Alabama was the first state to make it a crime to administer or prescribe puberty blockers and hormones to children who identify as transgender. The new law took effect Sunday.

A similar measure in Arkansas to halt the treatments was blocked by a federal judge before it took effect. A federal judge has not yet ruled on a preliminary injunction request to block Alabama from enforcing the law while a court challenge goes forward.

The legislature recently passed the law to protect minors (those under 19) from irreversible treatments to change a child’s gender. The law includes criminal penalties for doctors and other medical professionals who provide the banned medications and surgeries to minor children. Those penalties could include up to 10 years in prison.

Medical organizations and doctors who support these treatments claim that transgender children who receive the treatments when they are young have better mental health outcomes and report fewer cases of depression, self-harm and suicide or attempted suicide.

“Families are scared. How can you not feel like the floor was pulled out from under you?” Dr. Morissa Ladinsky, a pediatrician who founded a Birmingham medical team that treats children with gender dysphoria, said Sunday.

Ladinsky said she remains hopeful that a federal judge will grant an injunction request.

The families represented in the lawsuit claim that they are being denied medically necessary care that would be devastating for the mental and physical health of their adolescent children. The lawsuit alleges that the new Alabama law violates the Equal Protection Clause of the U.S. Constitution.

U.S. District Judge Liles Burke had cautioned attorneys on Friday that he might not have a decision on a request for a preliminary injunction by the Alabama law’s May 8 effective date. Burke said he and his staff would do “nothing else” but work on the issue.

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