South Dakota’s Republican-dominated House passed a bill on Wednesday that would ban physicians from treating transgender children with hormones and sex reassignment surgery, making it the first state to take action on a flurry of bills restricting medical interventions for transgender youth.

Lawmakers voted 46-23 in favor of the bill, which makes it a misdemeanor for doctors to provide puberty blockers or other treatments affecting gender expression to children under 16 years old. It carries a maximum penalty of one year in jail and a fine of up to $2,000.

The bill will be sent to the state Senate for a committee hearing as soon as next week.

Rep. Fred Deutsch, the bill’s primary sponsor, said the legislation would protect vulnerable children who “are being chemically castrated, sterilized, and surgically mutilated.”

“This is a bill of compassion,” Deutsch said as he introduced the bill at Wednesday’s hearing. “It simply says wait, wait until your 16th birthday.”

But to parents and advocates of transgender children, along with many members of the medical community, the bill is a form of discrimination that would take away lifesaving treatments. The debate is a stark symbol of the nation’s culture wars, with Republican and Democratic lawmakers disputing not just medical studies, but also parenting and the role of doctors in American life.

Conservative state legislators in Florida, Colorado, Missouri, Oklahoma, South Carolina and Kentucky have filed similar bills, which they argue protect young people from making what they call “life-altering changes.” Some lawmakers say sex-reassignment surgery and hormone treatments aren’t health care and should be considered criminal acts that are harmful for children.

LGBTQ advocates argue that such bills are unconstitutional and that decisions about medical treatments for gender expression should be between the young person, parents and their doctor. They also say surgeries are rarely performed on youth and puberty blockers, which require parental consent and extensive counseling, are reversible.

“By blocking medical care supported by every major medical association, the legislature is compromising the health of trans youth in dangerous and potentially life-threatening ways,” Libby Skarin, policy director for the American Civil Liberties Union of South Dakota, said in a statement after Wednesday’s vote.

The ACLU said it would launch a legal challenge to the South Dakota ban and others if they becomes law. In response, the Liberty Counsel, a conservative Christian organization, has offered pro-bono legal counsel to defend the bill at no charge to taxpayers, according to Rep. Lee Qualm, the Republican majority leader of the South Dakota House, who read a letter from the organization at Wednesday’s hearing.

On Friday, South Dakota’s Republican Gov. Kristi L. Noem said she has “concerns” about the bill.

“When you take public policy and try to fill parenting gaps with more government, you have to be very careful about the precedent you’re setting,” Noem said in a statement to reporters.

On Tuesday, a South Dakota state senator filed two other bills regarding transgender youth. One would require a counselor, psychologist or social worker employed by a South Dakota school to notify parents if a student is “articulating feelings of gender dysphoria” or interest in self-injury. The other would allow a parent to refuse consent for any health care service to a minor child if the parent believes it would “induce, confirm, or promote” the child’s transgender identity. Neither bill has been scheduled for a hearing.

South Dakota is seen as a laboratory for testing divisive social issues because Republicans hold a supermajority in the legislature. It also was one of the first states to pass a law restricting transgender students’ bathroom use. That 2016 law was vetoed by the governor, but it helped build momentum for a flurry of “bathroom bills” across the country.

Gayle Ruzicka, president of the Utah Eagle Forum, which describes itself as a conservative “pro-family” and “pro-life” group, said controversy over South Dakota’s bill banning treatments for trans youth has not stopped lawmakers from supporting similar bills across the country.

“We are all going forward,” Ruzicka said. “I’ve been talking to a lot of legislatures and they are gung-ho and ready.”

But the issue has proven more complex in Utah after the sister of State Rep. Brad Daw (R), who is considering pushing a bill to ban surgery and hormone therapy for transgender youth, begged him to reconsider his stance in an opinion piece published by the Salt Lake Tribune. Christy Florence is married to a transgender man and has a transgender daughter.

“I have SAT with families of transgender youth and heard their stories. I have SAT with transgender youth themselves and listened to their struggles, and I have held them while they cried,” she wrote. “I have SAT with grieving parents as they struggle to obtain the lifesaving care their kids need in order to start transition; but are met with insurmountable obstacles.”

Daw said in an interview that he was asked to sponsor the bill by the Utah Eagle Forum, but after talking to transgender advocates realized it’s “a lot more complex than I would have believed.”

In South Dakota, business leaders have openly disagreed with Republicans about the bill.

“National businesses — large banks for example — who do business here told me ‘We believe in inclusiveness. We value all people,” said David Owen, president of the South Dakota Chamber of Commerce and Industry, in an interview. “When South Dakota considers draconian rules that affect a limited number of people, we run the risk of triggering economic consequences that include the loss of conventions, tournaments, top-level entertainment and business investment from outside industries.”

South Dakota state Rep. Ray Ring (D) said in a phone interview that he plans to vote against the bill after receiving more than 75 emails and calls from constituents, who largely oppose the bill. Ring said he is “pro-life” and felt voting against it was also a move “to support life.”

He referred to research that found that transgender youth have a much greater risk of suicide, according to the U.S. Centers for Disease Control and Prevention. But if they have access to puberty blockers, their chances of suicide and depression decline, a new study published in the medical journal Pediatrics found.

“I prefer to trust professionals who are trained and experienced in these matters,” he said.

But in Wednesday’s hearing, Rep. Rhonda Milstead (R) described doctors as “imperfect humans.” She compared transgender treatments to the lobotomies of the mid-20th century and to the overprescribing of painkillers that led to the opioid epidemic.

Other lawmakers used graphic words to describe surgeries that local doctors say are not being performed on children in South Dakota.

“We’re talking about injecting little girls … South Dakotan daughters, with testosterone,” said Rep. Jon Hansen (R). “We’re talking about cutting off little girls’ breasts.”

But other Republicans in the House, such as Rep. Jess Olson, called the bill an overreach of government power, the kind of “nanny-state legislation” conservatives have previously stood against.

Olson recounted an email she received from a mother who said her child was identifying as transgender and threatening suicide. The woman said she hoped Olson would support the bill, so she wouldn’t have the option to put her child through such treatments.

“The problem with that is it’s not our place,” Olson said. “She needs to have that difficult conversation. She needs to be the parent.”

Rep. Linda K. Duba (D) read a portion of the testimony from a mother named Kim Parke, whose child, Quinn, struggled with suicidal thoughts and depression before going on puberty blockers as a teenager.

“This is a real life-and-death decision,” Parke said. “If you support this bill, you are telling me you know what’s best for my child. I am the one that knows my child. … Frankly, you don’t.”