The current status of North Dakota’s ban on transgender interventions on minors

During the 2023 legislative session, the North Dakota Legislature passed a law making it a crime for a health care provider to give any drug or to perform certain surgeries for the purpose of changing a minor’s sex to match the child’s internal sense of gender (the “ban”). The ban prohibits the use of puberty blockers, cross-sex hormones, gender-reassignment surgeries, and the like, on minors seeking to alter their biological sex. The ban, however, excludes interventions meant to alleviate medically verifiable genetic disorders of sexual development, such as sex chromosomal abnormalities. The ban was signed by Governor Doug Burgum in April 2023 and became the law of North Dakota. 

In September 2023, three families and Dr. Luis Casas, a pediatric endocrinologist at Sanford Children’s Medical Center in Fargo, filed a lawsuit in Burleigh County against the State of North Dakota, alleging that the state’s ban on transgender interventions on minors violates their rights under the North Dakota Constitution. Because no sex reassignment surgeries are currently being done on minors in North Dakota, only the ban on medical interventions was being challenged.  

After a period of pre-trial discovery, the three families were dismissed from the lawsuit for lack of standing, because the ban had a grandfather clause that allowed minors already receiving these medical interventions to continue to receive these medicines. Before trial, the trial court also rendered summary judgment against Dr. Casas on his claim that the ban was unconstitutionally vague and violated his due process rights. Dr. Casas, however, continued as the lone plaintiff in the suit, acting on behalf of his minor patients who would still be affected by the ban based on claims that it violates their rights under the North Dakota Constitution.  

The case went to trial this past February 2025 before Judge Jackson Lofgren in Bismarck, in a bench trial where the parties agreed that the judge, and not a jury, should decide the case. The trial included testimony from children and their families, testimony from expert witnesses, and hundreds of documents offered as evidence by both sides. After the trial ended, the judge took the case under advisement to examine the voluminous evidence, consider the legal arguments, conduct his own legal research, and carefully deliberate about the case before making his final decision.  

In October of this year, the judge issued an extensive Findings of Fact, Conclusions of Law, and Order for Judgment in the case, followed closely by a final Judgment dismissing the plaintiffs’ claims seeking to declare the ban unconstitutional under North Dakota’s Constitution and stop its enforcement. While this ruling goes a long way toward upholding North Dakota’s ban on transgender interventions on minors, the case is not necessarily over since the plaintiffs have the option to file an appeal within 60 days of the trial court’s entry of the final Judgment, which falls around mid-December 2025.  

In coming to his decision, the judge held that the State of North Dakota has the authority to regulate the practice of medicine in the state, including prohibiting certain procedures deemed harmful to minors. Following similar reasoning as the U.S. Supreme Court in the recent Skrmetti case (2025) upholding Tennessee’s ban on transgender treatments for minors, the judge rejected the argument that North Dakota’s ban creates an arbitrary sex-based classification that violates the right to equal protection under the North Dakota Constitution of those seeking these kinds of interventions. Instead, the court found that North Dakota’s ban has a rational basis for protecting minors from certain harmful medical procedures. The court also rejected the plaintiffs’ claim that preventing minors from obtaining these medical interventions violates their fundamental right to personal autonomy and self-determination. The judge reasoned that, while it is true that individuals have a fundamental right to refuse unwanted medical treatment based upon personal autonomy and self-determination, this does not mean they have a right to demand medical interventions determined by the state to be harmful, especially minors who lack the maturity to clearly understand the risks and benefits of the procedures. 

There was ample evidence presented at trial to indicate a rational basis for North Dakota’s ban prohibiting transgender treatments on minors. Some of the reasons recognized by the judge include: (1) legitimate concerns regarding the serious medical risks associated with providing puberty blockers and cross-sex hormones to minors, including the high likelihood of causing irreversible sterility; (2) evidence that many individuals who received these treatments as minors later express regret over this as adults; (3) evidence that many minors experiencing distress over their sexual identity resolve these issues over time; (4) the fact that minors often lack the maturity and experience to fully understand and appreciate the life-altering consequences of these treatments; (5) the ongoing international debate among medical experts over the safety and effectiveness of these treatments; (6) the weak evidence and poor quality of the studies offered to show the benefits of these treatments compared to the harms; and (7) the questionable value of positions taken by medical associations like the American Medical Association, American Association of Pediatricians, and others in support of transgender interventions that are highly politicized and do not represent the views of all doctors or even their own members. 

While the Catholic Church insists that individuals who are struggling with their sexual identity must be treated with compassion and respect, the Church also must always “speak the truth in love” (Eph 4:15). As Pope Francis emphasized on many occasions, gender ideology—which claims that a person can be born in the wrong body and can transition to the opposite sex through drugs and surgeries—is false and dangerous. The Church has always rejected dualistic accounts of human nature: the human person is not a soul in a body, and does not merely have a body, but is both body and soul, inseparably united. The Church also teaches that human nature is sexually differentiated as male or female, and that this sexual identity is constitutive of the person and not something one can change through medical and surgical interventions. Instead, human beings as creatures must respect the work of the Creator in making us male or female. 

The tide seems to be turning against the widespread and unthinking acceptance of gender ideology and transgenderism. Let us hope that the trial court’s decision in this case marks a new beginning in North Dakota of clear-sighted recognition that human persons are body/soul unities created as male or female, and that our healthcare must be consistent with this reality and follow the most fundamental principle of medical ethics, “first, do no harm.”