An Indiana law banning gender-affirming care for minors can remain in effect, a federal appeals court has ruled months after allowing the ban to take effect.

A panel of judges on the 7th U.S. Circuit Court of Appeals ruled 2-1 Wednesday that the law’s restrictions are within the purview of the Indiana General Assembly and do not infringe on the constitutional rights of transgender children, their parents or medical providers, The Times of Northwest Indiana reported.

Wednesday’s ruling follows a February decision by the Chicago-based appeals court that allowed the law to take effect by removing a temporary injunction that had blocked the law. The new ruling vacates that injunction entirely and definitively authorizes state officials to enforce the law.

Indiana’s law was enacted in spring 2023 amid a national push by GOP-led legislatures to curb LGBTQ+ rights. It was slated to go into effect on July 1, 2023, but the month before, U.S. District Court Judge James Patrick Hanlon issued an injunction preventing most of the law from taking effect. Hanlon blocked the state from prohibiting minors’ access to hormone therapies and puberty blockers but allowed the law’s prohibition on gender-affirming surgeries to take effect.

Hanlon’s order had also blocked provisions of the law that would prohibit Indiana doctors from communicating with out-of-state doctors about gender-affirming care for their patients younger than 18.

Since 2021, more than 20 states have enacted laws restricting or banning such treatments, even though they have been available in the United States for over a decade and are endorsed by major medical associations. Most of those state bans on gender-affirming care for minors have been challenged with lawsuits.