North Dakota Gov. Burgum signed HB 1254, a felony ban on gender-affirming care for minors

On April 19, 2023, North Dakota Governor Doug Burgum signed House Bill 1254 into law, enacting a new chapter of the state criminal code that bans gender-affirming medical care for transgender minors. The North Dakota Legislative Assembly had passed the measure by votes of 66-25 in the House and 37-10 in the Senate. The law took effect immediately under an emergency clause after being filed with the Secretary of State.

Under the statute, a health care provider who performs gender-affirming surgical procedures on a minor — including mastectomy, castration, vaginoplasty, or phalloplasty — for the purpose of aligning the minor's body with a gender identity inconsistent with their sex at birth commits a class B felony. Prescribing puberty blockers or cross-sex hormone therapy for the same purpose is a class A misdemeanor. The law conditions the legality of these treatments on the purpose for which they are provided: it preserves a narrow exception for minors with a medically verifiable intersex or disorder-of-sexual-development condition, while providing no comparable exception for transgender minors.

In signing the bill, Burgum said in a statement that it "is aimed at protecting children from the life-altering ramifications of gender reassignment surgeries." The law placed North Dakota among a wave of states that restricted or criminalized gender-affirming care for minors in 2023. Advocacy organizations including the Human Rights Campaign condemned the measure as targeting transgender youth and their families.

Updates

2025-10-09 — North Dakota district judge upheld the ban after trial [6]

A South Central Judicial District judge upheld HB 1254 following a legal challenge by North Dakota families, ruling that the law discriminates based on age and medical purpose rather than sex and does not violate the state constitution. The decision left families needing to seek gender-affirming care out of state.

2026-02-26 — Plaintiff appealed the district court ruling to the North Dakota Supreme Court [7]

Dr. Luis Casas, the pediatric endocrinologist who challenged HB 1254, appealed Judge Lofgren's October ruling upholding the law to the North Dakota Supreme Court. His attorneys at Gender Justice and the Lawyering Project argued the North Dakota Constitution does not support the district court's decision.

2026-06-30 — North Dakota Supreme Court heard oral arguments in the appeal [8]

The North Dakota Supreme Court heard oral arguments on Casas's appeal. His attorneys argued the ban denies North Dakotans' constitutional right to make their own healthcare decisions; the state's solicitor general urged the court to uphold the ban. No ruling had been issued as of this update.