Alabama can begin immediately enforcing a ban outlawing the use of puberty blockers and hormones to treat transgender people under 19, a federal appeals court ruled Thursday, granting the state’s request to stay a preliminary injunction that had blocked enforcement of the 2022 law.

The 11th U.S. Circuit Court of Appeals had previously ruled that the injunction should be vacated, but the decision had been effectively on hold while families with transgender children asked the full appellate court to reconsider the decision. The Thursday order will allow the ban to take effect while the full court decides whether it will revisit the decision.

The state Attorney General Steve Marshall called the order a “significant victory for our country, for children and for common sense.”

“The physical and psychological safety of our children can now be better protected from these untested and life-altering chemical and surgical procedures through the implementation of the Alabama Vulnerable Child Compassion and Protection Act,” Marshall said.

Lawyers representing parents of transgender adolescents who challenged the ban said the decision will “hurt parents and children in the state.”

“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,” read a joint statement from GLBTQ Legal Advocates & Defenders, the National Center for Lesbian Rights, the Southern Poverty Law Center and the Human Rights Campaign.

Alabama Gov. Kay Ivey signed the Vulnerable Child Compassion and Protection Act into law in 2022, making it a felony punishable by up to 10 years in prison for doctors to treat people under 19 with puberty blockers or hormones to help affirm their gender identity.

At least 22 states have now enacted laws restricting or banning gender-affirming medical care for transgender minors, and many of them face lawsuits or blocked enforcement. Courts have issued mixed rulings, with the nation’s first law, in Arkansas, struck down by a federal judge who said the ban violated the due process rights of young transgender people and their families.

Attorneys representing Tennessee transgender teens and their families have asked the U.S. Supreme Court to block the state’s ban on gender-affirming care for minors that a lower court allowed to go into effect. The court is expected to decide later this year if it will hear the case.

Four families with transgender children ranging in ages 12 to 17 challenged the Alabama law as an unconstitutional violation of equal protection and free speech rights, as well as an intrusion into family medical decisions. The U.S. Department of Justice joined their lawsuit, seeking to overturn the law.

U.S. District Judge Liles Burke, nominated to the court by then-President Donald Trump in 2017, ruled when issuing the preliminary injunction that Alabama had produced no credible evidence to show that transitioning medications are “experimental.” Alabama appealed the decision to the 11th Circuit. The challenge to the Alabama ban is scheduled to go to trial early this year.