BISMARCK -- The state of North Dakota made its case Monday, Nov. 25, to have a judge dismiss a lawsuit over a ban on gender-affirming care for transgender youth.

The plaintiffs -- a group of families with transgender children and a pediatric endocrinologist -- sued the state over a law that criminalizes medical treatment for transgender people under age 18.

The group argues the law is discriminatory against transgender children and that it goes against bodily autonomy and a parent's freedom to parent.

Further, the plaintiffs argue the law hinders health care providers' ability to provide necessary medical care and puts providers at risk of prosecution for doing so.

The state maintained the ban protects children and that medical professionals who practice accordingly are not at risk of prosecution. The state has the authority to regulate medical practices, the defense said.

In the Monday hearing, the state asked South Central District Court Judge Jackson Lofgren to dismiss the case in the state's favor for two reasons: because the plaintiffs lack legal standing based on who the law applies to and because of how they interpreted law in accordance with the state constitution.

Special Assistant Attorney General Joseph Quinn argued the state has a compelling interest in protecting children and that a parent's right to parent isn't "absolute," nor is the right of any person to receive "unfettered" medical treatment.

The law does not apply to one of the plaintiffs, a minor who is still receiving gender-affirming care under the grandfather clause, Quinn said.

Minors who were already receiving care at the time the law passed were grandfathered in, meaning they could continue to undergo treatment despite the ban.

Quinn argued that medical professionals who say the law is unconstitutionally vague are making "erroneous" interpretations and that the law clearly states what treatments are allowed.

"The intent to do something in the future without specific reference to adolescents diagnosed with gender dysphoria after the passage of the health care law does not satisfy the minimal requirements of standing," Quinn said.

Attorneys Brittany Stewart and Tanya Pellegrini represented the plaintiffs in Monday's hearing and asked the judge to bring the case to trial to examine its merits and review scientific evidence disputed by the defense.

"We are here today because the plaintiffs in this case have suffered and continue to suffer actual injury," Stewart said.

Parents and transgender children are harmed by being forced to travel out of state to receive care, missing school and other life events in doing so, and by falling vulnerable to negative mental health impacts of being refused treatment, according to the plaintiffs.

Stewart and Pellegrini argued the law is discriminatory toward transgender people, a violation of the state constitution.

Children who are not transgender can receive hormone treatment for medical conditions, for example, but transgender children cannot for gender dysphoria, Pellegrini said.

There is additional injury imposed on medical professionals because the state did not introduce alternatives or specify the legality of treating patients who are grandfathered in, she said.

Pellegrini and Stewart argued the evidence provided was enough to prove their parties' legal standing.

The lawsuit "is a result of the state's decision to institute a blanket ban on the best available medical treatment for a specific medical condition, placing the judgment of politicians above that of parents, patients and physicians," Stewart said.

Lofgren last June denied a request made by the plaintiffs to suspend the law while court proceedings take place.

His reasoning was based on the uncertainty he said is associated with both the benefits and risks of transgender health care for minors.

The law has been in effect since it was signed by Gov. Doug Burgum in 2023.

Passed overwhelmingly by North Dakota's Republican-dominated Legislature, the measure made transition-related surgeries, hormone treatment, puberty blockers and other forms of gender-affirming health care illegal for minors to obtain even with parental consent.

Conducting transition-related surgery is a Class B felony and punishable by up to 10 years in prison, a $20,000 fine or both. Providing hormone treatments and puberty blockers is a Class A misdemeanor that could lead to a year in jail, a $3,000 fine or both.

Lofgren said he will take the arguments heard Monday under advisement. The trial is scheduled for January 2025.