The conservative Texas Supreme Court has upheld a state law that prohibits minors from receiving gender-affirming care, overturning a lower court ruling that deemed the ban unconstitutional.

The law, which was approved by the Texas state legislature last spring and went into effect on Sept. 1, aims to prohibit anyone under the age of 18 from receiving puberty blockers, hormone therapy or gender-affirming surgery. Any minors who were already receiving any type of gender-affirming care were then to be "weaned off" their medications in a "medically appropriate" manner.

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Republican Sen. Donna Campbell, who wrote SB14, at one time included language making it allowable for transgender children who were already receiving puberty blockers and hormone treatments to continue their care. She suddenly changed that language after Republican opposition to that form of the exemption.

The American Civil Liberties Union joined other advocates in calling the legislation cruel, saying “Transgender youth and their families are forced to confront the start of the school year fearful of what awaits them. But, let us be clear: The fight is far from over.” A lower court agreed, but allowed the law to remain in place as the Supreme Court heard the case.

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Most major medical organizations, including American Medical Association and the American Academy of Pediatrics, have strongly opposed these new bans. However, more states are pushing legislation that intends to restrict gender-affirming health care for minors, claiming it protects children from making decisions they may regret later in life.

Friday's ruling is the latest in a wave of efforts from Republican-led states to target transgender health care for minors. At least 14 states have passed similar laws or policies that bar gender-affirming care for those under 18, including: Alabama, Arkansas, Arizona, Florida, Georgia, Idaho, Iowa, Kentucky, Mississippi, Missouri, Oklahoma, South Dakota, Tennessee and Utah.