HELENA — A district court judge in Missoula has struck down a 2023 state law that prohibits gender-affirming health care for transgender youth in Montana – but the decision is already going to be appealed.
District Judge Jason Marks ruled Wednesday that Senate Bill 99 violated fundamental rights and was unconstitutional, and he issued a permanent injunction blocking it.
Watch the video for reaction to the judge's decision:
SB 99 prohibited gender-affirming procedures, including hormone treatments and surgeries, for transgender people younger than 18 seeking to medically transition. It would threaten health care providers who do provide those treatments with a license suspension and legal liability.
Several transgender youths, their families and health care providers filed suit over the law, arguing it violated the rights to privacy and equal protection.
“There's no room for the Legislature to try to pass bills based on discriminatory intent, because our right to privacy is strong,” said Akilah Deernose, executive director of the ACLU of Montana, one of the groups representing the plaintiffs.
Marks held a hearing in Missoula last month, as both the plaintiffs and the state sought an immediate judgment in their favor.
Attorneys from the Montana Department of Justice argued minors can’t give informed consent on gender-affirming procedures, and that the state had a legitimate interest in protecting them from what they said could be long-term harms. Plaintiffs’ attorneys said the state hadn’t provided enough evidence to show a ban was necessary.
Marks sided with the plaintiffs, writing in his decision that the evidence the state had submitted might show some risk to the treatments, but that it didn’t rise to the level of a “medically acknowledged, bona fide health risk.”
Click here to read the full court decision (PDF).
He cited the Montana Supreme Court’s Armstrong decision – the ruling that found abortion was protected under the state constitution’s right to privacy – and said the state didn’t have a compelling interest to interfere with an individual getting a specific medical procedure without that level of risk.
While SB 99 has been on hold since 2023 under a preliminary injunction, Deernose said this decision was a relief for those who challenged the law.
“For those years that the law was paused, there was still a great uncertainty about what their future would be if we didn't win the case,” she said. “And for some people, that could look like whether or not they could continue to reside in Montana, because the ban on health care at issue in this case was lifesaving care.”
But this ruling is not going to be the end of the case, as Attorney General Austin Knudsen’s office quickly confirmed it would appeal to the Montana Supreme Court.
“Yet again, the Montana judiciary ignored the will of Montanans and went out of its way to advance the woke agendas of their political allies before the state could get a fair trial,” said spokesperson Chase Scheuer in a statement to MTN. “We plan to appeal this outrageous rejection of common sense that puts the wellbeing of Montana’s most vulnerable children at stake.”
While SB 99 remained on hold, the Montana Legislature passed several other bills affecting gender transition procedures during their 2025 session. Last week, Gov. Greg Gianforte signed into law Senate Bill 218, which says anyone who underwent one of those procedures as a minor can sue their health care provider if they believe they suffered “physical, psychological, emotional, or physiological harms.”
The Legislature and Gianforte also approved House Bill 121, which requires individuals in public facilities to use the bathroom that aligns with their sex at birth. The ACLU of Montana is also suing over that bill, and it is currently on hold under a temporary restraining order.
