AUSTIN, Texas (AP) — The Texas Supreme Court upheld the state’s ban on gender-affirming care for transgender youths Friday, rejecting pleas from parents that it violates their right to decide on and seek medical care for their children. The 8-1 ruling from the all-Republican court leaves in place a law that has been in effect since Sept. 1, 2023.

Texas is the largest of at least 25 states that have adopted laws restricting or banning gender-affirming medical care for transgender minors. The Texas law prevents transgender people under 18 from accessing hormone therapies, puberty blockers and transition surgeries, though surgical procedures are rarely performed on children. Children who had already started the medications had to taper off their use.

“We conclude the Legislature made a permissible, rational policy choice to limit the types of available medical procedures for children, particularly in light of the relative nascency of both gender dysphoria and its various modes of treatment and the Legislature’s express constitutional authority to regulate the practice of medicine,” Justice Rebeca Aizpuru Huddle wrote in the court's decision. The lawsuit that challenged the Texas law argued it devastates transgender teens who are unable to obtain critical treatment recommended by their physicians and parents. The Williams Institute at the UCLA School of Law estimates about 29,800 people ages 13-17 in Texas identify as transgender.

The only justice dissenting with Friday.