Arkansas’ governor on Monday vetoed a ban on gender-affirming medical care for transgender youths, calling the legislation a “vast government overreach” and a “product of the cultural war in America.”

Gov. Asa Hutchinson (R) said that if signed into law, the bill would interfere with physicians and parents “as they deal with some of the most complex and sensitive matters involving young people.”

The bill, which is part of a wave of similar legislation across the country, would have banned doctors from providing transgender minors with gender-affirming treatments such as puberty blockers, hormone therapies and transition-related surgeries, and from referring them for such treatments. Republican lawmakers in at least 17 other states have introduced similar bans on medical treatments for transgender minors, despite opposition from major pediatric and psychiatric organizations.

Because it takes a simple majority to override a governor’s veto in Arkansas, Hutchinson acknowledged that the General Assembly is likely to override the veto, given the overwhelming support for the bill in the state legislature.

“I’m hopeful, though, that my action will cause conservative Republican legislators to think through the issue again and hopefully come up with a more restrained approach,” Hutchinson said.

Arkansas was the first state to send such a bill to a governor’s desk, after lawmakers last week voted 28 to 7 in favor of the legislation. While Hutchinson had not previously discussed his position on the bill, transgender advocates had braced for the governor to sign the bill, given his support of other legislation restricting transgender rights. Last month, he signed into law a ban on transgender girls competing in school sports consistent with their gender identity, as well as a bill allowing doctors to refuse treatment to a patient based on religious or moral objections.

Hutchinson said he came to his decision after hearing out the concerns of transgender people and doctors in his state. He cited opposition from leading national medical associations that feared that denying access to this medical care could result in “significant harm” to transgender young people.

“The bill is overbroad, extreme and does not grandfather those young people who are currently under hormone treatment,” Hutchinson said. “The young people who are currently under a doctor’s care will be without treatment when this law goes into effect. That means they will be looking to the black market or go out of state … to find the treatment that they want and need. This is not the right path to put them on.”

If the legislature overrides the governor’s veto, Chase Strangio, deputy director for transgender justice at the American Civil Liberties Union, has vowed to challenge the ban in court, calling the bill “the single most extreme anti-trans law to ever pass through a state legislature.” But on Monday, he applauded the governor for his decision, tweeting: “I am crying. It will be hard to sustain but this is SO MEANINGFUL.”

“Thank you to everyone who called, emailed, tweeted Gov. Hutchinson,” Strangio wrote. “This is a powerful rebuke of this nightmare legislation.”

The Equality Act is a positive step forward for the LGBTQ community. But it came with swift backlash from conservative lawmakers. (Monica Rodman, Sarah Hashemi/The Washington Post)

Major medical organizations including the American Academy of Pediatrics and the Endocrine Society have supported access to puberty blockers and hormone treatments for children diagnosed with gender dysphoria, defined as the distress caused by a mismatch between one’s sex assigned at birth and one’s gender identity. Restricting access to this care has been shown to increase the risk of suicidal thoughts in an already vulnerable population, according to the American Academy of Child and Adolescent Psychiatry.

Medical guidelines do not recommend performing gender-affirming genital surgeries on transgender people before they turn 18. They also do not recommend any medical interventions before a child reaches puberty. But once transgender children reach the early stages of puberty, medical guidelines say they can consider puberty blockers, which are reversible treatments that pause puberty and give children time to decide what to do next. Later in their teenage years, transgender adolescents can consider hormone replacement therapies, such as estrogen for trans girls and testosterone for trans boys, which create more permanent changes to their bodies.

Several studies on puberty blockers have found that transgender young people who were treated with the medications showed lower rates of depression and anxiety and demonstrated better global functioning. A study from Harvard Medical School and the Fenway Institute published in the journal Pediatrics last year showed that young people who wanted a puberty suppressant and were able to access it had lower odds of considering suicide.

Pediatricians in Arkansas gathered at the state Capitol on Saturday for a rally against the legislation, carrying signs with the phrases “trust doctors” and “white coats for trans rights.” Last week, Lee Beers, president of the American Academy of Pediatrics, spoke in opposition to the Arkansas bill, saying “it puts politicians rather than pediatricians in charge of a child’s medical care.”

During last week’s Senate vote, one of the bill’s Republican sponsors, state Sen. Alan Clark, described gender-affirming treatments as “at best experimental and at worst a serious threat to a child’s welfare.” He argued that the bill would “protect children from making mistakes that they will have a very difficult time coming back from.”

In a Senate committee hearing on the bill last month, one of its Republican sponsors, state Rep. Robin Lundstrum, compared gender-affirming treatments to surgical and chemical “mutilation,” and said children should not be allowed to make such decisions before they turn 18.

“This is about protecting minors,” she said. “Many of you, I would hazard to guess, did things under 18 that you probably shouldn’t have done … why would we ever even consider allowing a sex change for a minor?”

But in that same hearing, the parents of transgender children in Arkansas said the treatments have been lifesaving for their children. One transgender man in the state, Cash Ashley, said, “If this bill passes, people will die.” If he had received gender-affirming care as a teenager, Ashley said, “I may not have tried to take my own life.”

“The world is already a hostile place for trans people, especially trans youth,” Ashley said. “Trans people have always been here, we will always be here, and you cannot erase us. Please stop trying.”

Read more: