AUSTIN, Texas (AP) — The Texas Supreme Court upheld the state’s ban on gender-affirming care for transgender youths Friday, rejecting pleas from parents that it violates their right to decide on and seek medical care for their children.

The 8-1 ruling from the all-Republican court 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.

The Texas law prevents transgender people under 18 from accessing hormone therapies, puberty blockers and transition surgeries, though surgical procedures are rarely performed on children. Children who had already started the medications had to taper off their use.

“We conclude the Legislature made a permissible, rational policy choice to limit the types of available medical procedures for children, particularly in light of the relative nascency of both gender dysphoria and its various modes of treatment and the Legislature’s express constitutional authority to regulate the practice of medicine,” Justice Rebeca Aizpuru Huddle wrote in the court’s decision.

The lawsuit that challenged the Texas law argued it devastates transgender teens who are unable to obtain critical treatment recommended by their physicians and parents. The Williams Institute at the UCLA School of Law estimates about 29,800 people ages 13-17 in Texas identify as transgender.

The only justice dissenting with Friday’s ruling said the Texas Supreme Court was allowing the state to “legislate away fundamental parental rights.”

“The State’s categorical statutory prohibition prevents these parents, and many others, from developing individualized treatment plans for their children in consultation with their physicians, even the children for whom treatment could be lifesaving,” Justice Debra Lehrmann wrote in a dissenting opinion. “The law is not only cruel — it is unconstitutional.”

A lower court had ruled the law unconstitutional, but it was allowed to take effect while the state Supreme Court considered the case.

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Texas’ Republican attorney general, Ken Paxton, vowed in a post on the social platform X after the ruling that his office “will use every tool at our disposal to ensure that doctors and medical institutions follow the law.”

Advocates criticized the ruling.

“It is impossible to overstate the devastating impact of this ruling on Texas transgender youth and the families that love and support them,” said Karen Loewy, senior counsel and director of Constitutional Law Practice at Lambda Legal, which was among the groups that sued the state on behalf of doctors and families.

“Our government shouldn’t deprive trans youth of the health care that they need to survive and thrive,” said Ash Hall, policy and advocacy strategist for LGBTQIA+ rights at ACLU of Texas. “Texas politicians’ obsession with attacking trans kids and their families is needlessly cruel.”

The law includes exemptions for children experiencing early puberty or who have “a medically verifiable genetic disorder of sex development.”

Such exemptions underscore the law’s discriminatory nature, said Dr. Jack Drescher, a psychiatry professor at Columbia University who edited the section about gender dysphoria in the American Psychiatric Association’s diagnostic manual. Gender dysphoria is the psychological distress experienced by those whose gender expression does not match their gender identity and is a required diagnosis before treatments can begin.

“They’re saying if you’re not a transgender child and you need these drugs, you can have them, but if you’re a transgender child who might benefit from these drugs, then sorry, you have to move to another state,” Drescher said.

The restrictions on health care are part of a larger backlash against transgender rights, touching on everything from bathroom access to participation in sports. Former President Donald Trump has vowed to pursue other measures that would restrict the rights of transgender people if he wins the November election, including a ban on gender-affirming care for minors at the federal level.

As more states move to enforce health care restrictions, families of transgender youths are increasingly forced to travel out of state for the care they need at clinics with growing waiting lists. At least 13 states have laws protecting care for transgender minors.

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Most of the states that have passed restrictions 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.

Gender-affirming care for transgender youths is supported by major medical organizations, including the American Medical Association, the American Academy of Pediatrics, the American Psychiatric Association and the Endocrine Society.

In a concurring opinion, one justice dismissed the position of the medical groups.

“The fact that expert witnesses or influential interest groups like the American Psychiatric Association disagree with the Legislature’s judgment is entirely irrelevant to the constitutional question,” Justice James Blacklock wrote. “The Texas Constitution authorizes the Legislature to regulate ‘practitioners of medicine.’”

Texas officials defended the law as necessary to protect children and noted a myriad of other restrictions for minors on tattoos, alcohol, tobacco and certain over-the-counter drugs.

Several doctors who treat transgender children testified in a lower court hearing that patients risk deteriorating mental health, which could possibly lead to suicide, if they are denied safe and effective treatment.

The ban was signed by Republican Gov. Greg Abbott, the first governor to order the investigation of families of transgender minors who receive gender-affirming care.

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DeMillo reported from Little Rock, Arkansas.

For all the time I spend digging, planting, pulling and weeding, one would think I’d have some poison ivy horror stories to tell, but I do not. I can’t say for sure whether I’m immune to the rash that tortures so many of my fellow gardeners or if I’ve just been lucky, but one thing is for sure: The plant does pose a serious problem for many who come into contact with it.

