An Ohio judge has upheld the state’s ban on gender-affirming care for transgender youth, as well as its ban on trans girls and women in women’s sports.

Two families of young trans people filed a lawsuit against the state’s law in March after Ohio lawmakers passed the legislation in January by overriding Gov. Mike DeWine’s veto. The families argued that the law violates the Ohio Constitution because it deals with more than one subject — sports and health care — which goes against the single-subject rule.

While the Franklin County Court of Common Pleas temporarily ruled in favor of the families in April, Franklin County Judge Michael J. Holbrook overturned its decision Tuesday, allowing the state’s law to go into effect. Patients under 18 can no longer receive gender-affirming care, save for an exception allowing those already on the treatment to continue.

Holbrook wrote in his ruling that those “dissatisfied with the General Assembly’s determinations” must settle their grievances “through their vote as opposed to the judicial system.”

“This is a devastating result for our clients and families like theirs across the state of Ohio,” Harper Seldin, senior staff attorney at American Civil Liberties Union, said in a statement. “HB 68’s ban on medical treatments for gender dysphoria remains medically baseless and genuinely dangerous to the current and future well-being of transgender youth in the state. We are particularly appalled the court claims the ‘regulation of transgender individuals’ is a legitimate subject for the legislature under the state constitution.”

Ohio is now one of 24 states that completely bans gender-affirming care for youth, according to the Movement Advancement Project. In six states, healthcare practitioners who provide such care can be charged with a felony.

The American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics, the American Academy of Child & Adolescent Psychiatry, the World Medical Association, and the World Health Organization all agree that gender-affirming care is evidence-based and medically necessary not just for adults but minors as well.

Freda Levenson, ACLU of Ohio’s legal director, ensured that the “fight” is not over, and that the organization will be “appealing immediately.”

“This loss is not just devastating for our brave clients, but for the many transgender youth and their families across the state who require this critical, life-saving health care,” Levenson said. “While this decision by the court is a genuine setback, it is not the end of the road in our fight to secure the constitutional rights of transgender youth, as well as all Ohioans’ right to bodily autonomy.”