The North Dakota Supreme Court on Thursday upheld the state law that bars health care providers from giving certain gender-affirming medications and procedures to minors, leaving the 2023 restrictions in force after a constitutional challenge by a pediatric endocrinologist.
In T.D. v. Wrigley, a unanimous court affirmed a Burleigh County judge’s refusal to declare the law unconstitutional or block its enforcement. Justice Douglas Bahr wrote that minors do not have a fundamental right under the North Dakota Constitution to a particular course of medical treatment. The court also concluded that the statute classifies by age and medical purpose, rather than by sex or transgender status, so it should receive the most deferential form of judicial review.
Under that “rational basis” standard, the court said the law is rationally related to the state’s legitimate interest in protecting minors’ health and welfare. The court’s official case summary identifies the decision as 2026 ND 162, docket 20260075. Chief Justice Lisa Fair McEvers and Justices Jerod Tufte and Jon Jensen joined Bahr’s opinion, along with District Judge Michael Hurly, who sat for the case. Tufte also filed a separate concurrence joined by Jensen.
The appeal was narrower than the original lawsuit. The opinion says Dr. Luis Casas, the remaining plaintiff, challenged only the provision covering puberty blockers and specified hormone treatments. The parents and minor plaintiffs had previously been dismissed for lack of standing because the district court interpreted the law’s grandfather clause to permit treatment that began before April 21, 2023. That interpretation was not challenged on appeal.
The North Dakota Century Code makes a willful violation of the medication provision a Class A misdemeanor. It separately classifies violations involving listed surgeries or removal of healthy tissue as Class B felonies. The chapter includes exceptions for certain medically verifiable disorders of sex development and for treatment that began before the law took effect.
Casas argued that the medication ban violated the state constitution’s protections for personal autonomy and equal protection. The state, represented by Attorney General Drew Wrigley’s office, defended the Legislature’s authority to regulate medical treatment for minors. A case record maintained by State Court Report shows that the Supreme Court heard the appeal after the district court upheld the statute in October 2025.
Before oral argument in June, Casas’s counsel at Gender Justice and the Lawyering Project said the law improperly inserted the state into decisions between families and clinicians. Their argument preview said Casas faced potential jail time and fines for prescribing covered care. The Supreme Court’s ruling rejects the constitutional claims that remained before it but does not rewrite the law’s existing exceptions.
For residents tracking other statewide developments, see The American Quorum’s North Dakota news archive.
