The trial for a lawsuit to overturn North Dakota’s ban against gender affirming medical care provided to minors started Monday. More than a year had passed since families of transgender kids and a doctor brought the suit, arguing that the law was in violation of the state constitution.

North Dakota is just one of the more than twenty states that has banned gender affirming care. Many of these states, like North Dakota have also been challenged in court over their laws.

Brittany Stewart is the lead attorney for Gender Justice. A nonprofit that advocates gender equality. All North Dakotans are entitled to their own autonomy in deciding what health care is needed or not to lead a happy and healthy life as themselves.

The North Dakota case filed in 2023 has been significantly reduced by court rulings. A state district court judge dismissed some of the claims, as well as children and families, who were plaintiffs. This left only a pediatric endocrinologist to be a plaintiff.

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The trial is expected to take eight days in Bismarck. The judge’s decision is not known.

Then-Gov. Doug Burgum, the Republican-led Legislature’s majority leader, signed the bill in law on April 20, 2023. A health care provider is guilty of a misdemeanor if they prescribe hormones or puberty blocks to a child who is transgender, or if they administer them to the child. It’s a felony if a doctor performs gender-affirming surgeries on a minor.

Joe Quinn, Special Assistant Attorney-General, said that the law was a constitutional regulation which the Legislature had the “power to do”, “the right to do” and “the responsibility to do”. He added that there were “no conclusive evidences to support medical gender transformation care.”

The bill, which was passed into law by the legislature, is said to protect children against irreversible operations and treatments.

Bill Tveit (a Republican Rep. who introduced the legislation) said, “We created an atmosphere in which if you felt that you were in that situation or that you had this mentality, we would cut off your body parts to affirm where you are without trying guide you through.” “Maybe that was the wrong decision at that age. If you want to make it when you are older, that is your right.”

He expressed his hope that the outcome of the trial would affirm the law.

The opponents of the bill said that it would harm transgender children, and pointed out that in North Dakota, gender-affirming surgery is not performed on minors.

In a survey conducted by the Centers for Disease Control and Prevention in the United States last year, transgender and gender questioning teens reported experiencing more bullying than their peers and about one in four transgender teens admitted to having attempted suicide within the past year.

Stewart stated in an interview that “When you prohibit the only medically supported treatment for a certain condition, and only for children under 18 years of age, you are not protecting these kids.” You are actively harming these children.”

Children who received treatment before the law’s date of implementation are exempted. Attorneys for the plaintiffs, however, said that providers delayed due to the perceived vagueness of the law. Stewart said that this forced families to miss work or school in order to get care for their children. One family drove eight hours round-trip to attend a 30 minute appointment.

Later, the judge said that the law did not apply to minors who received gender affirming care prior to North Dakota’s ban taking effect. This included the three plaintiffs children. The judge ruled that they can “receive any gender affirming care” they received previously. Stewart explained that their access to care remains the same because this ruling did not satisfy health care attorneys.

Stewart stated that at least two pediatric endocrinologists were providing gender affirming care in North Dakota before the ban.

She said: “As for the number of patients involved, I cannot say. But honestly, whether there are many or few, it doesn’t matter if this is constitutional.”

Donald Trump signed an executive decree declaring that only two sexes are recognized by federal government. State laws on gender affirming care, sports participation, and bathroom usage are not affected.

The American Medical Association and the American Academy of Pediatrics, two of the most prominent medical groups in the United States, have all opposed such bans, stating that gender affirming treatments are medically necessary, and supported by scientific evidence. Further research has shown that transgender adults and youths can become suicidal when they are forced to live according to the gender assigned to them at birth.

At least 26 state laws have been passed restricting or prohibiting gender-affirming care for minors. Most of these states are facing lawsuits. Federal judges ruled that the bans in Arkansas, Florida and other states were unconstitutional. However, a federal appeals Court has temporarily stayed the Florida decision. The ban is temporarily blocked by a judge’s order in Montana.

States that have passed legislation restricting or prohibiting gender affirming medical care are Alabama, Arkansas Arizona, Florida Georgia Idaho Indiana Iowa Kentucky Louisiana Mississippi Missouri Montana Nebraska New Hampshire North Carolina North Dakota Ohio Oklahoma South Carolina South Dakota Tennessee Texas Utah West Virginia Wyoming.