North Dakota State District Judge Jackson Lofgren during a court hearing on March 31, 2025, at the Burleigh County Courthouse in Bismarck, N.D. (AP Photo)
A North Dakota judge has upheld the state’s controversial ban on gender-affirming medical care for children. The ruling is a setback for families who have had to travel out of state to access treatments they consider essential for their children’s well-being.
District Judge Jackson Lofgren issued his decision Wednesday, stating the law discriminates based on age and medical purpose, not sex. He added there is “little evidence” that the Legislature intended to discriminate against transgender youth. The judge also highlighted ongoing debates about the safety and effectiveness of the medical procedures involved.
“The evidence establishes an international debate regarding the safety and effectiveness of these procedures,” Lofgren wrote. “Where there is uncertainty, deference is given to the Legislature to determine the boundaries.” He concluded the law does not violate the state constitution.
Impact on Families
The ruling affects parents seeking gender-affirming care for their children after the ban took effect in April 2023. Families must now obtain treatments outside North Dakota, often traveling long distances for care.
“This ruling is devastating for transgender youth and their families,” said Jess Braverman, legal director of Gender Justice, which represented the plaintiff. “The law inflicts real harm, strips families of constitutional rights, and denies young people necessary medical care.”
Republican state Rep. Bill Tveit, who sponsored the legislation, welcomed the decision. “This law is necessary. We need to protect our youth, and that has always been the goal,” Tveit said.
The lawsuit was filed by several families and a pediatric endocrinologist. Judge Lofgren dismissed some claims, leaving only the physician as a plaintiff.
Parents Devon and Robert Dolney, stand with their child, Tate, center, during a press conference, Sept. 14, 2023, in Bismarck, N.D. (AP Photo)
What the Law Restricts
North Dakota’s law makes it a misdemeanor for health providers to prescribe hormone treatments or puberty blockers to transgender minors. Gender-affirming surgeries for minors, though never performed in the state, are classified as felonies under the law.
Supporters argue the law protects children from the irreversible effects of these treatments. Opponents say it harms transgender youth by denying access to crucial medical care.
Though the law exempts children already receiving treatments before April 2023, many families avoided care due to legal uncertainty. Some had to travel to Minnesota, missing work and school, to ensure their children could continue treatment.
Judge Lofgren later clarified that these children could maintain any medical care they had been receiving before the ban. However, health care attorneys said the decision did not provide a comprehensive final ruling.
At least two pediatric endocrinologists offered gender-affirming care in North Dakota before the ban, highlighting the limited local access even prior to the law.
Broader Context
North Dakota is among nearly half of U.S. states that have imposed restrictions on gender-affirming care for minors, most of which are led by Republican governments. The U.S. Supreme Court confirmed in June that states may legally ban such care for transgender children.
So far, at least 27 states have enacted laws limiting or prohibiting gender-affirming medical treatment for minors, sparking a national debate over children’s health rights, parental authority, and the role of government in medical decisions.
The North Dakota ruling underscores the ongoing tension between state legislation, medical guidance, and families advocating for transgender youth. Many families continue to face difficult choices to secure care outside the state.
