The ruling comes as the U.S. Supreme Court seems poised to uphold a similar law from Tennessee and as the United Kingdom made efforts this week to ban minors from undergoing such treatments.

Justice Beth Baker authored the majority opinion Wednesday, justifying her decision on the basis that the Montana constitution provides robust rights to privacy in medical decision-making.

The law in question, Senate Bill 99, prevents “lawful medications and procedures administered by competent and licensed health care providers,” Baker wrote, finding that the law infringes on the ability of minors, their parents, and physicians to make individualized medical decisions.

Baker’s opinion was joined by five other justices, and one other, Justice Jim Rice, offered a concurrence and a dissent from her majority ruling.

Baker also noted that the plaintiffs presented sufficient evidence of potential harm to justify blocking the law.

“SB 99 affords no room for decision-making by a patient in consultation with their doctors and parents,” she wrote. “The statute is a complete ban, prohibiting individualized care tailored to the needs of each patient based on the exercise of professional medical judgment and informed consent.”

Lone dissent warns about shifting medical and legal grounds

Rice concurred in part with the majority but dissented on specific provisions, particularly regarding Medicaid funding. Rice argued that the state’s prohibition on using Medicaid funds for transgender procedures should be allowed to take effect during the legal proceedings.

“There is no current federal mandate for Medicaid funding of transgender procedures,” Rice wrote, adding that funding decisions are within the legislature’s constitutional authority and should be subject only to rational basis review.

Rice also expressed concern about the court’s broader reasoning, stating, “The medical and legal grounds regarding the subject treatment of minors addressed by SB 99 are moving under our feet.” He noted recent national and international developments questioning the medical benefits and long-term implications of these treatments.

International and national developments on transgender procedures for minors

The British government this week indefinitely banned the prescription of puberty blockers for individuals under 18 who identify as transgender. This decision follows a determination by the independent Commission on Human Medicines, which deemed these treatments an “unacceptable safety risk” for children and adolescents. Health Secretary Wes Streeting emphasized the lack of evidence supporting the safety and efficacy of these medications, stating, “It is a scandal that medicine was given to vulnerable young children without proof that it is safe or effective.”

The closure of the Tavistock and Portman NHS Trust, the country’s leading gender clinic, earlier this year due to safety concerns preceded this ban. A review led by Dr. Hilary Cass found that the benefits of puberty-suppressing hormones were “remarkably weak,” prompting the government to extend the ban to both NHS and private clinics.

In Washington, D.C., the House of Representatives this week approved an $895 billion defense policy bill that includes a provision prohibiting transgender medical treatments for minors. The legislation bans the use of Defense Department funds or facilities to “perform or facilitate sex change surgeries” and restricts TRICARE, the military’s health insurance program, from covering puberty blockers, hormone therapy, or other medical interventions for people under 18.

The bill passed with a bipartisan vote of 281-140, with 81 Democrats joining Republicans in favor. Several Democrats, including Rep. Adam Smith (D-WA), criticized the inclusion of the transgender treatment ban, arguing it denies essential medical care to minors dealing with gender dysphoria.

These legislative measures in the U.K. and the United States signify a significant shift in policy regarding transgender procedures for minors, reflecting debates over medical ethics, child welfare, and individual rights.

Broader legal and social implications

The Montana Supreme Court’s decision is the latest in a national wave of legal battles over transgender procedures for minors. SB 99, also known as the Youth Health Protection Act, was signed into law by Gov. Greg Gianforte (R-MT) in April 2023 and prohibited surgeries, hormone treatments, and puberty blockers for minors experiencing gender dysphoria.

Supporters of the law, including groups such as the American Principles Project, view these restrictions as critical safeguards for children.

“Despite their attempts to gaslight the country into believing that this dangerous medical malpractice is somehow ‘life-saving care,’ more and more states are seeing through the lies,” American Principles Project President Terry Schilling said at the time of the law’s passage.

Opponents, including the American Civil Liberties Union of Montana, argue the law infringes on private medical decisions.

ACLU of Montana executive director Akilah Deernose said the state Supreme Court’s ruling brought a momentary “sigh of relief.”

“But the fight for trans rights is far from over,” Deernose said. “We will continue to push for the right of all Montanans, including those who are transgender, to be themselves and live their lives free of intrusive government interference.”

What’s next

The Montana district court injunction blocking SB 99 will remain in place while the case proceeds to a future trial on the merits at the Missoula County District Court.

Meanwhile, the U.S. Supreme Court could issue a decision before the end of June 2025 surrounding the fate of Tennessee’s similar law protecting minors from undergoing transgender procedures.

The law bars minors from undergoing surgeries, cross-sex hormone treatments, or puberty blockers regardless of whether a doctor recommends such treatments or if parents consent to those procedures.

The eventual ruling has the chance to affect roughly 24 states with similar laws on the books. Most states include carve-outs allowing minors to undergo treatments if they are experiencing conditions like early puberty.

South Texas College of Law Houston professor Josh Blackman wrote for Reason last week that he believes the majority on the high court was “prepared to uphold” the Tennessee law.

“There may even be seven votes for that outcome,” Blackman wrote. “But as always, Justice [Elena] Kagan is in the middle, trying to broker a compromise that preserves future challenges for transgender litigants.”