for trans service members.

What the judge asked

During a hearing in late July, the federal judge asked government lawyers a direct question. Why can a cisgender male soldier with low testosterone receive hormone therapy, while a transgender male soldier cannot? Both prescriptions involve the same drug. Both are supervised by military doctors. The judge said the difference in treatment needed a clear legal reason.

Government lawyers argued that the policy is about readiness, not identity. They said the Department of Defense has the right to set medical standards for service. The judge did not rule immediately. But the question itself signals that courts are looking closely at whether the ban treats similar patients differently without cause.

How the policy came about

In January 2026, President Donald Trump signed an executive order on military service and gender identity. The order stated that a “man’s assertion that he is a woman” is not compatible with military standards. Defense Secretary Pete Hegseth then issued guidance to carry out the order. Under that guidance, service members with a diagnosis or history of gender dysphoria face separation from the armed forces.

The guidance also limits medical care. Hormone therapy tied to gender transition is not covered. Surgeries linked to transition are not paid for. According to Pentagon figures cited in court filings, several thousand active troops are affected. Exact numbers are disputed. The Department of Defense has said about 4,200 service members have a gender dysphoria diagnosis. Advocacy groups say the real figure is higher.

The lawsuits

Several lawsuits are now moving through federal courts. The main cases are Talbott v. Trump and Shilling v. Trump. The plaintiffs include active-duty soldiers, sailors, airmen and Marines. Some have served for more than a decade. They argue the policy violates the Fifth Amendment’s guarantee of equal protection.

In one recent development, a federal judge blocked the Trump administration’s attempt to dismiss a lawsuit from Air Force members. The judge said the plaintiffs had shown enough evidence to move forward. A separate ruling in the US House also blocked an effort to write a permanent ban into the annual defense bill. That means the fight remains in the courts and in future budget votes.

Why testosterone is the key issue

Testosterone is a common prescription drug in the US military. Cisgender men with low levels can get it through military health care. The medicine is used to treat fatigue, low muscle mass and other symptoms. The dose and monitoring are similar to the treatment given to transgender men.

The plaintiffs’ lawyers argue this is the heart of the case. If two soldiers need the same drug, at the same dose, with the same medical supervision, the government must explain why one gets it and the other does not. Legal experts say this is a classic equal-protection question. The Supreme Court has ruled in past cases that the government must give a clear reason when it treats similar people differently.

What both sides say

The Department of Defense argues that military service is unique. Commanders need troops who can deploy anywhere at short notice. The Pentagon says ongoing medical treatment can complicate deployment. It also points to a 2018 review under the first Trump administration that reached similar conclusions.

Lawyers for the trans troops disagree. They point out that many cisgender troops take daily medication and deploy without issue. They also note that trans service members have served openly since 2016, when the Obama administration lifted the earlier ban. During those years, the Pentagon did not report readiness problems tied to gender identity, according to a 2016 RAND Corporation study commissioned by the Department of Defense.

What happens to affected troops

Under current guidance, service members with gender dysphoria face administrative separation. Those with fewer than 18 years of service can be discharged. Those close to retirement may be allowed to finish their careers, depending on individual review. Court orders have paused parts of the policy for named plaintiffs. Other troops remain in a legal grey zone.

For readers who want more background on how courts handle similar rights questions, see our explainer on Japan’s ruling on gender change without surgery. That case also turned on whether the state can require medical steps that treat trans people differently from others.

The wider context

The military case is one of several legal fights over trans rights in the US. State laws on youth health care, sports and identity documents are also in court. The federal government has cut funding for some LGBTQ+ health programs. Veterans’ care networks that served trans veterans have been reduced or closed, according to reporting by The Advocate.

Outside the US, other countries are moving in different directions. Germany passed a self-identification law in 2024. Japan’s high court ruled that forced sterilisation for legal gender change is unconstitutional. For readers interested in how these cases connect to protection claims, our piece on asylum rights for LGBTQ+ refugees in Europe explains the legal framework.

What to watch next

Three things will shape the coming months. First, the federal judge’s written ruling on the testosterone question. That ruling could set a standard for other cases. Second, appeals to higher courts, likely including the DC Circuit and possibly the Supreme Court. Third, the annual defense bill in Congress, where lawmakers may try again to write the ban into permanent law.

Legal experts say the testosterone question is unusually clear. It puts two soldiers side by side, with the same prescription, and asks the government to justify the difference. How the courts answer that question will affect not only trans troops, but also how the US applies equal-protection law to medical care in general.