Oct. 9, 2025:
BISMARCK, N.D. (AP) — A North Dakota judge has upheld the state’s ban on gender-affirming care for children, in a blow to families who have had to travel out of state to obtain the medical treatments they said are crucial for their kids’ well-being.
District Judge Jackson Lofgren’s said in his decision Wednesday (Oct. 8, 2025) that the law discriminates based on age and medical purpose, not sex, and that there’s little evidence the Legislature passed the law for “an invidious discriminatory purpose.” He also noted various concerns and ongoing debates over the medical treatments involved.
“The evidence presented at trial establishes there is a legitimate concern regarding the capacity of minors to understand and appreciate the long-term consequences of the practices prohibited by the Health Care Law,” the judge wrote, adding that he doesn’t believe the law violates the state constitution.
The ruling means parents who decided to seek gender-affirming medical care for their children after the state’s ban took effect in April 2023 will need to do so out of state.
“This ruling is devastating for transgender youth and their families in North Dakota. The evidence in this case was overwhelming: this law inflicts real harm, strips families of their constitutional rights, and denies young people the medical care they need to thrive,” Jess Braverman, the legal director for the gender equity nonprofit Gender Justice, which represented the plaintiff, said in a statement.
Republican state Rep. Bill Tveit, who introduced the legislation, said he is pleased with the ruling.
“It’s a law that needs to be there. We need to protect our youth, and that’s what the whole goal of this thing was from the beginning,” Tveit said.
The lawsuit was brought by several affected families and a pediatric endocrinologist, but the judge dismissed some of their claims and left only the physician as a plaintiff.
About half of U.S. states, nearly all of which have fully Republican-led governments, have banned gender-affirming care for minors. North Dakota’s law makes it a misdemeanor for a health care provider to prescribe or give hormone treatments or puberty blockers to a transgender child. It also makes it a felony to perform gender-affirming surgery on a minor.
The law’s backers said it would protect children from what they said are irreversible effects of treatments and surgeries, though such surgeries were never available in the state. Opponents said the law harms transgender children by denying them crucial medical care.
Although the law exempts children who were already receiving treatments before North Dakota’s ban took effect, attorneys for the families who sued said providers held off because they perceived the law as vague and didn’t want to risk it. That led the families to miss work and school so they could travel to Minnesota for treatment.
The judge later said those kids can receive any medical care they were receiving before the law took effect, though that decision wasn’t enough of a final ruling to satisfy attorneys for health care organizations. His Wednesday ruling granted a request that those kids’ treatments continue, citing the law and his previous findings.
At least two pediatric endocrinologists were providing gender-affirming care in North Dakota before the ban.
The U.S. Supreme Court ruled in June that states can ban gender-affirming medical care for transgender minors.
At least 27 states have adopted laws restricting or banning the care.
January 27, 2025:
BISMARCK, N.D. (AP) — A lawsuit seeking to strike down North Dakota’s ban on gender-affirming medical care for minors will go to trial Monday (Jan. 27, 2025), more than a year after families of transgender children and a doctor filed the suit that argued the law violates the state’s constitution.
North Dakota is one of more than two dozen states that have banned gender-affirming care. Like North Dakota, many of those states have faced court challenges to the laws.
“Our argument is that all North Dakotans have a right to access health care that helps improve their lives and well-being, and our clients are no different,” said lead counsel Brittany Stewart, senior staff attorney at Gender Justice, a nonprofit advocating gender equity.
Court rulings have significantly reduced the scope of the North Dakota case, filed in late 2023. Earlier this month, a state district judge dismissed from the case some of the claims as well as the children and families who were plaintiffs, leaving only a pediatric endocrinologist as a plaintiff.
The trial in Bismarck, the state capital, is expected to last eight days. It’s unclear when the judge will rule.
Then-Gov. Doug Burgum signed the bill into law in April 2023 after it overwhelmingly passed the Republican-led Legislature. It makes it a misdemeanor for a health care provider to prescribe or give hormone treatments or puberty blockers to a transgender child, and a felony to perform gender-affirming surgery on a minor.
Lawmakers who supported the bill that became law said it would protect children from what they said are irreversible treatments and operations.
“We were creating an atmosphere where if you felt you had that situation, that you were of that mentality, that we would go ahead and cut off body parts and affirm where you’re at without trying to guide you through it,” said Republican Rep. Bill Tveit, who introduced the bill. “Maybe it was a wrong thought at that age, and if you want to make that decision when you’re of age … that’s your prerogative once you’re an adult.”
He said he hopes the trial’s outcome affirms the law. North Dakota Attorney General Drew Wrigley declined to comment on the case.
Opponents said the legislation would have harmful effects on transgender kids, and noted that gender-affirming surgeries are not performed on minors in North Dakota.
A U.S. Centers for Disease Control and Prevention survey last year found that transgender and gender-questioning teens reported higher rates of bullying at school than their peers and that about 1 in 4 transgender teens said they had attempted suicide in the past year.
Stewart said, “When you ban the only medically supported care for a specific condition and only for young people who are under 18, you’re not protecting those kids. You’re actively harming those children.”
The law contains an exemption for children who were already receiving treatments before the ban’s effective date. But attorneys for the plaintiffs said providers held off due to perceived vagueness in the law. That led the families to travel and miss work and school to seek care for their kids — including an eight-hour round trip drive for one family to attend a 30-minute appointment, Stewart said.
The judge later said the law does not apply to any minors who were receiving gender-affirming care before North Dakota’s ban took effect, including the three plaintiff children. The judge said they “can receive any gender-affirming care they could have received” previously. But their access remains unchanged because that ruling was not enough of a final decision to satisfy attorneys for health care organizations, Stewart said.
At least two pediatric endocrinologists in North Dakota were providing gender-affirming care before the ban, Stewart said.
“As far as the number of patients, I can’t really say, but honestly whether it’s a lot or a few is really irrelevant to whether this is constitutional,” she said.
President Donald Trump recently signed an executive order declaring only two sexes, male and female, are recognized by the federal government. State laws on sports participation, bathroom use, gender-affirming care and other issues are not directly affected.
Every major U.S. medical group, including the American Academy of Pediatrics and the American Medical Association, has opposed such bans and said that gender-affirming treatments can be medically necessary and are supported by evidence. Research has further shown that transgender youths and adults can be prone to suicidal behavior when forced to live as the sex they were assigned at birth.
At least 26 states have adopted laws restricting or banning gender-affirming medical care for transgender minors, and most of those states face lawsuits. Federal judges have struck down the bans in Arkansas and Florida as unconstitutional, though a federal appeals court has stayed the Florida ruling. A judge’s order is in place temporarily blocking enforcement of the ban in Montana.
The states that have passed laws restricting or banning gender-affirming medical care for transgender minors include Alabama, Arkansas, Arizona, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia and Wyoming.
June 6, 2024:
BISMARCK, N.D. (AP) — A North Dakota judge has denied a preliminary injunction as three families challenge the state’s law banning gender-affirming care for kids. He also clarified Wednesday (June 5, 2024) that a grandfather clause does allow children to continue their treatment if they were receiving such medical care before the law took effect in April 2023. The plaintiffs had called that exception unconstitutionally vague. The families and a doctor filed suit last September. Supporters say protecting children is the goal of the ban, which was signed by Republican Gov. Doug Burgum after it was overwhelmingly approved by the GOP-led Legislature. Opponents say the law is harmful to transgender youth.
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