A court has struck down Montana’s gender-affirming care ban for trans youth, declaring that the state acted out of “a political and ideological” interest.

Judge Jason Marks of the Fourth Judicial District Court wrote that the law is focused on “ensuring minors in Montana are never provided treatment to address their ‘perception that [their] gender or sex’ is something other than their sex assigned at birth. In other words, the State’s interest is actually blocking transgender expression.”

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“I will never understand why my representatives worked so hard to strip me of my rights and the rights of other transgender kids,” Phoebe Cross, a 17-year-old transgender boy and plaintiff in the suit, said in a statement. “It’s great that the courts, including the Montana Supreme Court, have seen this law for what it was, discriminatory, and today have thrown it out for good. Just living as a trans teenager is difficult enough, the last thing me and my peers need is to have our rights taken away.” 

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Judge Marks pointed out that “Montana does not ban other medical treatments based on potential risks or inadequate evidence of efficacy.” Additionally, he said the state was “unable to clearly and convincingly establish that a bona fide health risk exists.”

He said the state tried to show that there is no consensus on the benefits of gender-affirming care, but that it is the “incorrect standard.”

“The question,” he said, “is whether a medically acknowledged, bona fide health risk exists. Based on the position of the United States’ major medical organizations and their endorsement of the Guidelines for treating adolescents with gender dysphoria, there is no genuine dispute that it does not.”

He also criticized the state’s argument that the existence of detransitioners proves an inherent risk to gender-affirming care since regret rates are low. “It is illogical for the Montana Legislature to pass laws regulating medical treatment that would hurt a majority where it might help the minority,” he said, adding that if the state banned every medical procedure patients sometimes regretted, they would have to ban them all.

Gov. Greg Gianforte (R) signed S.B. 99 into law in 2023 to ban all types of gender-affirming healthcare for trans kids under 18. Afterward, Lambda Legal, the American Civil Liberties Union (ACLU), and the ACLU of Montana sued on behalf of two families and two health care providers.

“Today, the court saw through the state’s vitriol and hollow justifications and put the final nail in the coffin of this cruel, and discriminatory, law,” Lambda Legal staff attorney Nora Huppert said in a statement. “No parent should ever be forced to deny their child access to the safe and effective care that could relieve their suffering and provide them a future. Because Montana’s Constitution protects their right to privacy, transgender youth in Montana can sleep easier tonight knowing that they can continue to thrive.” 

“We are very pleased that the Court saw through the State’s unfounded arguments about why gender-affirming medical care should be treated differently from other forms of care,” added ACLU staff attorney Malita Picasso. “The Court recognizes S.B. 99 for what it truly is, an effort by the State to legislate transgender Montanans out of existence.” 

In December, the state’s supreme court issued a temporary injunction against the law, becoming the first state in the nation to uphold access to trans health care. The high court’s support of the injunction indicates that it will likely uphold the permanent ban if the state appeals Marks’s decision.

The initial debate over S.B. 99 made waves across the country when Republicans voted to ban state Rep. Zooey Zephyr (D) – the first trans lawmaker in the state – from entering the state house floor after she said that her Republican colleagues would have “blood on your hands” for supporting the bill.

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