Judge rules in favor of North Dakota’s ban on transgender care for minors

South Central Judicial District Judge Jackson Lofgren presides over a trial to determine the constitutionality of North Dakota's ban on gender-affirming care for minors on Feb. 3, 2025. (Mary Steurer/North Dakota Monitor)A judge has upheld a North Dakota law that bans gender-affirming care for minors, which some families say has forced them to seek health care out of state. 

South Central District Court Judge Jackson Lofgren wrote in a Wednesday order that the 2023 law that makes it a crime to prescribe puberty blockers and other treatments to adolescents does not violate the state constitution. 

Lofgren presided over a seven-day court trial that ended in February and included testimony from doctors and transgender teens and their parents.

In his 85-page order, Lofgren writes that there is “legitimate ongoing debate regarding the safety and effectiveness” of prescribing gender-affirming treatments like puberty blockers or hormone therapy to a minor. He adds that the evidence at trial shows a valid concern about whether adolescents have the capacity to understand the long-term risks of the medications.

“Where there is uncertainty, deference is given to the Legislature to decide where the line should be drawn,” Lofgren wrote.

The lawsuit was brought by North Dakota pediatric endocrinologist Luis Casas, who alleged that the ban is an unconstitutional infringement of personal autonomy and equal protection rights. 

Brittany Stewart, right, delivers the opening statement for the plaintiffs at the beginning of a trial over North Dakota’s ban on gender-affirming care for minors on Jan. 27, 2025. Jess Braverman, another attorney for the plaintiffs, is shown at left. (Photo by Mary Steurer/North Dakota Monitor)

Jess Braverman, legal director for Gender Justice, which represented Casas, called the order “really disheartening.”

“The evidence at trial clearly showed how hard this ban has hit North Dakota families and transgender adolescents,” Braverman said Thursday. “It’s just really disappointing that these families won’t be able to get the health care they need.”

Braverman said attorneys were still digesting the judge’s order and it was too soon to comment on whether they would appeal to the North Dakota Supreme Court. 

North Dakota Attorney General Drew Wrigley said Lofgren’s ruling recognizes the state’s “constitutionally permissible interest in health care legislation that protects minors.”

“The North Dakota Legislature considered this matter thoroughly and determined that medical gender transition procedures and protocols cannot be appropriately undertaken for minors,” Wrigley said in a statement. “The district court’s thorough and thoughtful decision makes it clear that our elected legislative body appropriately reached this medical health determination and passed legislation that is constitutionally sound.”

Witnesses for the plaintiffs said there is consensus among leading medical associations, including the American Academy of Pediatrics and the American Medical Association, that hormone therapy is safe and effective to treat gender dysphoria. 

Lofgren wrote that the positions of the associations don’t necessarily reflect the views of all health care professionals.

The plaintiffs had also argued that statements from some lawmakers showed they were motivated by a bias against LGBTQ people. Lofgren cited other court rulings that said individual comments by legislators cannot be considered the intent of the entire Legislature. He also wrote that the bill received significant debate and was approved by a majority of legislators.

Gov. Doug Burgum signed the bill in April 2023 after it was approved by the Republican majority in the Legislature, though some Republicans did vote against it.

Initially, the plaintiffs also included three families who sought to challenge the state law. Lofgren limited the scope of the lawsuit, however, finding that the families could not sue because their children received gender-affirming before the ban took effect and fell under an exemption in the law. 

In Lofgren’s ruling this week, he also affirms the health care exemption for families receiving the treatments in North Dakota prior to April 2023, when the law was signed. 

Attorneys for the plaintiffs have said previously that minors who fall under the law’s exemption could not access gender-affirming care in North Dakota because medical providers were uncertain how to interpret the ban. Families have traveled to Minnesota for health care even if they qualified for the exemption.

During the trial, a North Dakota transgender teen testified that puberty blockers and hormone therapy turned her life around. A mother testified that the state law is a threat to her son’s health and happiness. Casas, a pediatric endocrinologist, said during the trial that one of his patients who planned to pursue medical treatment attempted suicide after learning the state had passed the ban for minors.

“What gets lost in the shuffle is that these are real people, real people’s lives that are being impacted,” Braverman said.

The law makes it a class A misdemeanor to administer medications — including puberty blockers and hormone therapy — to children for the purpose of providing gender-affirming care.

Providers who violate this part of the law could face up to 360 days in jail, fines of up to $3,000 or both.

The law also makes it a class B felony to perform transition-related surgery on a minor — which means up to 10 years in prison and a maximum $20,000 fine. In hearings on the bill, health care professionals testified that transition-related surgeries are not performed on minors in North Dakota.

In June, the U.S. Supreme Court upheld Tennessee’s law prohibiting gender-affirming care for minors.

This story has been updated with additional reporting and to correct the date of the judge’s order.

Oct 8 order

This story was originally produced by North Dakota Monitor, which is part of States Newsroom, a nonprofit news network which includes Florida Phoenix, and is supported by grants and a coalition of donors as a 501c(3) public charity.