North Dakota Physician Appeals Ruling Allowing Criminal Ban On Gender-Affirming Care For Youth

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On Feb. 26, Dr. Luis Casas announced an appeal to the North Dakota Supreme Court, seeking to overturn a 2025 district court ruling that upheld the state’s ban on gender-affirming care for transgender and nonbinary youth. In the lawsuit, T.D. v. Wrigley, the pediatric endocrinologist is challenging a measure that criminalizes doctors who provide such care with up to 360 days in prison and $3,000 in fines.

The appeal is led by Gender Justice, a legal and policy organization working to advance gender equity through the law, and the Lawyering Project.

“We’re taking this fight to the state’s highest court, because this law is a direct assault on the North Dakota constitution’s promise of liberty and self-determination,” said Megan J. Peterson, Executive Director, Gender Justice in a press conference on Thursday.

Related: NYU Langone Ends Gender Medical Care for Transgender Youth

“When the government can criminalize health care based on political disapproval rather than medical evidence, the question is not just who is affected today, but who could be next,” said Tanya Pellegrini, Co-Director, Litigation, at the Lawyering Project. “North Dakota’s ban on established health care sets a dangerous precedent for every North Dakotan who believes the government should stay out of their personal medical decisions.” 

The counsels assert that the law strips families of the ability to make deeply personal medical decisions in consultation with qualified medical providers. Multiple medical organizations, such as the American Academy of Pediatrics, have advocated against taking a “one-size-fits-all” approach.

“Every family I work with is trying to do the right thing for their child. They come to me, they ask questions and we make decisions together based on the best medical evidence available,” Dr. Casas said via his attorneys at the Thursday press conference. “This law takes that away; instead putting the government between me and my patients and tells North Dakota families that their private medical decisions are no longer their own. These families deserve the same freedom as any other family in this state to work with their doctor and do what’s best for their child.”

Dr. Casas’ appeal arises from prior court proceedings. Last October, South Central District Court Judge Jackson Lofgren found that a 2023 law criminalizing the prescription of puberty blockers and other medical treatments to minors does not violate the state constitution. The lawsuit was originally filed against the state of North Dakota by three families with transgender children, along with Dr. Casas. However, Lofgren dismissed the families and their children from the case, determining they lacked legal standing to sue, leaving the physician as the sole remaining plaintiff.

T.D. v. Wrigley is one of several cases nationwide that have been challenging politically motivated bans on medical care for trans individuals. The lawsuit also states “that the consequences of abruptly pulling a patient off puberty blockers are irreversible and can include long-term medical and mental health consequences.” Abruptly withdrawing a testosterone suppressant, for instance, “can result in depressed mood, hot flashes, headaches, or a spike in blood pressure increasing a risk of heart attack or stroke.”

At the press conference, referring to the 2023 trial, Jess Braveman, Gender Justice’s Legal Director, pointed out: “Despite years of litigation, the state was never able to present even one family who has ever been harmed as a result of this care in the state of North Dakota. Instead, the court heard stories of transgender kids who went from hopeless to thriving as a result of this care.”