Yesterday brought a major development in the ongoing legal battle over gender-affirming care for transgender youth in North Dakota. In a significant victory for families seeking medical autonomy, a judge denied the state’s motion to dismiss T.D. v. Wrigley, a lawsuit challenging North Dakota’s ban on gender-affirming care for minors. The trial, scheduled to start on January 27, promises to shed light on the constitutionality of the law and to determine the future of critical health care for young transgender and nonbinary people across the state.
This lawsuit comes amid a broader national conversation on the rights of transgender youth and whether lawmakers can legitimately restrict age-appropriate treatments recommended by major medical associations, including the American Medical Association (AMA) and the American Academy of Pediatrics (AAP). Plaintiffs in T.D. v. Wrigley—initially three families, their physician, and several advocacy groups—argue that North Dakota’s ban violates constitutional rights to equal protection, bodily autonomy, self-determination, and parents’ rights to direct the upbringing of their children.
However, as the case has progressed, South Central Judicial District Judge Jackson Lofgren has limited the lawsuit’s scope, concluding that the three families who initially joined the suit no longer have standing to challenge the law. Because their children were already receiving gender-affirming care before the ban took effect in April 2023, they qualify for a narrow exemption that allows ongoing treatment. Lofgren’s decision leaves pediatric endocrinologist Dr. Luis Casas as the lone remaining plaintiff, representing himself and his current and future patients in arguing that North Dakota’s ban is unconstitutional.
Below, we break down the key points of the case, the legal arguments on both sides, and what may lie ahead once the trial begins.
A Law Under Scrutiny
At the heart of the dispute is House Bill 1254 (HB 1254), signed into law by then-Governor Doug Burgum in 2023. Under this law:
- Providing Gender-Affirming Care is Criminalized: Medical professionals who prescribe or administer hormone therapy or puberty blockers to anyone under age 18 can face up to 360 days in jail and $3,000 in fines. This is classified as a Class A misdemeanor.
- Surgery Ban: The law also makes it a Class B felony to perform transition-related surgeries on minors, carrying a penalty of up to 10 years in prison, a fine of up to $20,000, or both.
- Exemption for Those in Care Before the Ban: The law contains a narrow exception for minors who already began receiving gender-affirming care before it took effect in April 2023.
Despite that exemption, the families who initially brought suit, along with many other families across North Dakota, argue that medical professionals are unsure of how to interpret the ban and its exemptions. As a result, they say, many providers fear legal penalties or license revocation. This uncertainty, according to plaintiffs, makes it harder for even exempt children to continue receiving consistent care within the state.
Plaintiffs further argue that the law treats transgender and nonbinary youth differently from cisgender youth. While doctors can provide the same hormone therapies or puberty blockers to cisgender children for various conditions—including early puberty or endocrine disorders—transgender children are singled out and denied those very same treatments when medically indicated for gender dysphoria. This discrepancy, plaintiffs maintain, violates equal protection guarantees under the North Dakota Constitution.
The Court’s Latest Rulings
In denying North Dakota’s motion to dismiss, the judge confirmed that the lawsuit raises legitimate constitutional questions warranting a full trial. This decision means that both sides will now present evidence and expert testimony before Judge Lofgren. However, the judge narrowed the lawsuit’s scope in two key ways:
- Standing Limited to Dr. Casas: The three families challenging the law were removed as plaintiffs because their children qualify for the “grandfathered” exception. With that exemption in place, the judge concluded they are not directly impacted by the ban’s core prohibitions.
- No Challenge to Surgery Provisions: Because gender-affirming surgeries “are not approved under the current standard of care” for minors in North Dakota, the judge found there is no real, immediate controversy to resolve on that point.
These rulings shift the focus of the trial onto whether the law’s criminalization of puberty blockers and hormone therapy for new patients violates the constitutional rights of transgender youth who seek care after the ban’s enactment. According to the plaintiffs, Dr. Casas has direct stake in this question because his current and future patients could face denial of critical, medically recommended care.
Legal Arguments Moving Forward
When trial begins on January 27, attorneys for the plaintiffs will attempt to demonstrate that HB 1254 violates several constitutional rights under North Dakota’s state constitution:
- Equal Protection: By banning treatments for transgender youth but allowing the same treatments for cisgender youth, North Dakota effectively singles out transgender children for different treatment.
