Republicans in the Tennessee Senate on Monday overwhelmingly passed a bill banning gender transition health care for minors in the state, legislation that will almost certainly trigger a legal fight if it is signed into law.

Senate Bill 1 bans minors in Tennessee from accessing gender dysphoria and transition treatments such as puberty blockers and hormone therapies, in addition to surgeries.

People who received the treatments as minors would also be able to sue parents, guardians and physicians for authorizing the care under a 30-year statute of limitations under the legislation.

The Senate approved the bill 26-6, with all of the chamber's Democrats voting against the measure.

Bill sponsor Senate Majority Leader Jack Johnson, R-Franklin, has argued the treatments are experimental and harmful to children. Democrats and Tennessee parents with transgender children have sharply disagreed.

Johnson said Monday that the bill does not represent "animus toward or disapproval" of children living with gender dysphoria or block mental health treatment for transgender children.

"Gender dysphoria is a mental health condition, and should therefore be treated as a mental health condition," Johnson said.

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The legislation was narrowly tailored to allow the same treatments to be used medically elsewhere, as long as they are not used to treat gender dysphoria, and Republicans rebuffed pointed Democratic attempts to block other plastic and reconstructive surgeries that minors can obtain in Tennessee.

"Frankly, you can get any number of cosmetic surgeries that reinforce how feminine or masculine your child feels, as long as you don't cross" the line into gender dysphoria care, Sen. Jeff Yarbro, D-Nashville, said. "When this body starts talking about making it illegal to think one way, or a parent to think one way and choose something, that's when everybody in here should pause."

Filed as the first bill of the session following a high-profile controversy that erupted last fall over Vanderbilt University Medical Center offering gender transition care, the legislation moved quickly through the General Assembly.

Conservative media personalities and two young women who said they regretted beginning gender transitions as teenagers have testified in support of the bill. Both women received their gender transition care outside of Tennessee.

"I believe every Tennessean should have the opportunity to live a life of purpose and dignity in the lawful manner they so choose," Johnson said. "If that involves seeking permanent, irreversible alterations to your body, I support your right to do so, when you're an adult. Not when you're a child and you do not have the mental capacity to do so."

LGBTQ advocates and families with gender transition experiences have decried the legislation and argued the treatments help, not harm, young people living with gender dysphoria.

"At the end of the day, we're creating a scenario where many families do not feel welcome here, many young adults do not feel welcome here," said Sen. Raumesh Akbari, D-Memphis, "We are legislating many of our personal beliefs into a blanket ban on this medically necessary care."

Ahead of the vote on Monday, the American Civil Liberties Union threatened legal action, saying in a statement Republicans have "ignored the warnings of transgender youth, their families, and their medical providers about the potential harms of these bills."

“Trans youth in Tennessee deserve the support and care necessary to give them the same chance to thrive as their peers," ACLU-TN staff attorney Lucas Cameron-Vaughn said. "Gender-affirming care is a critical part of helping transgender adolescents succeed in school, establish healthy relationships with their friends and family, live authentically as themselves, and dream about their futures.”

“Politicians are risking the lives of young people by forcing their way into family decision-making, a fundamental right which has traditionally been protected against government intrusion," Cameron-Vaughn said. "Gender-affirming healthcare for trans youth is safe, effective, and necessary care."

In a Republican meeting prior to the floor vote, Johnson said he had worked closely with Attorney General Jonathan Skrmetti's office on the bill as they expect legal challenges.

Republican lawmakers initially sought to open up parents or guardians to child abuse or neglect claims under the law, though that language has now been stripped from both Senate and House versions of the bill.

The House bill would require a "hard stop" of such treatments on March 31, 2024, a timeline that House Democrats argued could medically harm existing patients. The House bill is slated for another committee meeting on Wednesday, likely its last stop before a full House vote.

South Dakota Gov. Kristi Noem signed a similar bill into law prohibiting several forms of gender-affirming care for minors.

The new law that went into effect Monday prevents several forms of bottom surgery, prohibits the potential for top surgery for those assigned female at birth and stops hormone therapy and puberty blockers, according to the Sioux Falls Argus Leader.

The new law also prohibits health care professionals from providing certain forms of care for patients under 18 who want to alter the appearance of, or validate their perception of, their gender if it doesn’t match their sex assigned at birth. 

Examples include any drugs to delay or stop puberty; Taking testosterone, estrogen or progesterone, "in amounts greater than would normally be produced endogenously in a healthy individual of the same age and sex," and performing "any sterilizing surgery, including castration, hysterectomy, oophorectomy, orchiectomy, penectomy and vasectomy."

Any minors taking prescriptions or being administered drugs or hormones prohibited by this new law will have to stop taking those prescriptions, drugs, or hormones by Dec. 31.

In a release, Noem said the bill protects kids from “harmful, permanent medical procedures.”

South Dakota's new law faced opposition from multiple LGBTQ+ groups and organizations similar to Tennessee including the ACLU that argue such legislation discriminates against trans youth.

Morgan Matzen of the Sioux Falls Argus Leader contributed.

Reach Melissa Brown at mabrown@tennessean.com.