COLUMBUS, Ohio (AP) — An Ohio law that limits gender-affirming health care for youth under 18 can go into effect, a county judge ruled Tuesday.

The American Civil Liberties Union of Ohio said it will file an immediate appeal.

The law bans transgender surgeries and hormone therapies for minors, unless they are already receiving such therapies and it is deemed a risk to stop by a doctor. The law also includes restrictions on the type of mental health services a minor can receive.

State lawmakers in January enacted the law, which also bans transgender athletes from taking part in girls’ and women’s sports, after overriding a veto by Republican Gov. Mike DeWine.

Franklin County Judge Michael Holbrook, in upholding the law, wrote that the ban “reasonably limits parents’ rights to make decisions about their children’s medical care consistent with the state’s deeply rooted legitimate interest in the regulation of medical profession and medical treatments.”

The groups that challenged the law said it denies transgender youth health care and specifically discriminates against their accessing it. The lawsuit also argued that the combination of the two bans violates Ohio’s single-subject rule for bills.

“This loss is not just devastating for our brave clients, but for the many transgender youth and their families across the state who require this critical, life-saving health care,” said ACLU of Ohio Legal Director Freda Levenson.

The office of Republican Ohio Attorney General Dave Yost said in a statement that “this case has always been about the legislature’s authority to enact a law to protect our children from making irreversible medical and surgical decisions about their bodies.”

Ohio’s governor vetoed the law at the end of 2023 after touring the state to visit children’s hospitals and to talk to families of children with gender dysphoria. DeWine cast his action as thoughtful, limited and “pro-life” — citing the suicide risks associated with not getting proper treatment for gender dysphoria.

DeWine simultaneously announced plans to move to administratively to ban transgender surgeries until a person is 18, and to position the state to better regulate and track gender-affirming treatments in both children and adults — a move he hoped would allay the concerns of fellow Republicans that rule the Ohio Statehouse. But the administration swiftly backed off that plan, after transgender adults raised serious concerns about how state regulations could affect their lives and health.

Ohio lawmakers stood their ground on the bill after DeWine’s veto, easily overriding it and making Ohio the 23rd state at that time to ban gender-affirming health care for trans youth.