North Dakota governor signs gender-affirming care ban for most minors

(CNN) — North Dakota’s Republican Gov. Doug Burgum signed a bill Wednesday banning gender-affirming care for most minors with the possibility of a felony for health care professionals who provide it.

House Bill 1254 prohibits health care providers from performing a variety of gender-affirming care and procedures on those under the age of 18. Mike Nowatzki, communications director for the governor, confirmed the bill’s signature in an email Thursday.

Burgum, in a statement to CNN, said the bill "is aimed at protecting children from the life-altering ramifications of gender reassignment surgeries," although it also bars providers from prescribing minors puberty-blocking medication and hormone therapies for the purpose of gender transition.

Transgender youths’ access to gender-affirming care — medically necessary, evidence-based care that uses a multidisciplinary approach to help a person transition from the gender they were designated at birth to the gender by which they want to be known — has become a flashpoint in red states across the country.

Though the care is highly individualized, some children may decide to use reversible puberty suppression therapy. This part of the process may also include hormone therapy that can lead to gender-affirming physical change. Surgical interventions, however, are not typically done on children and many health care providers do not offer them to minors.

Burgum acknowledged in his statement that "physicians and other health care providers testified these types of surgeries have not been and are not being performed on minors in North Dakota."

Some Republicans have expressed concern over long-term outcomes and whether children should be able to make such consequential decisions, even with parental consent. But major medical associations say that gender-affirming care is clinically appropriate for children and adults with gender dysphoria — a psychological distress that may result when a person’s gender identity and sex assigned at birth do not align, according to the American Psychiatric Association.

Because the bill has an emergency clause, it will take "effect as soon as it is signed and filed by the North Dakota Secretary of State, which will be tomorrow or early next week," Nowatzki said in an email to CNN.

Those in violation of the new legislation could face a class B felony charge, which is punishable by up to 10 years in prison or a fine of $20,000, according to North Dakota law.

The bill, like similar bans put in place across the country, includes some exceptions, particularly for minors "born with a medically verifiable genetic disorder of sex development." Children currently receiving gender-affirming care will still have access to that care under the new law, Burgum said.

The new law was opposed by the American Civil Liberties Union of North Dakota.

"This ban won’t stop North Dakotans from being trans, but it will deny them critical support that helps struggling transgender youth grow up to become thriving transgender adults," advocacy manager Cody Schuler said in a statement Thursday.

The Trevor Project, a suicide prevention and crisis intervention organization for LGBTQ young people, called the bill "dangerous" and said it would negatively impact the mental health of trans and non-binary youth in North Dakota.

"This legislation flies in the face of best-practice standards of care, and contradicts every major medical and mental health association in the country," said Casey Pick, director of law and policy at The Trevor Project.

North Dakota is only the latest state seeking to restrict access to health care services for transgender youth — Indiana and Idaho enacted their own bans earlier this month, and several other states have signed into law restrictions on gender-affirming care for minors since the start of the year.

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