AUSTIN, Texas (AP) — The Texas Supreme Court will allow the new state law banning gender-affirming care for minors to take effect on Friday, setting up Texas to be the most populous state with such restrictions on transgender children.

Legal advocates who sued on behalf of the families and doctors, including the American Civil Liberties Union, called the law and the high court’s decision “cruel.“

“Transgender youth and their families are forced to confront the start of the school year fearful of what awaits them. But let us be clear: The fight is far from over,” the advocacy groups said Thursday in a joint statement.

Last week, a state district judge ruled the pending law violated the rights of transgender children and their families to seek appropriate medical care. The judge issued a temporary injunction to block the law.

State officials immediately appealed to the state’s highest court for civil cases.

The Supreme Court order allowing the law to take effect did not explain the decision. The order did not address whether the law is unconstitutional, and a full hearing is expected.

More than 20 states have adopted laws to ban some gender-affirming care for minors, although some are not yet in effect or have been put on hold by courts.

The Texas law would prevent transgender minors from accessing hormone therapies, puberty blockers and transition surgeries, even though medical experts say such surgical procedures are rarely performed on children. Children who already started the medications being banned are required to be weaned off in a “medically appropriate” manner, the law said.

The Texas Supreme Court is all Republican.

The lawsuit argued the Texas law will have devastating consequences for transgender teens if they are unable to obtain critical treatment recommended by their physicians and parents.

Several doctors who treat transgender children said they worry their patients will suffer deteriorating mental health, which could possibly lead to suicide, if they are denied safe and effective treatment.

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