North Dakota Supreme Court upholds ban on sex-rejecting procedures, hormones for minors

The North Dakota Supreme Court unanimously upheld a state law banning puberty blockers, cross-sex hormones and sex-rejecting surgeries for minors, rejecting a constitutional challenge from a pediatric endocrinologist who argued the ban interferes with medical decision-making.

The ruling in T.D. v. Wrigley upholds House Bill 1254, a 2023 law prohibiting health care providers from administering “gender-transition” treatments to minors with gender dysphoria. 

Writing for the court, Justice Douglas Bahr found the state constitution’s plain language contains no mention of a minor’s right to a particular medical treatment, concluding, “Although times have changed, the meaning of the constitution has not.” 

The opinion added that lawmakers “need not defer to certain medical experts, professional associations, or advocacy groups when determining whether or how best to protect the health and welfare of our children from medical procedures with potential serious and irreversible adverse effects.”

The court also rejected arguments that the law discriminates based on sex or transgender status, holding that it “classifies based on age and medical purpose.”

Alliance Defending Freedom, which filed an amicus brief supporting the state, said the decision tracks with the U.S. Supreme Court’s 2025 ruling in United States v. Skrmetti upholding a similar Tennessee law. “Our laws should protect children and recognize biological reality,” said Jonathan Scruggs, ADF senior counsel and vice president of litigation strategy.

Attorneys for the plaintiffs criticized the outcome. Jess Braverman, legal director at Gender Justice, called the ruling “devastating for transgender youth and their families in North Dakota.” Dr. Luis Casas, the pediatric endocrinologist who brought the suit, argued that adolescents have a fundamental “right to medical decision-making without undue government interference.” 

The court disagreed with Casas’ assertion, stating in its opinion, “North Dakota’s criminalization of abortion since statehood belies Dr. Casas’s argument that the State defers to the medical community. The State has regulated the practice of medicine since statehood, including prohibiting particular medical procedures notwithstanding physician approval.”

North Dakota’s law is among dozens of state restrictions on youth “gender-transition” treatment enacted since 2021. Zeale News has reported on the broader rollback, including a June settlement in which the Cleveland Clinic agreed to halt such procedures for minors for 20 years following a U.S. Justice Department and Ohio state investigation.