North Dakota Supreme Court upholds gender-affirming care ban for minors

North Dakota’s highest court has upheld a law that prevents minors in the state from accessing gender-affirming care.

On Thursday, the North Dakota Supreme Court ruled unanimously that House Bill 1254, which was signed into law in 2023, does not violate the state’s constitution.

The ruling comes after several families affected by the law, as well as pediatric endocrinologist Luis Casas, announced in February that they would appeal an October 2025 district court decision, which kept the law in place following an initial legal challenge.

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The court’s ruling blocks trans minors in North Dakota from accessing puberty blockers, as well as surgical forms of gender-affirming care, like top and bottom surgery, which were already almost never performed on minors before the law was passed.

“The government still stands between me and my patients,” Casas said in a statement released Thursday through the Minnesota-based advocacy group Gender Justice. “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.”

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In their decision, the justices said the law does not violate the constitutional rights of minors, “because minors do not have a fundamental right to a particular course of medical treatment.” The court also claimed that the law does not discriminate against trans youth on the basis of their sex or gender identity.

Trans rights advocates worry that the decision will block minors from medical services that are widely viewed by professional associations as safe and beneficial for youth mental health.

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“This ruling is devastating for transgender youth and their families in North Dakota,” said Jess Braverman, legal director at Gender Justice, in Thursday’s press release. “It should worry every North Dakotan who believes private medical decisions should be made by families in consultation with their trusted medical providers, not by politicians.”

“When the state can criminalize a doctor for providing a young person with evidence-based medical care, it strips families of the right to make their own medical decisions,” said Tanya Pellegrini, co-director of litigation at the Lawyering Project, in the press release. “We will continue to stand with transgender young people and their families until the rights and dignity of all North Dakotans are upheld.”