BISMARCK — A trial regarding North Dakota’s ban on gender-affirming care for minors wrapped up this week, but a ruling is still months away. In 2023, North Dakota made it illegal for health care providers to offer these treatments to anyone under 18.
Dr. Luis Casas, a pediatric endocrinologist, is challenging the ban, arguing it violates personal autonomy and equal protection rights. Judge Jackson Lofgren listened to the arguments and will review the evidence before making a decision.
During the trial, the state called Stephen Levine, a psychiatrist with decades of experience. Levine argued that only adults should receive gender-affirming treatment and insisted that adolescents lack the ability to consent. He suggested therapy is a better option for dealing with gender dysphoria.
Levine shared that he knows of adults who have not benefited from gender-affirming care, which led him to question the rising number of young people seeking such treatments. He suggested that many are likely facing other mental health issues instead.
Jan Conlin, the attorney representing the plaintiffs, noted that less than a dozen children in North Dakota have sought gender-affirming care. This surprised Levine, who insisted that while the ban could cause distress, it might also offer a chance for reflection for affected youth.
Testifying for the plaintiffs, psychiatrist Gabriela Balf pointed out that while research on care for minors is limited, available studies suggest that transgender adolescents often benefit from gender-affirming care. She criticized the state’s heavy scrutiny of this issue while similar medical practices remain largely unregulated.
Balf emphasized that “more than 600 medications” are prescribed off-label to children without similar oversight, questioning why gender-affirming care deserves special treatment.
Throughout the trial, Dr. Casas and others testified that gender-affirming medication can be essential for the well-being of patients. Two of Casas’ teenage patients spoke about how treatment changed their lives, stating that therapy alone would not have been sufficient for their needs.
With only two pediatric endocrinologists in North Dakota, Casas explained that he and his colleague Amanda Dahl follow the same guidelines for providing care. No minor receives treatment without a diagnosis of gender dysphoria, and families are fully informed about the process and risks involved.
The ban received strong support from North Dakota’s Republican-majority Legislature, passing with over two-thirds approval in both the House and Senate. While there is an exemption for kids who were already receiving treatment, many still find themselves unable to access care.
Due to fears of legal consequences, Casas has stopped providing gender-affirming care to minors. His previous patients now have to travel out of state for treatment, with the law making violations a Class A misdemeanor, risking jail time and fines for medical professionals.
The law also makes it a Class B felony for minors to undergo transition-related surgery—something that experts testified was never commonly done in North Dakota.
This ongoing legal battle highlights the complex issues surrounding gender-affirming care for minors and the implications of these laws on young people’s health and well-being.
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