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Arkansas has become the first US state to ban puberty blocking treatments and surgery for transgender children after lawmakers voted to override a late veto by the governor.
The Republican-controlled House and Senate voted to enact measures which prohibit doctors from providing gender-confirming hormone treatment, puberty blockers or surgery to anyone under 18 years old, or from referring them to other providers for the treatment.
Opponents have vowed to sue the state in an attempt to stop the ban before it takes effect this summer.
Governor Asa Hutchinson vetoed the bill following pleas from pediatricians, social workers and the parents of transgender youth who said the measure would harm a community already at risk for depression and suicide.
The ban was opposed by several medical and child welfare groups, including the American Academy of Pediatrics.
"This legislation perpetuates the very things we know are harmful to trans youth," said Dr. Robert Garofalo, division head of adolescent and young adult medicine at Lurie Children's Hospital in Chicago.
"They're not just anti-trans. They're anti-science. They're anti-public health."
The bill's sponsor dismissed opposition from medical groups and compared the restriction to other limits the state places on minors, such as prohibiting them from drinking.
"They need to get to be 18 before they make those decisions," Republican Rep. Robin Lundstrum said.
The Family Council, a conservative group that backed the measure, praised lawmakers for enacting "historic legislation."
Mr Hutchinson said the measure went too far in interfering with parents and physicians, and noted that it will cut off care for transgender youth already receiving treatment.
He said he would have signed the bill if it had focused only on gender confirming surgery, which currently isn't performed on minors in the state.
"I do hope my veto will cause my Republican colleagues across the country to resist the temptation to put the state in the middle of every decision made by parents and health care professionals," Mr Hutchinson said in a statement after the vote.
At least 16 other states are considering similar legislation.
The Arkansas law will take effect in late July at the earliest. The American Civil Liberties Union said it planned to challenge the measure before then.
"This is a sad day for Arkansas, but this fight is not over - and we're in it for the long haul," Holly Dickson, ACLU of Arkansas' executive director, said in a statement.