“We conclude the Legislature made a permissible, rational policy choice to limit the types of available medical procedures for children,” Justice Rebeca Huddle wrote for the majority on the all-Republican court.

Texas is one of about two dozen states that have passed such bans as conservatives have pushed to broadly restrict transgender rights, an issue that has emerged as a flash point of the nation’s cultural and political divides. Former president Donald Trump, who is running for a second term, has also pledged to end gender-affirming care for minors, NBC News reported in January. He has equated the procedures, which medical groups say are safe and sometimes medically necessary, to “child abuse.”

Texas is the largest state to have banned gender-affirming care. Republicans there have also pushed to restrict teaching about LGBTQ people and issues in schools, part of an effort framed as expanding parental rights.

Attorney General Ken Paxton (R) said on X that his office would “use every tool at our disposal to ensure that doctors and medical institutions follow the law.”

The measure’s sponsor, Rep. Tom Oliverson (R), added that the state has a “duty” to regulate medical care.

“Very gratifying to see @SupremeCourt_TX concurs,” he wrote on X.

LGBTQ+ advocates criticized the decision, saying it would curtail their rights as parents and hurt their transgender children in a conservative state that has expanded parental control over issues such as their children’s schooling.

“Instead of leaving medical decisions concerning minor children where they belong, with their parents and their doctors, the Court here has elected to let politicians … determine the allowed course of treatment,” said Karen Loewy, a spokesperson for Lambda Legal, which was among the groups that sued on behalf of five Texas families.

Justice Debra Lehrmann, the dissenting justice in Friday’s ruling, agreed with Loewy, calling the law “not only cruel” but also unconstitutional. She added that it allows the state to “legislate away fundamental parental rights.”

“The Court’s ‘parental rights for me but not for thee’ approach has no objective criteria and renders parents entirely without guidance on whether their parental liberty will be meaningfully protected,” Lehrmann wrote. “The Court’s opinion thus puts all parental rights in jeopardy.”

The majority countered that while “fit parents” have a right to make decisions for their children without state interference, legislatures are permitted to enact limits on child labor and regulate medical care.

While the plaintiffs said the court’s ruling left no avenue for further challenges, they will continue to challenge measures like it.

On Monday, the U.S. Supreme Court agreed to review a Tennessee law that bans gender transition care for minors, the first opportunity the nation’s top court will have to consider the constitutionality of such restrictions.

The American Civil Liberties Union is tracking more than 500 bills it calls “anti-LGBTQ” across the country.

Ash Hall, an ACLU of Texas strategist for LGBTQIA+ rights, said the law has caused suffering among adolescents and families since its passage in June 2023.

“Our government shouldn’t deprive trans youth of the health care that they need to survive and thrive — while offering that exact same health care to everyone else,” Hall said in a statement. “Texas politicians’ obsession with attacking trans kids and their families is needlessly cruel.”

A majority of Americans oppose puberty-blocking medications and hormonal treatments for trans children, according to a Washington Post-KFF poll. For gender-diverse people, however, the ability to access such treatments improves their overall well-being, according to the American Psychological Association.

Major medical associations have said treatment such as puberty blockers lower rates of depression and suicide in transgender people and have opposed this legislation, saying laws should not discriminate against trans patients or interfere with doctors’ ability to provide individualized, evidence-based care for patients.

More than 100,000 transgender youths live in states that ban gender-affirming care, according to the Williams Institute, a research center that reports on LGBT community demographics. It estimates that almost 30,000 Texans between the ages of 13 and 17 identify as transgender.