Montana Supreme Court Ruling Hollow as Last Facility Stops ‘Transgender’ Child Procedures

MISSOULA — Montana’s highest court blocked the legislature’s ban on medical procedures and hormone drugs for minors with gender dysphoria, but the legal victory, granted by what many Montanans see as an activist judiciary serving the agenda of out-of-state legal organizations and ideological activists, proved meaningless as the last medical facility providing such interventions in the state has ceased offering them to minors.

Community Medical Center in Missoula, the final medical facility in Montana performing these procedures on minors, stopped providing the interventions in June, citing “the state and federal regulatory environment,” according to NPR reporting. Montana children are now protected from these procedures within state borders, making the Montana Supreme Court’s preliminary injunction against the legislature’s ban irrelevant.

The development demonstrates how the Trump administration’s enforcement efforts have accomplished what Montana’s blocked legislation sought to achieve, with hospitals and medical providers discontinuing programs even in states where the procedures remain legally protected by courts.

Montana’s Legal Battle

Missoula County District Court Judge Jason Marks initially blocked Senate Bill 99, the Youth Health Protection Act, which Governor Greg Gianforte signed in 2023, with a preliminary injunction in September 2023. The Montana Supreme Court affirmed Marks’ ruling in December 2024, and Marks permanently struck down the law in May 2025, ruling it violated state constitutional privacy rights.

The lawsuit was brought by the ACLU of Montana, Lambda Legal, and former Clinton law firm Perkins Coie as part of a coordinated legal campaign to dismantle state-level bans on gender-related medical procedures for minors. Their legal team argued that the law violated Montana’s constitutional protections for privacy, equal protection, and access to medical care.

State Rep. John Fuller, who authored the legislation, previously criticized the court’s reasoning, saying “determining that sterilizing children is a privacy right is mental gymnastics of the highest order.”

The U.S. Supreme Court’s June decision upholding Tennessee’s similar ban has not affected Montana’s case, as the state Supreme Court based its ruling on state constitutional grounds rather than federal Equal Protection claims.

Federal Enforcement Actions

Community Medical Center’s decision to stop the procedures coincides with a broader federal effort to eliminate these medical interventions for minors nationwide. Sixteen states and the District of Columbia filed a lawsuit Friday against the Trump administration, alleging an “unconstitutional pressure campaign” against doctors and hospitals providing such procedures.

“The federal government is running a cruel and targeted harassment campaign against providers who offer lawful, lifesaving care to children,” New York Attorney General Letitia James stated.

However, a growing number of jurisdictions are finding out the medical interventions are far from “lifesaving.” Several countries have restricted or discouraged gender-related medical interventions for minors, citing safety concerns and lack of evidence. Sweden, Finland, and the U.K. now recommend psychological support over hormones or surgery, with Sweden warning of “uncertain science” and the U.K.’s Cass Review finding the evidence base “remarkably weak.” These international reversals reflect growing global skepticism about the benefits and long-term safety of such procedures for youth.

The Trump administration has issued subpoenas and threatened criminal prosecution for medical providers, according to the multi-state lawsuit filed in federal court in Massachusetts.

U.S. Attorney General Pamela Bondi has argued that federal laws against female genital mutilation apply to certain surgeries for gender dysphoria. The Department of Justice has also cited Medicaid fraud and drug safety laws in its enforcement efforts.

Montana Parents Seek Out-of-State Procedures

The hospital’s decision has left some Montana parents seeking alternatives out of state. Liz, an 18-year-old from Missoula who declined to provide her last name, described feeling betrayed by the hospital’s decision.

“I feel it’s their job as health care providers, is to stand up to this and to say this is care that saves lives, which they didn’t do,” Liz told NPR.

She plans to travel to Seattle Children’s Hospital to continue the procedures, but said she worries about capacity limits as more medical facilities halt procedures nationwide and parents seek dwindling options outside their home states.

Another Missoula mother, identified only as “E,” is pursuing these medical procedures for her child. E’s child, who suffers from gender dysphoria, is about a year from puberty, and E had planned to have medical providers administer puberty blockers followed by cross-sex hormones on her child. E is finding that options for these procedures and drugs are no longer available in Montana.

E’s child, who cannot legally consent to permanent body modification, has been led to believe these interventions are inevitable. “To her, it wasn’t even a thought [that] it wouldn’t happen. She was like, ‘I’m a girl, so when I go through puberty, I’m going through girl puberty,'” E told NPR about explaining the hospital’s decision to end the practice to her child.

Nationwide Pattern

Community Medical Center’s decision reflects a national trend of medical facilities discontinuing programs providing these procedures to minors. Prominent programs at children’s hospitals in Los Angeles and Washington, D.C., have also shuttered in recent weeks, even though such procedures remain legal in those jurisdictions.

Since 2021, more than half of U.S. states have banned these medical interventions for youth. Montana’s ban remains blocked by court order, but the practical effect mirrors states with active prohibitions.

Some private pediatricians may still offer hormone drugs in Montana, but NPR reported that families interviewed were unaware of available providers.

The Trump administration has made opposition to “gender identity” policies a central priority, signing executive orders declaring what many see as common sense truths that: only two sexes exist, women should not have to complete with men in women’s sports, and describing these medical interventions performed on minors as “chemical and surgical mutilation.” The administration has also addressed school policies that can undermine parental authority regarding children with gender dysphoria and canceled millions in federal funding for so-called “gender identity research.”

Professional medical organizations, including the American Academy of Pediatrics and American Medical Association, continue to support these procedures for minors, while Republican lawmakers and attorneys general have challenged the evidence basis for such recommendations. Several European countries, including the United Kingdom, Sweden, and Finland, have restricted or discontinued similar procedures for minors citing insufficient evidence of benefit and concerns about long-term consequences.

Despite the growing body of evidence revealing the harm to minor children, Dr. Lauren Wilson, president of the Montana chapter of the American Academy of Pediatrics, has defended the practice, stating that “gender-affirming care is evidence-based and supported by every major medical association in the United States.” Her advocacy has placed her at the forefront of efforts in the State of Montana to maintain access to these irreversible medical procedures on children, even as international health systems reverse course and U.S. hospitals and medical facilities quietly shut down their programs.