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 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.

Most of those states face lawsuits, and the U.S. Supreme Court recently agreed to hear an appeal from the Biden administration attempting to block state bans on gender-affirming care. The case before the high court involves a Tennessee law that restricts puberty blockers and hormone therapy for transgender minors, similar to the Texas law.

The Texas law prevents transgender minors from accessing hormone therapies, puberty blockers and transition surgeries, even though surgical procedures are rarely performed on children. Children who had already started the medications that are now banned had to be weaned off in a "medically appropriate" manner.

"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 has devastating consequences for transgender teens who are unable to obtain critical treatment recommended by their physicians and parents. The only justice dissenting with Friday's ruling said the Texas Supreme Court was allowing the state to "legislate away fundamental parental rights."

"The State's categorical statutory prohibition prevents these parents, and many others, from developing individualized treatment plans for their children in consultation with their physicians, even the children for whom treatment could be lifesaving," Justice Debra Lehrmann wrote in a dissenting opinion. "The law is not only cruel — it is unconstitutional."

A lower court ruled the law unconstitutional, but it had been allowed to take effect while the state Supreme Court considered the case.

Texas' Republican attorney general, Ken Paxton, vowed in a post on the social platform X after the ruling that his office "will use every tool at our disposal to ensure that doctors and medical institutions follow the law."

Advocates criticized the ruling.

"It is impossible to overstate the devastating impact of this ruling on Texas transgender youth and the families that love and support them," said Karen Loewy, senior counsel and director of Constitutional Law Practice at Lambda Legal, which was among the groups that sued the state on behalf of doctors and families.

"Our government shouldn't deprive trans youth of the health care that they need to survive and thrive," said Ash Hall, police and advocacy strategist for LGBTQIA+ rights at ACLU of Texas. "Texas politicians' obsession with attacking trans kids and their families is needlessly cruel."

The restrictions on health care are part of a larger backlash against transgender rights, touching on everything from bathroom access to participation in sports.

As more states move to enforce health care restrictions, families of transgender youths are increasingly forced to travel out of state for the care they need at clinics with growing waiting lists. At least 13 states have laws protecting care for transgender minors.

Over 300,000 people ages 13 to 17 identify as transgender in the U.S., and about 29,800 of them are in Texas, according to estimates by the Williams Institute at the UCLA School of Law. Not all trans people choose or can afford gender-affirming care.

Gender-affirming care for youths is supported by major medical organizations, including the American Medical Association, the American Academy of Pediatrics, the American Psychiatric Association and the Endocrine Society.

In a concurring opinion, one justice dismissed the position of the medical groups.

"The fact that expert witnesses or influential interest groups like the American Psychiatric Association disagree with the Legislature's judgment is entirely irrelevant to the constitutional question," Justice James Blacklock wrote. "The Texas Constitution authorizes the Legislature to regulate 'practitioners of medicine.'"

Medical professionals define gender dysphoria as psychological distress experienced by those whose gender expression does not match their gender identity. Opponents of gender-affirming care say there's no solid proof of purported benefits and say children shouldn't make life-altering decisions they might later regret.

Texas officials defended the law as necessary to protect children, and noted a myriad of other restrictions for minors on tattoos, alcohol, tobacco and certain over-the-counter drugs.

Several doctors who treat transgender children testified in a lower court hearing that patients risk deteriorating mental health, which could possibly lead to suicide, if they are denied safe and effective treatment.

The Texas ban was signed into law by Republican Gov. Greg Abbott, who was the first governor to order the investigation of families of transgender minors who receive gender-affirming care

During the legislative debate over the ban in 2023, transgender rights activists disrupted the Texas House with protests from the chamber gallery, which led to state police forcing demonstrators to move outside the building.

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DeMillo reported from Little Rock, Arkansas.