Earlier this month, a North Dakota trial court upheld the state’s ban on gender-affirming care for trans minors. It was one of the first state court rulings on the issue since the U.S. Supreme Court ruled in June that a similar ban in Tennessee did not violate the U.S. Constitution’s equal protection guarantee.
in TD vs Wrigleya North Dakota doctor, three transgender children, and the children’s parents have challenged the state’s so-called 2023 health care law that bans gender-affirming care for trans minors. They argued that the law was unconstitutional based on several provisions of North Dakota’s constitution, including the Equal Protection Clause, as well as federal constitutional claims against the Tennessee law that were challenged before the U.S. Supreme Court. USA vs. Scumetti. and just like I shrieked.a North Dakota state court upheld the health care law, finding that the law “restricts medical care based on the purpose of the treatment, rather than the sex of the person seeking treatment.”
There are many reasons why this decision is troubling to those who care about the dignity and equality of transgender people. First, given the tenacity of state courts to interpret state constitutions in lockstep with federal courts; I shrieked. Provides a template for denying equal protection challenges to medical prohibitions. Case in point: Although the North Dakota case was brought under the state constitution, the court relied heavily on: I shrieked.explained that while the state constitution’s equal protection clause has a history of being interpreted differently than the federal constitution, a recent case from the North Dakota Supreme Court found that “its equal protection analysis is consistent with that of the United States Supreme Court.”
This decision also brings to the surface something that was hidden but still existed. I shrieked.: Incorporating transmedicalism into legal theory. Broadly speaking, transmedicalism refers to the assumption that transgender identity is medical in nature. For example, one variation of transmedicalism is the belief that being transgender requires a complete medical transition from one’s birth sex to the anatomy of the opposite sex. Another is the belief that a diagnosis of gender dysphoria is a prerequisite for being transgender.
But in reality, gender dysphoria is just one of many experiences that can, but need not, accompany being trans. While “transgender” is “an umbrella term for a person whose gender identity, expression, or behavior does not match that typically associated with the sex assigned at birth,” “gender dysphoria” is more specifically defined as “psychological distress resulting from the mismatch between sex and gender assigned at birth.” identity. ” Placing transgender identity at the center of medical diagnosis is not only wrong, it is especially exclusionary for gender nonconforming and transgender people who do not identify in the gender binary, and even for transgender people who identify in the binary who do not want to fully transition medically.
In upholding a health care law, a North Dakota court held that the law was subject to rational basis review, the most permissive standard that courts use to evaluate a law’s constitutionality, even though it discriminated on the basis of transgender status. In doing so, the court conflated transgender identity with gender dysphoria, holding that the law’s discrimination based on transgender identity simply stems from the law’s regulation of “medicine for therapeutic purposes.” The court said that because gender dysphoria is a “condition that can be remitted or resolved,” it is not an “immutable characteristic” that would subject transgender people to scrutiny as a class under the state constitution’s Equal Protection Clause.
This logic has two major flaws. First, it misunderstands the medical evidence. The court held that the immutability statement was supported by the American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th edition.. But the court seems to ignore that the Manual’s description of gender dysphoria alerts us to discussions of possible remission or resistance in a variety of ways. For example, the word “remit” appears only once in the context of the following discussion. Not enough Any research on the adolescence and adulthood experiences of children who have experienced “childhood gender differences.” In this context, “remit” is used in a very narrow sense, referring only to the following propositions: some children experiencing gender dysphoria May As we age, we experience remissions, but even those who experience remission may experience recurrence of discomfort later in life. Even more dramatically, the manual uses the word “disgust” only twice, and both times it clearly recognizes that some children experiencing gender dysphoria may experience “periods” in which their dysphoria “disappears or is denied,” and that so-called disgust is often a form of self-denial, with later dysphoria “recurring.” Additionally, the court heard testimony about high rates of resistance among children who “identify as the opposite sex,” but the research behind that statistic was largely debunked, leading to suggestions that the concept of resistance should be completely removed from clinical practice and research on gender dysphoria.
Second, and more importantly, this logic is pure transmedicalism. The court’s justification for conflating transgender identity and gender dysphoria is that a diagnosis of gender dysphoria is a prerequisite for receiving medical intervention, which is prohibited by medical law. That’s not what the law requires. The text of the law prohibits the treatment of affirming a minor’s gender based solely on “if the minor’s perception of gender does not match the minor’s gender.” This language omits the “emotional distress” element required for a diagnosis of gender dysphoria, which would result in a wider range of people being denied care. In fact, the legal definition is much closer to the broad definition of transgender than to the more specific definition of gender dysphoria.
Such an analysis wrigley is part of I shrieked.early legacy. I shrieked. It found that Tennessee’s ban on providing puberty blockers and hormone treatments to trans minors does not discriminate on the basis of gender or transgender status, but rather on the basis of age and medical diagnosis. “The law does not prohibit acts of one sex that are permitted of the other,” Chief Justice John Roberts explained in the court’s majority opinion. “Under (Tennessee law), no Minors may be given puberty blockers or hormones to treat gender dysphoria, gender identity disorder, or gender nonconformity. minor of Any Sex may be given puberty blockers or hormones for other purposes. ”
While such logic may at first glance appear to subvert transmedicalist ideology by treating gender dysphoria and transgender identity as separate, it is actually an inversion of transmedicalism that has the same negative effects on transgender people. Similar to traditional transmedicalism, reflected in the North Dakota court’s opinion, the Supreme Court’s approach defines transgender identity only in the context of gender dysphoria. Rather than claiming that it is gender dysphoria, need When someone is transgender, courts say gender dysphoria is transgender not enough For someone to be transgender. In other words, because only some transgender people experience gender dysphoria and may seek treatment for it, a law prohibiting such treatment does not imply transgender identity. Roberts explains: “While only transgender individuals seek treatment for gender dysphoria, gender dysphoria, and gender nonconformity, there is a ‘lack of identity’ between transgender status and an excluded medical diagnosis, just as only biological women can become pregnant.” However, while not all transgender people experience gender dysphoria, gender dysphoria is closely related to transgender identity. Claiming that gender dysphoria is an independent medical diagnosis is just as exclusionary and ignores reality as traditional transmedicalist beliefs.
This emergence of transmedicalism in court opinions may be limited to cases involving bans on gender-affirming care. After all, the distinction between transgender identity and gender dysphoria makes more sense in that context than, say, a challenge to a law that excludes transgender girls from participating in women’s sports. However, the emergence of transmedicalism in legal thinking reinforces societal prejudices about trans identity and gender nonconformity, including the perception that trans identity is a pathology that needs to be corrected, or that trans people are some kind of abnormality or curiosity, separate from “normal” people. State courts grapple with transgender rights issuesI shrieked. The world should avoid relying on transmedicalist tropes that degrade and demonize transgender people.
Morgan Munro is a student at New York University School of Law. She previously attended the Brennan Center’s Public Policy Advocacy Clinic.
Recommended Quote: Morgan Munro U.S. Supreme Court ruling on trans health care spills over into state courtsSᴛᴀᴛᴇ Cᴏᴜʀᴛ Rᴇᴘᴏʀᴛ (October 29, 2025), https://statecourtreport.org/our-work/analysis-opinion/us-supreme-courts-decision-trans-healthcare-ripped-through-state-courts
