NASHVILLE, Tenn. (AP) — Tennessee’s Republican-led Senate approved a measure Monday that would ban gender-affirming care for transgender minors, spurring civil rights groups to promise an immediate lawsuit if and when it becomes law.

The Senate’s 26-6 vote keeps the bill on a fast track to passage even though there’s more work to be done on the House side. GOP legislative leaders and Republican Gov. Bill Lee spoke favorably about the ban even before a bill was filed.

“I believe that every Tennessean should have an opportunity to live a life of purpose and dignity in a lawful manner that they choose. And if that involves seeking permanent, irreversible alterations to your body, I support your right to do so — when you are an adult,” said Senate Majority Leader Jack Johnson, a Republican.

The American Civil Liberties Union, the ACLU of Tennessee, and Lambda Legal on Monday promised they were prepping a lawsuit.

The push in Tennessee comes as state lawmakers across the United States are advancing attacks on gender-affirming medical care for young people. Similar bills are being advanced in Nebraska, Oklahoma and South Dakota. In Utah, the Republican governor recently signed a ban into law, and judges have temporarily blocked similar laws in Arkansas and Alabama.

Yet Tennessee in particular has been caught in the center of this conflict ever since video surfaced on social media last year of a Nashville doctor touting that gender-affirming procedures are “huge money makers” for hospitals.

The video prompted calls by Tennessee’s Republican leaders for an investigation into Vanderbilt University Medical Center, but to date, it’s unknown if any authorities have done so. The private nonprofit hospital said it had provided only a handful of gender-affirming surgeries to minors over the years but has put a temporary pause on the procedures to review its policies.

On average, VUMC has provided five gender affirming surgeries to minors every year since its transgender clinic opened in 2018. All were over the age of 16 and had parental consent, and none received genital procedures.

Meanwhile, GOP leaders have used the incident to try to expand Tennessee’s ban on transgender medical treatment for children. These services have been available in the U.S. for more than a decade and are endorsed by major medical associations.

“We are bringing up issues that take away people’s freedoms and focusing on things that people then have to then fight for so they can just be who they are,” said Democratic Sen. Heidi Campbell

If the Senate’s version is enacted, doctors would be prohibited from providing gender-affirming care to anyone under the age of 18, including prescribing puberty blockers and hormones.

However, the legislation spells out some exceptions, including allowing doctors to perform these medical services if the patient’s care had begun prior to July 1, 2023 which is when the ban is proposed to go into effect. The bill then states that that care must end March 31, 2024.

“Tennessee legislators seem hellbent on joining the growing roster of states determined to jeopardize the health and lives of transgender youth, in direct opposition to the overwhelming body of scientific and medical evidence supporting this care as appropriate and necessary,” said Lambda Legal Staff Attorney for Youth Sruti Swaminathan in a statement. “And, just as we have done in other states engaging in this anti-science and discriminatory fear-mongering, so too we will do in Tennessee and challenge this bill should it be signed into law.”

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