LITTLE ROCK, Ark. (AP) A federal judge struck down Arkansas first-in-the-nation ban on gender-affirming care for children as unconstitutional Tuesday, the first ruling to overturn such a prohibition as a growing number of Republican-led states adopt similar restrictions.

U.S. District Judge Jay Moody issued a permanent injunction against the Arkansas law, which would have prohibited doctors from providing gender-affirming hormone treatment, puberty blockers or surgery to anyone under 18.

Arkansas law, which Moody temporarily blocked in 2021, also would have prohibited doctors from referring patients elsewhere for such care.

Republican lawmakers in Arkansas enacted the ban in 2021, overriding a veto by former GOP Gov. Asa Hutchinson. Hutchinson, who left office in January, said the law went too far by cutting off treatments for children currently receiving such care.

The ruling affects only the Arkansas ban but may carry implications for the fates of similar prohibitions, or discourage attempts to enact them, in other states.

At least 19 other states have enacted laws restricting or banning gender-affirming care for minors following Arkansas law, and federal judges have temporarily blocked similar bans in Alabama and Indiana. Three states have banned or restricted the care through regulations or administrative orders.

Floridas law goes beyond banning the treatments for youth, by also prohibiting the use of state money for gender-affirming care and placing new restrictions on adults seeking treatment. A federal judge has blocked Florida from enforcing its ban on three children who have challenged the law.

Childrens hospitals around the country have faced harassment and threats of violence for providing such care.

The state has argued that the prohibition is within its authority to regulate the medical profession. People opposed to such treatments for children argue they are too young to make such decisions about their futures. Major medical groups, including the American Medical Association and the American Academy of Pediatrics, oppose the bans and experts say treatments are safe if properly administered.

The state is likely to appeal Moodys decision to the 8th U.S. Circuit Court of Appeals, which last year upheld the judges temporary order blocking the law.

Gov. Sarah Huckabee Sanders , Hutchinsons successor, in March signed legislation attempting to effectively reinstate Arkansas ban by making it easier to sue providers of gender-affirming care for children. That law doesnt take effect until later this summer.

A roughly two-week trial before Moody included testimony from one of the transgender youths challenging the states ban. The teenager testified in October that the hormone therapy he has received has transformed his life and that the ban would force him to leave the state.