The Texas Supreme Court upheld the state’s ban on gender-affirming care for minors, rejecting pleas from parents that it violates their right to seek medical care for their transgender children.

The 8-1 ruling from the all-Republican court, released Friday, leaves in place a law that has been in effect since Sept. 1, 2023. Texas is the largest of at least 25 states that have adopted laws restricting or banning gender-affirming medical care for transgender minors.

Most of those states face lawsuits, and the U.S. Supreme Court recently agreed to hear an appeal from the Biden administration attempting to block state bans on gender-affirming care. The case before the high court involves a Tennessee law that restricts puberty blockers and hormone therapy for transgender minors, similar to the Texas law.