- Bodily Autonomy and Self-Determination: Access to health care, particularly when recognized as medically necessary, is a key component of personal autonomy. Plaintiffs assert that denying transgender youth this care infringes on a fundamental liberty interest.
- Parents’ Rights: Parents have a constitutional right to make decisions concerning the care of their children, including medical decisions. Plaintiffs argue the ban unlawfully strips parents of that right when it comes to gender-affirming care.
Judge Lofgren has dismissed separate claims involving due process and vagueness, focusing the trial more narrowly on the equal protection and autonomy issues.
Medical Consensus and Real-World Impacts
Major medical associations, including the AMA and AAP, endorse age-appropriate gender-affirming treatments as evidence-based and beneficial for transgender and nonbinary youth. Research highlighted by the American Medical Association suggests that such care can reduce depressive symptoms by 60% and lower the risks of self-harm and suicide by as much as 73%. These findings reinforce that gender-affirming care is not experimental or fringe medicine but rather a well-studied intervention.
In North Dakota, a new study by the Harbor Health Initiative underscores the urgency of these treatments. The report found significantly higher rates of suicidal ideation among LGBTQ youth in the state: 67% of gay-identified children and 74% of transgender youth “seriously” considered self-harm or suicide in the past year. For perspective, only 20% of their straight peers reported such thoughts. This stark contrast highlights the intense pressures facing LGBTQ kids in an environment where they frequently experience bullying, discrimination, and social isolation.
Experts in psychology and adolescent medicine stress that restricting access to care can exacerbate mental health struggles in transgender youth. They note that providing hormonal treatments during puberty can be crucial for mental well-being. Delaying this care, or forcing families to leave the state in search of it, can lead to increased psychological distress, social challenges, and even self-harm.
Statements From the Plaintiffs’ Legal Team
Brittany Stewart, senior staff attorney at Gender Justice and lead attorney for the plaintiffs, expressed optimism about the upcoming trial:
“We’re confident that once the overwhelming evidence of this law’s cruelty and unconstitutionality is presented, the court will vindicate the rights of all North Dakotans, including young transgender people, to access the health care they need.”
Her co-counsel, Tanya Pellegrini of the Lawyering Project, stressed that the state has no business dictating what medical professionals can or cannot prescribe when those treatments align with established standards of care:
“Politicians have no place in deeply personal health care decisions, and we are pleased our challenge is going to trial. North Dakota has no business banning science-based health care, and we are proud to continue to stand with these bold, brave families.”
What Happens Next
The trial will take place as an eight-day bench trial—meaning there will be no jury—in Bismarck, starting on January 27. Dr. Casas will present his case, joined by a team of attorneys who plan to call expert witnesses in endocrinology, psychiatry, and adolescent medicine. While the three North Dakota families who initially filed the suit are no longer plaintiffs, they will be able to testify as witnesses, sharing firsthand accounts of how the ban has affected them.
Should the plaintiffs succeed, the judge could issue an injunction preventing the state from enforcing the law, effectively allowing new transgender and nonbinary minors to receive hormone therapy and puberty blockers under appropriate medical supervision. A ruling on the law’s constitutionality could also set a precedent that echoes beyond North Dakota. If the judge finds that restricting gender-affirming care violates the state constitution, this case could serve as a persuasive example for other jurisdictions where similar bans have been enacted or are under consideration.
If the plaintiffs do not prevail, the ban will remain in effect for those not already receiving care. In practical terms, families whose children develop gender dysphoria after April 2023 may have to travel out of state for care or forgo it entirely—a scenario that doctors and advocates warn could endanger these youths’ mental and physical health.
The Bottom Line
Throughout North Dakota, transgender youth and their families are watching anxiously. For many, this trial represents not just a legal matter but a question of whether their children’s lives and identities will be validated and protected. Advocates emphasize that when transgender children are affirmed and supported, they experience better mental health outcomes and a stronger sense of belonging.
In the lead-up to January 27, advocacy groups plan to educate the community, mobilize supporters, and provide resources to families in need of guidance. They see this case as more than a single lawsuit; it is a broader referendum on whether transgender youth have the same rights to health care and self-determination as any other child.
No matter the outcome, North Dakota’s transgender community has made one thing clear: they will not give up the fight for their right to exist as their authentic selves. For now, the stage is set for a historic trial that could reshape the legal landscape of transgender rights and provide clarity—one way or another—on the future of gender-affirming care in the Peace Garden State.
