North Dakota Supreme Court Upholds Ban on Transition Drugs for Minors

What the court upheld

The court rejected the asserted fundamental right to a particular medical treatment. It treated the law’s classifications as based on age and medical purpose, rather than sex or transgender status, and applied rational-basis review: whether the restrictions reasonably relate to a legitimate government objective.

The decision concerns Article I, Sections 1 and 21 of North Dakota’s Constitution. Crucially, paragraph 21 of the opinion limits the appeal to the medication prohibition. The surgery provisions remain in the statute, but their constitutionality was not separately decided on the merits in this appeal.

All five participating judges joined the majority opinion. Justice Jerod Tufte also wrote a separate concurrence, joined by Justice Jon Jensen.

What the law restricts — and what it exempts

The statute targets specified procedures intended to change or affirm a minor’s perception of sex when it differs from biological sex. It covers puberty blockers used to stop normal puberty and hormone drugs, including testosterone for females and estrogen for males at doses above normal physiological levels.

Its surgical provisions cover listed genital procedures, mastectomies and removal of otherwise healthy tissue for that purpose. Willful violations by providers carry a Class B felony for the surgical provisions or a Class A misdemeanor for the medication provision.

This is not a ban on every use of those medicines in children, and it does not cover adults. The statute also exempts qualifying good-faith medical decisions involving minors born with medically verifiable genetic disorders of sex development, as well as treatment begun before April 21, 2023.

Why the families were removed from the case

Pediatric endocrinologist Luis Casas and three families originally brought the lawsuit. The families were dismissed for lack of standing because their children had begun treatment before the cutoff and were exempt. Casas pursued the appeal.

The trial court interpreted that grandfather protection broadly, allowing qualifying patients access to care they could have received before the law. The state did not challenge that interpretation on appeal. The decision therefore does not mean every existing patient must stop treatment.

The disagreement over protecting children

Supporters regard the restrictions as safeguards against medical interventions they believe children cannot adequately evaluate. The court’s own summary emphasizes the state’s legitimate interest in protecting young people’s health and welfare; its ruling allows lawmakers to maintain these restrictions.

Gender Justice, which represented the challengers, opposed the outcome in a September 17 statement. Its legal director, Jess Braverman, argued that families and medical providers should make these decisions rather than politicians. Casas likewise criticized the restrictions as a barrier to care. Those objections remain part of the debate even though the legal challenge failed.

FaithfulHeartbeat perspective: protection with compassion

From a Christian-conservative perspective, this is a welcome affirmation that lawmakers can set boundaries around medical transition procedures for children. Respect for the body as God’s creation and concern for a child’s future provide strong reasons to support a cautious approach to decisions with potentially lasting consequences.

That conviction should be expressed with compassion, not contempt. Children experiencing distress and their families deserve patient attention, dignity and support. Defending protective limits does not require ridiculing the people affected by them.

The strongest case for this ruling rests on what it actually decided. North Dakota’s medication restrictions survived this state-constitutional challenge, the broader law remains in place, and its exemptions still matter. Accurate reporting strengthens the argument for protecting children; it does not weaken it.