Alabama has been granted the ability to enforce a ban on gender-affirming care for transgender youth.

Alabama has been granted the ability to enforce its felony ban on gender-affirming health care for minors, as per a federal court ruling on Thursday.

The decision allows the state to proceed with the ban, lifting a preliminary injunction that had prevented officials from enforcing it for over a year.

On Thursday, the U.S. 11th Circuit Court of Appeals lifted the injunction against Alabama’s 2022 law, turning it into a felony for physicians to prescribe puberty blockers or hormones to transgender individuals under 19. Convictions could lead to sentences of up to a decade in prison.

When the injunction was issued in 2022, U.S. District Judge Liles C. Burke stated that Alabama failed to provide credible evidence demonstrating that gender-affirming treatments are “experimental.”

In August, a federal appeals court reversed this decision, stating, “The use of these medications in general—let alone for children—almost certainly is not ‘deeply rooted’ in our nation’s history and tradition,” referencing the Supreme Court’s decision overturning Roe v. Wade.

In November, Alabama’s attorneys requested the 11th Circuit stay the enforcement of the district court’s preliminary injunction, which was granted Thursday in a brief unsigned order.

A September request for a rehearing made by the Alabama families challenging the law is still pending, and a full trial on the constitutionality of the ban is slated for August.

Alabama Attorney General Steve Marshall praised Thursday’s decision as “a significant victory for our country, for children, and for common sense.”

In a joint statement, lawyers representing the families challenging the law said the ruling will cause significant harm to children and parents in Alabama.

“Alabama’s transgender healthcare ban will harm thousands of transgender adolescents across the state and will put parents in the excruciating position of not being able to get the medical care their children need to thrive,” according to the statement, issued Thursday by the National Center for Lesbian Rights, GLBTQ Legal Advocates & Defenders, the Southern Poverty Law Center, and the Human Rights Campaign.

Including Alabama, 23 states have enacted laws or policies that heavily restrict or ban gender-affirming health care for transgender minors. Laws passed in five states — Alabama, Florida, Oklahoma, North Dakota, and Idaho — include provisions that make it a felony crime to provide treatment to trans youth under 18.