FARGO — North Dakota’s
ban on gender-affirming healthcare
for transgender children has been upheld by the state’s top court.
The North Dakota Supreme Court
unanimously ruled on Thursday, Sept. 17, in favor of the law that prohibits sex-reassignment surgeries, hormone treatments and puberty blockers. Children do not have a “fundamental right” to the treatments, but state lawmakers have the authority to determine if the procedures are “too dangerous” for children, the ruling said.
“The Legislature could rationally determine that restricting gender-affirming treatment for minors advances the legitimate governmental interest of protecting the health and welfare of minors,” the ruling said.
The opinion cements into law 2023 legislation signed by former Gov. Doug Burgum. Doctors who perform sex-reassignment surgeries face up to 10 years in prison and a $20,000 fine, and prescribing hormone treatments or puberty blockers is punishable by up to 360 days in jail and a $3,000 fine.
Dr. Luis Casas and several transgender children sued the state in an effort to reverse the law. The civil case claimed the ban violated a child’s right to “life- and health-preserving gender-affirming treatment.”
After a trial in 2025,
Burleigh County Judge Jackson Lofgren
ruled North Dakota had the power to pass the law. The right to make healthcare decisions belongs to an adult who has “a clear understanding of the risks and benefits of the medical treatment,” he wrote in an 85-page opinion published in October.
The Supreme Court affirmed Lofgren’s position. In a 50-page opinion, Justice Douglas Bahr wrote that North Dakota has a history of regulating and prohibiting medical procedures.
“It also shows the state has regulated the actions and activities of minors even more closely than those of adults,” Bahr wrote. “This history is inconsistent with the alleged right of a minor to a particular course of medical treatment.”
Casas filed the appeal against Lofgren’s ruling, meaning he doesn’t have standing as a parent, Bahr wrote. The North Dakota Constitution doesn’t mention a minor’s right to receive a certain type of medical care, and Casas did not present evidence that minors have a “fundamental right to receive a particular course of medical treatment,” Bahr wrote.
Bahr wrote that the ban was based on age and medical purpose, not gender.
“The issue is not about transgender people,” he wrote. “It is about whether (the state Constitution) bars the Legislature from prohibiting certain medical treatment for minors.”
Bahr also mentioned
North Dakota’s ban on abortion,
with exceptions for cases of rape, incest or serious health risk to the patient’s life less than six weeks into the pregnancy, as an example of the state regulating medical procedures.
“The ruling aligns with established constitutional principles, common sense and respect for the attainment of adulthood before making decisions of such profound and lasting consequence,” North Dakota Attorney General Drew Wrigley said in a statement. “As it has since the beginning of statehood, our Legislature made an important healthcare judgment after appropriately engaging in fact-finding, deliberation and accountable decision-making on behalf of the citizens of North Dakota.”
Upholding the ban is “devastating for transgender youth and their families in North Dakota,” Gender Justice Legal Director Jess Braverman said. Gender Justice and the Lawyering Project argued the case on behalf of Casas.
“This ruling means the government still stands between me and my patients,” Casas said in a statement. “Families I’ve worked with for years are being forced into an impossible choice: uproot their lives and leave the state, or go without the care their doctors recommend and their kids need.”
April Baumgarten is the Fargo city government reporter. The North Dakota native started her journalism career in 2011 and joined The Forum in February 2019. Readers can reach her at 701-241-5417 or abaumgarten@forumcomm.com.