HELENA, Mont. (AP) — Montana became the latest state to ban or restrict gender-affirming medical care for transgender kids Friday when its Republican governor signed legislation that exiled transgender lawmaker Zooey Zephyr told fellow lawmakers would leave “blood” on their hands.

Montana is one of at least 15 states with laws to ban such care despite protests from the families of transgender youth that the care is essential.

Debate over Montana’s bill drew national attention after Republicans punished Zephyr for her remarks, saying her words were personally offensive. House Speaker Matt Regier refused to let Zephyr speak on the House floor until she apologized. She has not.

Zephyr decried the bill’s signing, saying “it is unconscionable to deprive Montanans of the care that we need.”

“I know that this is an unconstitutional bill. It is as cruel as it is unconstitutional. And it will go down in the courts,” Zephyr said. To trans youth she added: “There’s an understandable inclination towards despair in these moments, but know that we are going to win and until then, lean on community, because we will have one another’s backs.”

On Monday, Zephyr had stood defiantly on the House floor with her microphone raised as protesters shouted “Let her speak,” disrupting House proceedings for at least 30 minutes. Zephyr was then banned from the House and its gallery and voted on bills from a bench in the hallway outside the House on Thursday and Friday.

Lambda Legal, the American Civil Liberties Union and the ACLU of Montana have said they would file a court challenge against the ban, which is set to take effect on Oct. 1, starting a five-month clock in which Montana youth can try to find a way to work around the ban or to transition off of hormone treatment.

“This bill is an overly broad blanket ban that takes decisions that should be made by families and physicians and puts them in the hands of politicians,” the Montana Chapter of the American Academy of Pediatrics has said.

Gov. Greg Gianforte signaled his willingness to sign the bill on April 17 when he offered some amendments to make it clear that public funds could not be used to pay for hormone blockers, cross-sex hormones or surgical procedures.

The bill “protects Montana children from permanent, life-altering medical procedures until they are adults, mature enough to make such serious decisions,” Gianforte wrote in his letter accompanying the amendments.

Debate over the amendments led Zephyr to admonish supporters the following day. House Majority Leader Sue Vinton said Zephyr’s language was “entirely inappropriate, disrespectful and uncalled for.”

The Montana Freedom Caucus deliberately misgendered Zephyr, using male pronouns in a letter saying she should be censured. After Monday’s protest, the caucus said she should be further disciplined.

Under the new law, health professionals who provide care banned by the measure could have their medical licenses suspended for at least a year. They could also be sued in the 25 years following a banned procedure if a patient suffers physical, psychological, emotional or physiological harm. Physicians could not hold malpractice insurance against such lawsuits. The law also prohibits public property and employees from being involved in gender-affirming treatment.

During hours of emotional committee hearings, opponents testified that hormone treatments, and in some cases, surgery, are evidence-based care, supported by numerous medical associations and can be life-saving for someone with gender dysphoria — the clinically significant distress or impairment caused by feeling that one’s gender identity does not match one’s biological sex.

Parents of transgender children testified that the bill infringed on their parental rights to seek medical care for their children.

Opponents also noted that treatments such as puberty-blockers and breast-reduction surgery would still be legal for minors who are not suffering from gender dysphoria, a difference they argue is unconstitutional.

In the letter to legislative leaders accompanying his proposed amendments, Gianforte said he met with transgender residents, understands that their struggles are real and said Montanans who struggle with gender identity deserve love, compassion and respect.

“That’s not what trans Montanans need from you,” Zephyr said as the House considered his amendments. “We need access to the medical care that saves our lives.”

This was the second legislative session in which Sen. John Fuller brought the bill to ban gender-affirming care for transgender children. In 2021, when he was a member of the House, he brought a bill to ban surgical and hormone treatments for transgender children, which was voted down. He brought a second bill to ban surgical treatments which was also rejected. He was successful in 2021 in passing a bill to ban transgender females from participating in girls and women’s sports. The part of the bill that applied to colleges was ruled unconstitutional.