Texas became the 18th state in the country to prohibit doctors from performing sex changes on children after Gov. Greg Abbott signed legislation banning such procedures on Friday, June 2.

Under the new law, which will go into effect Sept. 1, neither physicians nor health-care providers can perform surgeries on a minor’s genitals or breasts to facilitate a gender transition. The law also prohibits the prescription of puberty blockers, testosterone or estrogen when used for the purpose of a gender transition.

The American Civil Liberties Union of Texas and other groups have vowed to fight the legislation in court. 

“Abbott can’t stop trans youth from thriving in Texas — and we’ll take him to court to make sure of it,” the ACLU of Texas said in a statement on Twitter. “We are doing everything in our power to preserve access to this life-saving, evidence-based health care.”

Rep. Tom Oliverson, R-Cypress, the primary sponsor of the bill and a medical doctor, said the bill was written to withstand legal challenges.

“Children in Texas are officially protected from harmful, experimental medical and surgical treatments for gender dysphoria,” Oliverson said on Twitter. “Thank you for signing SB14 [Gov. Greg Abbott]. We knew there would be court challenges. SB14 was written with that in mind and will prevail.”

The surgeries on minors prohibited under the new law include castration, vasectomies, the removal of the uterus, the removal of ovaries, the removal of the penis, or any other procedure that would sterilize the child. The new law will also prohibit the removal of healthy female breasts or any otherwise healthy and non-diseased body part or tissue. 

Per the legislation, doctors cannot prescribe puberty blockers or any drug that is intended to stop or delay the normal process of puberty. It also prohibits prescriptions of testosterone or estrogen at levels higher than what would normally be present in the child at his or her age.

The ban only applies when the surgery or the drugs are intended to facilitate a gender transition and includes exceptions for medically necessary procedures. The law also includes exceptions for children who are born with a genetic sex development disorder and children who do not have a normal sex chromosome structure for the male or female sex.

If a child is already receiving gender-transition drugs, the doctor is not required to immediately halt the prescription if it could endanger the child’s health. Rather, the doctor will be allowed to wean the child off of the drugs in a safe and medically appropriate manner. 

Medical practitioners who violate the law will have their medical licenses revoked. The law also gives the attorney general’s office the authority to step in and prevent violations if they are occurring. 

The law further prohibits any public money from being used directly or indirectly to pay for these procedures or provide these drugs to minors. It also prohibits Medicaid reimbursements for such procedures and drugs for children.

Several states that have imposed similar restrictions have been taken to court over their rules, and some are still fighting lawsuits in court. 

At the same time, a handful of other states, including Minnesota, Maryland, and California, have passed bills to ensure a legal right for minors to access these medical procedures.