BISMARCK, N.D. (Valley News Live) – A North Dakota district court has upheld the state’s ban on gender-affirming medical treatments for minors, rejecting constitutional challenges from families and a physician who argued the law violated equal protection and parental rights.

The court’s ruling for T.D. vs. Wrigley, handed down on October 8, dismissed most of the plaintiff’s claims while allowing the law to remain in effect. The court found that North Dakota’s Health Care Law, passed in 2023, does not violate the state constitution’s equal protection clause or fundamental rights provisions.

Law prohibits multiple treatments

The Health Care Law prohibits providers from performing specific 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.

Healthcare providers who violate the law face Class B felony or Class A misdemeanor charges. The law includes exceptions for minors with certain genetic disorders or those who began treatment before April 21, 2023.

Standing issues limit case

The court dismissed most plaintiffs, including minor patients and their parents, finding they lacked standing to challenge the law. Many were already receiving care before the law’s effective date, placing them under the grandfather exception, while others sought procedures not performed on minors in North Dakota.

Court applies rational basis review

The court determined the Health Care Law classifies based on age and medical purpose rather than sex, rejecting arguments that it discriminated against transgender individuals. The judge found that age is not a “suspect classification” because it changes over time, and concluded that transgender status is not a suspect classification under the North Dakota Constitution.

Applying rational basis review, the court found the law had a reasonable relationship to legitimate government purposes, citing recognized medical risks of puberty blockers and cross-sex hormones for minors, concerns about minors’ capacity to understand long-term irreversible effects like sterility, and ongoing international debate among medical experts about treatment safety and effectiveness.

Personal autonomy claims rejected

While acknowledging that a right to personal autonomy and self-determination exists under the North Dakota Constitution, the court found that this right traditionally applies to competent adults refusing unwanted medical treatment, not to minors seeking statutorily prohibited treatments.

The court ruled that there is no affirmative right to obtain specific medical treatment when the government has reasonably prohibited it and found that the Health Care Law satisfies rational basis review on grounds of personal autonomy.

Final ruling preserves grandfather clause

The court denied requests for a declaratory judgment that the Health Care Law violates the North Dakota Constitution and denied a permanent injunction to stop enforcement. However, the court granted a declaratory judgment confirming the law does not apply to minors who were receiving gender-affirming care before April 21, 2023.

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