Botanically known as Toxicodendron radicans, poison ivy contains oily chemical compounds called urushiols in its leaves, stems and roots. According to the American Skin Association, about 85% of the U.S. population is allergic to urushiols, with roughly 10% to 15% of those considered “highly allergic.”

That makes the plant concerning — and possibly dangerous — for most Americans, with 50 million people affected each year, the group says. So, in most cases, it should be removed.

But the itchy, blistering and sometimes painful dermatitis that affects most people who brush up against poison ivy can discourage efforts to tackle it.

It’s a Catch-22: You need to remove it because you’re allergic but you’re allergic so you can’t remove it.

First, know how to identify it

Making a positive ID can be tricky.

Poison ivy takes on different appearances at different times of year. Most often, its leaves are composed of three leaflets apiece (as referenced in the childhood rhyme, “leaves of three, let it be”). The middle stem is longer than the stems of the side leaflets. Young foliage is shiny; older leaves are dull. Larger, older vines, especially those climbing up trees, are hairy. Leaf color can be green, red, pink-tinged, yellow or orange. Leaf shape can also vary, with smooth, lobed or toothed margins.

This article is part of AP’s Be Well coverage, focusing on wellness, fitness, diet and mental health. Read more Be Well.

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I’ll confess, it confuses me, too. I once pulled up a raspberry plant (RIP) that I misidentified as poison ivy.

Consult with a poison ivy expert, bring a (bagged) sample to your local cooperative extension office, download a plant identification app or compare photos of your vine to those in books or on an educational website.

Then, either call in a professional or, if removing it yourself, carefully implement protective measures.

How to remove it safely

Wear long sleeves, pants, gloves and goggles, and don’t touch anything, especially your face, during the process. Avoid contact with tools or clothing used during the job, and remove all clothing afterward so as not to allow it to come into contact with skin or other surfaces.

The best way to eradicate poison ivy is to pull it up by its roots. If you garden in a four-season area, the job will be easiest in early spring, after winter’s freeze-thaw cycles have softened the ground. Otherwise, waiting until after rainfall is best for the same reason.

Pulling, you’ll notice, will likely leave some of the roots behind, as they can grow up to a foot deep. The entire root system must be completely dug up to avoid a reoccurrence, but if you’re tired, that can wait until tomorrow.

As you dig, you’ll notice the plant also has runner roots that have grown horizontally under the soil surface. Depending on the size of the plant, they can extend up to 20 feet from it. Remove them, too.

How to clean up properly afterward

Proper disposal of all plant parts is critical. Place them in a tightly sealed, heavy black plastic bag and set it out with the trash. Never burn poison ivy, because the smoke would contain toxins that could be fatal if inhaled.

When you’re finished, don’t touch your door. Don’t get yourself a drink. Don’t open the washing machine. Don’t. Touch. Anything.

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This is easiest if you have someone to open the door, put your clothes into the washer, etc. If not, take care to do things in the proper order to avoid cross-contamination: Strip naked, remove your gloves then wash your hands with a liquid cleanser specially formulated to remove traces of the resins. One is Tecnu, which also can be used to launder contaminated clothing.

Then, bring the bottle into the shower with you. Avoid bathing with ordinary soap because it can spread the oils to other parts of your body.

Urushiols can also be transmitted to people via gardening tools, footwear, clothing and pets for as long as a year or two after contact, so anything that touched the plant should be thoroughly cleaned, too. Then wash your hands again. You can’t be too careful.

As time goes on, some sprouts will likely reappear, so repeated pulling and digging may be required over the next several seasons.

Other options

If pulling is not possible, herbicides containing triclopyr or glyphosate can be used to kill the plant. I do not advocate the use of these chemicals except in extreme circumstances, such as to control Japanese knotweed. But if you are severely allergic, I consider poison ivy removal in that category.

Just know that these herbicides will kill every plant they come in contact with, including grass. They also have toxic properties that will remain in the soil for some time. Use them only on a windless day to avoid overspray and take care to directly target only the poison ivy. Apply to leaves as directed, following precautions on the package label.

Plants should wilt within 24 hours, turn brown within three days and die in a couple of weeks, at which point they can be removed. Take the same precautions as above because dead (and dormant) plants still contain toxins. Repeat applications may be necessary.

And don’t get cocky. Just because you’re not allergic today doesn’t mean you won’t be tomorrow. Always protect yourself.

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Jessica Damiano writes weekly gardening columns for the AP and publishes the award-winning Weekly Dirt Newsletter. You can sign up here for weekly gardening tips and advice.

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For more AP gardening stories, go to https://apnews.com/hub/gardening.