The federal appeals court in Alabama ruled on Monday that it can enforce the ban against the use of hormones and puberty blockers to treat transgender kids. This is the second appellate win for gender affirming care restrictions adopted by an increasing number of Republican-led state.

The 11th U.S. Circuit Court of Appeals, a three-judge panel, has vacated a judge’s temporary injunction against enforcing the law. The Circuit Court of Appeals vacated a temporary injunction that prevented enforcement of the law. The judge set a trial date of April 2, to decide whether or not the law should be permanently blocked.

Alabama Attorney General Steve Marshall described the ruling as a “significant win for our country, children and common sense”.

Marshall stated that “the Eleventh Circuit confirmed the State’s authority to protect the physical and mental wellbeing of minors.”

The judges lifted the injunction because they felt that the state had a “compelling interest” in protecting its children from drugs. This is especially true for those drugs whose benefits are uncertain, whose use has increased recently, or if their effects are irreversible.

Families of transgender kids who were receiving treatment are now scrambling to find care. The injunction remains in place until the court gives the mandate. This could take several days. Once the injunction is lifted, the Attorney General’s Office will have the power to enforce the ban. Doctors who violate the ban could face prison time.

Advocacy groups that represent families that challenged the Alabama law have vowed to fight on, saying, “parents are the best people to make medical decisions for children, not the government.”

The Southern Poverty Law Center and other organizations, including the National Center for Lesbian Rights and GLBTQ Legal Advocates & Defenders and the Human Rights Campaign, said that their clients were devastated by the decision. It leaves them vulnerable to irreparable damage as a result from losing the medical treatment they had been receiving.

The American Medical Association, the American Academy of Pediatrics and other major medical groups oppose these bans. Experts say that treatments can be safe when administered properly.

These medications are usually given as injections or implants. Hormone treatment can cause sexual development and changes in appearance.

Birmingham pediatrician Dr. Morissa ladinsky said in a Monday statement that she hopes “today’s ruling is only a temporary setback.”

“As a physician who has treated hundreds transgender teenagers, I understand the challenges that these youth and their families face. And the benefits of these treatments for those who need them. It is a proven, safe and effective medical treatment. Ladinsky stated that there is no reason to ban the care.

This ruling is the latest in a series of recent decisions against similar bans. In June, a federal judge struck down Arkansas’s first such ban. At least 20 state laws have been passed restricting or prohibiting gender-affirming child care.

Opponents to youth transgender treatment claim there is no solid evidence of the purported benefits. They cite discredited research, and argue that children shouldn’t take life-altering choices they may regret.

Federal judges have temporarily blocked bans in Florida, Indiana and Kentucky. A federal appeals Court has allowed Tennessee’s ban to go into effect, after a federal judge had blocked it.

This ruling only applies to the Alabama ban. However, most state bans have been challenged in court.

Alabama Gov. Kay Ivey has signed into law the Vulnerable Child Compassion and Protection Act in 2022. This makes it a crime punishable by 10 years imprisonment for doctors who treat children under 19 with hormones or puberty blocks to affirm their gender identities.

Four families with children who are transgender, ranging from 12-17 years old, challenged the Alabama law on grounds that it violated equal protection rights and freedom of speech as well as a violation of family medical decisions. The U.S. Department of Justice, which was also involved in the lawsuit to overturn this law, joined them.

When he issued the preliminary injunction, U.S. district judge Liles Burke – who was appointed to the court in 2017 by President Donald Trump – ruled that Alabama had not produced any credible evidence that transitioning medication is “experimental.”

Alabama appealed the decision to the 11th Circuit.

Burke also allowed for two other sections of the law to come into effect. The first bans gender affirming surgeries on transgender minors. Doctors had testified that these surgeries are not performed in Alabama. One bans gender-affirming surgeries for transgender minors, which doctors testified are not done on minors in Alabama.

Other GOP states will soon ban gender-affirming child care. Last month, Democratic governors of Louisiana and North Carolina vetoed the bans. However, both were overridden.