South Dakota has joined five other states that have restricted transition-related care for transgender minors in the past two years.

On Monday, Gov. Kristi Noem, a Republican, signed the «Bill Help Not Harmprohibiting health professionals from providing puberty blockers, hormone therapy and surgery to minors as a treatment for gender dysphoria, which is distress caused by a sense of conflict between the sex assigned at birth and the gender identity of person.

Providers who are already treating trans minors with puberty blockers, temporarily pausing puberty, or hormone therapy will need to phase out medications for minors by December 31.

The bill makes exceptions for intersex infants and for treatment of conditions unrelated to gender dysphoria.

“The children of South Dakota are our future”, Noem said in a statement. “With this legislation, we are protecting children from permanent and harmful medical procedures. I will always stand up for the next generation of South Dakotans.»

Health care providers who violate the law could have their medical license revoked. Until they turn 25, minors receiving care in violation of the law can also sue providers.

People protest a bill that would ban transgender girls from playing on sports teams that match their gender identity in front of the state Capitol in Pierre, South Dakota, on January 15, 2022.Toby Brusseau / AP for the human rights campaign

Elliot Morehead, a trans teen who uses they/them pronouns and had planned to access gender-affirming care within the next year, said the move has «profoundly affected my future.»

“I was hoping to maybe start some kind of treatment for myself and now our legislators who are supposed to support us have taken away that opportunity and I am bummed out.” they told CBS affiliate KELO-TV in Sioux Falls on Thursday after the bill passed the Senate.

Morehead, 16, told House committee members last month that they had to receive six months of therapy and a letter from their therapist before they could start hormone therapy.

“People think you can just go in and then get testosterone, estrogen or puberty block; It doesn’t work like that,» they said. according to the associated press.

Over the years, South Dakota has been what advocates have described as a testing ground for legislation targeting trans people.

In 2016, the state was the first to pass a school “bathroom bill,” which would have required students to use school facilities corresponding to their sex assigned at birth. The measure was finally vetoed by the then governor. Dennis Daugaard, a Republican, who said at the time that he was «not addressing any urgent issues related to South Dakota’s school districts,» according to the Argus Leader, a Local newspaper. Three states, Alabama, Oklahoma and Tennessee, prohibit transgender students from using school facilities in accordance with their gender identity, according to the Movement Advancement Projecta group of LGBTQ experts.

the state was also the first to pass a gender-affirming care ban in 2020, although the bill could not pass a Senate committee.

On Saturday, over 400 South Dakotansincluding trans youth, their families and allies, protested the bill’s passage in the Senate, according to the Transformation Project Advocacy Network, a local trans rights group.

After Noem signed the bill into law Monday, the American Civil Liberties Union and the ACLU of South Dakota said in a joint statement that the measure «will not prevent South Dakotans from being trans, but it will deny them the critical support that helps transgender youth in distress.” grow up to be prosperous transgender adults.”

«But make no mistake, this fight is not over,» the groups said. “We will never stop fighting for the right of trans youth to receive the love, support and attention that every young person deserves. As much as Governor Noem wants to force these young people to live a lie, we know they are strong enough to live their truth, and we will always fight for communities and policies that protect their freedom to do so.»

more than a dozen major medical organizations, including the American Medical Associationhe American Academy of Pediatrics and the American Psychological Association — support gender-affirming care for minors.

So far this year, lawmakers in at least 24 states, including South Dakota, have introduced legislation that would restrict transition-related child care, according to an NBC News analysis. The governors of six states (Alabama, Arkansas, Arizona, South Dakota, Tennessee, and Utah) have signed off on such restrictions. Federal judges have blocked the bans in Alabama and Arkansas from taking effect pending the outcome of the lawsuits.