A federal judge upheld North Dakota’s 2023 ban on gender-affirming care for minors. South Central District Court Judge Jackson Lofgren ruled that the ban doesn’t violate state constitutional protections for personal autonomy and self-determination because the legislature has the right to regulate and prohibit certain medical procedures.

In his decision, Judge Lofgren said legislative oversight was warranted based on the “legitimate ongoing debate regarding the safety and effectiveness” of providing gender-affirming care to trans minors. However, such care has been provided to minors for decades and is recommended by America’s largest medical associations.

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Lofgren oversaw a seven-day court trial in February that included testimony from a pediatric endocrinologist as well as transgender teens and their parents who have been affected by the ban. However, the judge dismissed some of the families’ claims. leaving only the physician as a plaintiff, MPR News reported.

The law allows trans kids who were already receiving gender-affirming care before the ban took effect to continue their treatment. However, the families said that medical providers in the state have stopped providing the care due to concerns they could be sued, leaving the families to miss work and school to pursue treatment in nearby Minnesota.

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The suit could be appealed, but in June, the U.S. Supreme Court essentially ruled that states can ban gender-affirming medical care. At least 27 states have laws restricting the practice. Almost all major medical associations — including the American Medical Association, the American Academy of Pediatrics, and the Endocrine Society — support gender-affirming care as necessary, evidence-based, and effective for trans youth.

“This ruling is devastating for transgender youth and their families in North Dakota. The evidence in this case was overwhelming: this law inflicts real harm, strips families of their constitutional rights, and denies young people the medical care they need to thrive,” Jess Braverman, the legal director for the gender equity nonprofit Gender Justice, which represented the plaintiff, said in a statement cited by KFYR-TV.

Then-North Dakota Gov. Doug Burgum (R) signed the law in 2023 after all Democrats in the legislature voted against it.

The law, H.B. 1254, bans reversible puberty blockers and hormone replacement therapy – forms of gender-affirming care available to some trans teens. Burgum said the law is “aimed at protecting children from the life-altering ramifications of gender reassignment surgeries,” but he acknowledged that these surgeries are not performed on minors in the state.

Despite the non-existence of gender-affirming surgery for minors in the state, the law makes providing gender-affirming surgery to a minor a felony punishable with up to 10 years in prison and $20,000 in fines. Providing other forms of gender-affirming care is now a misdemeanor, punishable with up to 360 days in prison and $3000 in fines.

The law does not ban any particular medical treatment, but rather only bans using the treatments to help trans youth. Puberty blockers, for example, have been shown to reduce lifelong suicide risk among transgender people who wanted them and got them. But only young people getting treatment for early onset puberty and other rare conditions can access them now.

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