ND Supreme Court upholds ban on sex-change surgeries, hormone drugs for minors
North Dakota’s highest court has upheld a state ban on cosmetic sex-change surgeries and puberty-blocking drugs for minors who identify as the opposite sex.
In a unanimous decision last Thursday, the North Dakota Supreme Court ruled in the case of T.D. v. Wrigley to uphold a law passed in 2023 that bans trans treatments for children.
North Dakota Justice Douglas Bahr authored the opinion, writing that the law, also known as House Bill 1254, did not violate the state constitution, which is silent on the issue.
“Although times have changed, the meaning of the constitution has not,” wrote Bahr. “Defining a fundamental right by a modern medical diagnosis or procedure, as some courts have done, forecloses recognition of a fundamental right because the diagnosis or procedure could not be shown to be deeply rooted in history and tradition.”
“The plain language of Article I, § 1 [of the state constitution] does not mention a minor’s right to determine the minor’s medical care.”
Jess Braverman, legal director at Gender Justice, an LGBT advocacy group that helped represent the plaintiffs, released a statement denouncing the state Supreme Court ruling.
“This ruling is devastating for transgender youth and their families in North Dakota — and 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,” Braverman stated.
“If the North Dakota Constitution does not ban the government from interfering with North Dakotans’ private medical decisions, then all North Dakotans are vulnerable to the whims of politicians when it comes to their ability to access life and health preserving medical care.”
Jonathan Scruggs, senior counsel at the Alliance Defending Freedom, a conservative legal group that filed an amicus brief supporting the law, celebrated the high court decision.
“Our laws should protect children and recognize biological reality,” said Scruggs in a statement. “North Dakota’s law does exactly that by ensuring that children experiencing gender dysphoria won’t be subjected to dangerous drugs and surgeries but will have the chance to heal through evidence-based medical care.”
“Children across the country have suffered for too long because of the lies of gender ideology. We look forward to seeing more state legislatures reject this lie and follow the examples set by North Dakota and dozens of other states.”
Republican Gov. Doug Burgum signed HB 1254 into law, which took effect in April 2023, with North Dakota joining several other states in banning the controversial provisions for minors.
North Dakota pediatric endocrinologist Luis Casas and three families that included LGBT youth filed a complaint against the law, arguing that it violated the state constitution. The families were later dropped from the litigation as their children had already begun receiving the procedures before the state ban took effect and thus were exempt from the law.
In October 2025, South Central District Court Judge Jackson Lofgren ruled in favor of the law, writing that there was “legitimate ongoing debate regarding the safety and effectiveness” of “gender-affirming care.”
“Where there is uncertainty, deference is given to the Legislature to decide where the line should be drawn,” Lofgren wrote, reported The North Dakota Monitor.
In June 2025, the U.S. Supreme Court ruled 6-3 in the case of United States v. Skrmetti that Tennessee could ban body-mutilating surgeries and hormone drugs for trans-identified minors.
“This case carries with it the weight of fierce scientific and policy debates about the safety, efficacy, and propriety of medical treatments in an evolving field. The voices in these debates raise sincere concerns; the implications for all are profound,” wrote Chief Justice John Roberts for the majority.
“The Equal Protection Clause does not resolve these disagreements. Nor does it afford us license to decide them as we see best. … Having concluded it does not, we leave questions regarding its policy to the people, their elected representatives, and the democratic process.”
