North Dakota Judge Upholds Ban on Gender-Affirming Care for Minors

Court Upholds State Law

BISMARCK, N.D. – North Dakota District Judge Jackson Lofgren has upheld the state's ban on gender-affirming care for minors, a decision announced on Wednesday, October 8, 2025. The ruling affirms House Bill 1254 (HB 1254), a law enacted in April 2023 that prohibits medical professionals from providing puberty blockers, hormone therapy, and gender-affirming surgeries to individuals under the age of 18.

In his decision, Judge Lofgren stated that the law 'discriminates based on age and medical purpose, not sex,' and found little evidence that the Legislature passed the law for 'an invidious discriminatory purpose.' He further noted an 'ongoing international debate regarding the safety and effectiveness' of the prohibited medical procedures, concluding that 'Where there is uncertainty, deference is given to the Legislature to decide where the line should be drawn.'

Implications for Families and Legal Challenge

The ruling means that parents seeking gender-affirming medical care for their children in North Dakota after the ban's effective date in April 2023 will need to pursue such treatments out of state. The lawsuit challenging the ban was initially brought by several affected families and a pediatric endocrinologist, Dr. Luis Casas. However, the judge dismissed claims from the families, leaving only Dr. Casas as the plaintiff.

The law makes it a misdemeanor for health care providers to prescribe or administer hormone treatments or puberty blockers to a minor, and a felony to perform gender-affirming surgery on a minor. An important aspect of the ruling is the affirmation of an exemption for minors who were already receiving gender-affirming care prior to the law's enactment in April 2023, allowing them to continue their treatments.

Reactions and National Context

The decision has drawn strong reactions from both proponents and opponents of the ban. Jess Braverman, Legal Director for Gender Justice, which represented the plaintiff, expressed deep disappointment. Braverman stated, '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.'

Conversely, Republican State Representative Bill Tviet, who introduced the legislation, welcomed the ruling. Tviet commented, '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.' North Dakota Attorney General Drew Wrigley also supported the ruling, stating it 'recognizes North Dakota's constitutionally permissible interest in healthcare legislation that protects minors.'

North Dakota is among at least 27 states in the United States that have adopted laws restricting or banning gender-affirming care for minors. This trend follows a June 2025 ruling by the U.S. Supreme Court, which indicated that states have the authority to ban gender-affirming medical care for transgender minors.