New Hampshire has become the first New England state to ban gender-affirming care for transgender minors.

Republican Gov. Kelly Ayotte signed House Bill 377 into law Friday, The Boston Globe reports. It bars health care providers from prescribing puberty blockers or hormone treatment to people under 18 if the medications are used for gender transition. It allows young people already receiving these treatments to continue past the law’s effective date, January 1, 2026.

The law calls for disciplinary action by New Hampshire’s medical board for providers who violate it, but not criminal charges. It also lets anyone claiming to be harmed by a violation file suit.

Additionally, she signed House Bill 712, which “limits breast surgeries for minors to only those procedures needed to treat malignancy, injury, infection, or malformation and those needed to reconstruct the breasts after such procedures,” as the bill’s text says. Therefore, breast surgeries for gender transition will not be allowed. It carries the same penalties as the other bill.

“Medical decisions made at a young age can carry lifelong consequences, and these bills represent a balanced, bipartisan effort to protect children,” Ayotte said in a statement.

The bills passed largely along party lines, with Republicans supporting them and Democrats opposed. Last year, Ayotte’s predecessor, fellow Republican Chris Sununu, signed a bill into law prohibiting genital surgeries for trans minors, although these are extremely rare.

Civil rights groups and Democratic legislators condemned the bills. “These laws are merciless, cruel, and painful for transgender young people, their families, and their doctors,” said a statement from Courtney Reed, policy advocate at the American Civil Liberties Union of New Hampshire. The ACLU will continue working “to ensure all people have the dignity and equality they deserve and the freedom to shape their own futures,” she added.

“HB 377 epitomizes extreme government overreach into the private lives and personal decisions of New Hampshire families,” Chris Erchull, senior staff attorney at GLBTQ Legal Advocates & Defenders (GLAD Law), said in a statement. “The best way to protect the health and well-being of transgender young people is to ensure they can continue to access essential, age-appropriate medical care from licensed clinicians practicing according to well-established medical standards of care.”

His organization “will continue to work with our allies and use every legal tool we have to ensure all New Hampshire residents — including transgender Granite Staters — can live freely and safely without government intrusion.”

Even though the U.S. Supreme Court ruled in U.S. v. Skrmetti that states can ban gender-affirming care for trans youth, Erchull told the Globe there are still ways to challenge these bans. “That could include a challenge based on the New Hampshire constitution, arguing that the intent of the law was to harm transgender people, or a challenge on the basis of parental rights,” the paper reports.

Deputy House Democratic Leader Laura Telerski told the Globe, “These bills don’t protect anyone, they criminalize essential medical care, attack families, and dangerously undermine parental rights.”

The rest of the New England states — Maine, Vermont, Massachusetts, Connecticut, and Rhode Island — not only do not ban gender-affirming care for trans youth but have shield laws protecting access to it, according to the Movement Advancement Project.