Trump appointees at the Bureau of Prisons, a division of the Justice Department, provided an array of gender-affirming treatments, including hormone therapy, for a small group of inmates who requested it during Mr. Trump's four years in office. In a February 2018 budget memo to Congress, bureau officials wrote that under federal law, they were obligated to pay for a prisoner's "surgery" if it was deemed medically necessary. Still, legal wrangling delayed the first such operation until 2022, long after Mr. Trump left office.