Transgender youth in North Carolina on Wednesday lost access to the gender-affirming treatments many credit as live-saving after the Republican-controlled General Assembly overrode the Democratic governor’s veto of that legislation and others touching on gender in sports and classroom instruction.

GOP supermajorities in the House and Senate enacted —over Gov. Roy Cooper’s opposition— a bill barring medical professionals from providing hormone therapy, puberty-blocking drugs and surgical gender-transition procedures to anyone under 18, with limited medical exceptions.

The policy takes effect immediately, but minors who had begun treatment before Aug. 1 may continue receiving that care if their doctors deem it medically necessary and their parents consent.

North Carolina becomes the 22nd state to enact legislation restricting or banning gender-affirming medical care for trans minors. But most of those laws face legal challenges, and local LGBTQ+ right advocates have vowed to challenge the ban in court.

The Senate voted 27-18 to complete the veto override after an earlier House vote, 73-46.

Democratic Sen. Lisa Grafstein, North Carolina’s only out LGBTQ+ state senator, said the gender-affirming care bill “may be the most heartbreaking bill in a truly heartbreaking session.”

Some LGBTQ+ rights advocates in the Senate gallery began yelling after Republican Lt. Gov. Mark Robinson, who was presiding, cut off Grafstein to let another lawmaker speak. Several people were then escorted from the chamber by capitol police.

Sen. Joyce Krawiec, a Forsyth County Republican and chief sponsor of the bill restricting gender-affirming care, said the state has a responsibility to protect children from receiving potentially irreversible procedures before they are old enough to make their own informed medical decisions.

Earlier, the Senate and House voted minutes apart to override another Cooper veto of a bill limiting LGBTQ+ instruction in the early grades, also making that law.

That law requires public school teachers in most circumstances to alert parents before they call a student by a different name or pronoun. And the law also bans instruction about gender identity and sexuality in K-4 classrooms, which critics have previously likened to a Florida law opponents call “Don’t Say Gay.”

Both chambers also voted Wednesday to override Cooper’s veto of another bill banning transgender girls from playing on girls’ sports teams from middle and high school through college. It, too, immediately became law.

A day of divisive deliberations saw anger and emotion at times in the assembly.

Democratic state Rep. John Autry of Mecklenburg County, who has a transgender grandchild, choked up while debating the gender-affirming care bill on the House floor. “Just stop it,” he begged his Republican colleagues shortly before they voted to enact the law.

And Cooper blasted the decisions of the Republican-controlled chambers in a blistering statement, calling them “wrong priorities” even before lawmakers had completed all their votes.

“The legislature finally comes back to pass legislation that discriminates,” he said, adding it would have several negative impacts for North Carolina. “Yet they still won’t pass a budget when teachers, school bus drivers and Medicaid Expansion for thousands of working people getting kicked off their health plans every week are desperately needed.”

Parents of transgender and nonbinary children, like Elizabeth Waugh of Orange County, said hours before the voting started that they have been considering whether to move their families out of North Carolina so their children will have unrestricted access to gender-affirming care.

Waugh’s nonbinary child did not begin receiving treatment before Aug. 1 and would need to travel elsewhere if they decide they want to start taking hormones.

“I have felt like I had a lump in my throat for months,” Waugh said. “Just talking to other families who are dealing with this, I mean, the pain that they are feeling, the suffering, the fear for their children —it’s devastating.”

Gender-affirming care is considered safe and medically necessary by the leading professional health associations, including the American Academy of Pediatrics, the American Medical Association and the Endocrine Society. While trans minors very rarely receive surgical interventions, they are commonly prescribed drugs to delay puberty and sometimes begin taking hormones before they reach adulthood.

The House kicked off the day’s rush of votes with a 74-45 vote to override Cooper’s veto of a bill that would prohibit transgender girls from playing on girls’ middle school, high school and college sports teams. The Senate completed the override soon after.

A former Olympic swimmer, Rep. Marcia Morey, had spoken in House floor debate before the vote about possible repercussions for young athletes.

“This bill affects 10-, 11-, 12-year-olds who are just starting to learn about athletics, about competition, about sportsmanship,” Morey, a Durham County Democrat, said. “To some of these kids, it could be their lifeline to self-confidence.”

Critics have said limits on transgender girls’ participation in sports are discriminatory and have called it a measure disguised as a safety precaution that would unfairly pick on a small number of students.

But such supporters of the bill as Payton McNabb, a recent high school graduate from Murphy, argued that legislation is needed to protect the safety and well-being of young female athletes and to preserve scholarship opportunities for them.

“The veto of this bill was not only a veto on women’s rights, but a slap in the face to every female in the state,” said McNabb, who says she suffered a concussion and neck injury last year after a transgender athlete hit her in the head with a volleyball during a school match.