North Dakota Supreme Court Hears Challenge to Criminal Ban on Gender-Affirming Care

06.30.2026 — (PRESS RELEASE) Today, the North Dakota Supreme Court heard oral arguments in T.D. v. Wrigley, a case asking whether North Dakota’s Constitution means what it says — that every person is ‘by nature equally free and independent’ — and whether that promise protects doctors who provide established, evidence-based medical care for transgender youth.  

Gender Justice and the Lawyering Project represent Dr. Luis Casas, a North Dakota-based pediatric endocrinologist who is challenging a state law that criminalizes gender-affirming care. The law threatens him with up to 360 days in prison and $3,000 in fines for following the evidence and doing his job. 

“This law puts the government between me and my patients,” said Dr. Luis Casas, the North Dakota-based pediatric endocrinologist at the center of the case. “Every parent I’ve worked with just wants to do right by their kid. They shouldn’t have to choose between their child’s health and staying in North Dakota. And politicians shouldn’t have more power over private medical decisions than families.”  

Gender-affirming care is recognized as safe, effective, and often medically necessary by major medical associations across the country, including the American Academy of Pediatrics and the American Medical Association. If the government can strip families of access to proven health care and criminalize physicians following common sense practices, that won’t only harm the trans youth targeted by this law. It opens the door to continued political interference in North Dakotans’ private medical decisions. It also violates the North Dakota Constitution’s fundamental commitment to personal freedom.  

“Whatever the outcome, this case puts on record what this law actually does: it criminalizes doctors for following the evidence and strips families of the freedom to care for their own children,” said Tanya Pellegrini, Co-Director, Litigation, at the Lawyering Project. “The North Dakota Constitution was written to prevent this kind of government overreach, and we will keep fighting until that promise is fulfilled.” 

North Dakotans themselves have been clear on where they stand: a 2024 statewide survey found that 93% of North Dakota adults agree the government has no business in the private lives of transgender and nonbinary people, and 71% say parents of trans and nonbinary kids should be able to access the health care and counseling they need. 

“North Dakota’s founders wrote a Constitution that protects personal freedom and self-determination. That promise has to mean something, especially when it comes to defending North Dakota families from government overreach,” said Jess Braverman, Legal Director at Gender Justice. “Politicians are not qualified to override medical decisions made by families in consultation with trusted, licensed, medical professionals. This case is a critical step in making good on North Dakota’s founding promise of freedom for all.” 

Case Background

In 2023, Gender Justice and the Lawyering Project filed suit on behalf of Dr. Casas, challenging North Dakota’s ban on gender-affirming care for transgender youth as a violation of the state constitution’s guarantees of personal freedom and autonomy. In 2025, a district court upheld the ban. Dr. Casas appealed that ruling to the North Dakota Supreme Court, which will now decide whether the state’s sweeping constitutional protections for individual liberty prohibit the government from criminalizing established medical care. 

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