North Dakota Supreme Court upholds ban on transgender healthcare for minors

The North Dakota Supreme Court on Thursday unanimously found the state’s ban on gender-affirming care for minors constitutional, upholding a lower court’s ruling from last year. 

The 2023 law makes it a crime to prescribe puberty blockers and other treatments to adolescents.

The high court’s reasoning for its decision mirrored that of South Central Judicial District Judge Jackson Lofgren, who in October 2025 rejected a North Dakota pediatric endocrinologist’s claims that the law forces him to withhold necessary medical care from his patients. 

The Supreme Court found that the North Dakota Legislature hadn’t abused its power in enacting the ban, and that it isn’t the court’s place to interfere with how lawmakers want to regulate the medical field.

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

“The forum for Dr. Casas’s factual arguments regarding the safety and effectiveness of gender-affirming treatment is the Legislature, not this court,” the justices said in an opinion authored by Justice Douglas Bahr.

The North Dakota Supreme Court also agreed with Lofgren’s conclusion that transgender people do not qualify for special legal protections, and that the gender-affirming care ban does not discriminate on the basis of sex.

Bahr noted in the opinion that other state and federal appellate courts have arrived at the same conclusion about similar laws restricting access to gender-affirming care.

Unless judges find that a law affects a protected group or restricts an important right, they usually are deferential to the Legislature, experts told the North Dakota Monitor previously.

Pediatric endocrinologist Luis Casas and his attorneys announced in February they would appeal Lofgren’s decision to the Supreme Court. 

The North Dakota Supreme Court heard oral arguments on the appeal in late June. Northeast Judicial District Judge Michael Hurly sat in for Justice Mark Friese, who recused. 

Attorneys for Casas claimed the law discriminates on the basis of sex because it bars minors with gender dysphoria from obtaining medical treatments that are otherwise available to kids to treat other medical conditions. They argued that because Lofgren did not make this finding, he used the incorrect framework to analyze the law. They asked the high court to send the case back to Lofgren for further review.

Casas’s attorneys also claimed the law interferes with North Dakotans’ right to make their own healthcare decisions.

One of the attorneys representing Casas, Tanya Pellegrini, during oral arguments called it “completely unprecedented” for North Dakota lawmakers “to single out a population from being able to receive medical care, categorically ban their medical treatment, and override parental consent.”

Defending the law, North Dakota Solicitor General Phil Axt during arguments before the court characterized gender dysphoria as a mental health condition, and said that North Dakota courts have not found that North Dakotans have a right to obtain care for mental health purposes. He said that the safety of gender-affirming care is still being debated and that the state has an interest in regulating access to the treatment to protect minors. Axt also said that the law does not discriminate based on sex.

The lawsuit was originally brought against the state of North Dakota in 2023 by three families with transgender children, in addition to Casas. Lofgren later dismissed the families and children from the suit, finding they did not have standing to participate. That left Casas as the sole plaintiff.

Lofgren presided over a seven-day court trial in early 2025 that included testimony from doctors, as well as two transgender teens and their parents who were initially plaintiffs in the case.

Attorneys for Casas during the trial noted that the majority of leading medical associations in the U.S. have found gender-affirming care to be a safe and effective treatment for adolescents with gender dysphoria.