In a ruling delivered October 8, 2025, District Judge Jackson Lofgren upheld North Dakota’s law barring gender-affirming medical care for minors. The decision is a major blow to transgender youth and their families in the state, many of whom must now look out of state for life-affirming care.
Passed in April 2023, North Dakota’s “Health Care Law” classifies prescriptions of puberty blockers and cross-sex hormones for transgender youth as a misdemeanor and makes transition-related surgeries (though rarely performed on minors in North Dakota) a class B felony. The law also creates a “grandfathering” exception that allows minors who began gender-affirming care before the law took effect to continue existing treatments.
In his 85-page decision, Judge Lofgren ruled that the statute does not violate the state constitution’s equal protection or parental rights provisions. He determined that the law draws distinctions by age and medical purpose, not by sex or transgender status, and is therefore subject to only rational basis review. Lofgren emphasized what he described as “an ongoing international debate regarding the safety and effectiveness” of such treatments, concluding that “where there is uncertainty, deference is given to the Legislature.”
The judge also dismissed many challenges raised by plaintiffs, which included families of transgender youth and a pediatric endocrinologist, citing lack of standing. He allowed continuation of pre-existing treatments under the grandfather clause but declined to strike down the law entirely.
The immediate fallout has been devastating for affected families. Parents now must travel out of state to access hormone therapy, puberty blockers, or other gender-related care for their children. Jess Braverman, Legal Director of Gender Justice, which represented plaintiffs, called the ruling “devastating” and said the law “inflicts real harm, strips families of their constitutional rights, and denies young people the medical care they need to thrive.”
This decision follows a national pattern. In June 2025, the U.S. Supreme Court upheld a Tennessee ban on gender-affirming care for minors in United States v. Skrmetti, ruling that such laws do not constitute sex-based discrimination under the 14th Amendment. That ruling emboldened several states to defend or enact similar restrictions. As of mid-2025, more than two dozen states have active bans or severe limits on gender-affirming treatments for minors.
For transgender youth, the consequences are deeply personal. Research consistently shows that access to gender-affirming care is associated with better mental health, lower suicidal ideation, and improved overall well-being. Restricting this care leaves many young people vulnerable to depression, anxiety, and hopelessness. Families now face financial strain and emotional exhaustion as they seek support in states where their children’s identities are recognized and protected.
At a time when trans youth are facing increasing legislative attacks, the ruling in North Dakota serves as a reminder that these battles are far from over. Advocates and families have vowed to appeal, continuing to fight for the right of every young person to live authentically and receive the care they need to survive and thrive.
