By: Devin Fry
BISMARCK, N.D. (Valley News Live) – The legal fight over North Dakota’s ban on gender-affirming medical care for minors is returning to the state’s highest court.
Attorneys for three minor patients and their families, along with North Dakota pediatric endocrinologist Dr. Luis Casas, filed a notice of appeal Wednesday in the North Dakota Supreme Court, challenging a district court ruling that upheld the state’s Health Care Ban. They announced the appeal in a press release on Thursday.
Background
In October 2025, Burleigh County District Court Judge Jackson Lofgren upheld the ban following a bench trial, applying rational basis review and finding the law had a reasonable relationship to legitimate government interests, including medical risks and concerns about minors’ capacity to understand long-term, irreversible effects. He denied requests to declare the law unconstitutional and refused to block its enforcement.
What the Law Does
North Dakota’s Health Care Law, passed in 2023, prohibits providers from performing procedures or prescribing certain medications to minors for gender affirmation purposes. Banned treatments include puberty blockers, cross-sex hormones, and surgeries such as castration, hysterectomy, and mastectomy. Doctors who violate the law face up to 360 days in prison and $3,000 in fines.
Issues on Appeal
Appellants are raising two central questions before the Supreme Court:
Whether the district court erred by applying only rational basis review, rather than a higher standard of scrutiny, arguing the ban implicates constitutional rights to life, liberty, safety, happiness, self-determination, and equal protection under the North Dakota Constitution.
Whether, even under rational basis review, the district court erred in finding the law is rationally related to a legitimate government interest, specifically by disregarding evidence of harm to affected adolescents and alleged evidence of legislative animus in passing the law.
In Their Own Words
Dr. Casas said the law removes families’ ability to make private medical decisions with their doctor.
