In a move that flies in the face of major medical guidelines, the South Dakota House of Representatives passed sweeping legislation Wednesday that criminalizes trans-affirming medical care for young people.

House Bill 1057 passed by a vote of 46-23, despite a national campaign to defeat it. It now heads to a Republican-dominated senate.

The bill would make it a misdemeanor for a doctor to provide any trans-affirming health care to a person under the age of 18. That includes offering puberty-blockers, a treatment that studies have found to be life-saving.

The vote comes just days after the publication of a major study that found puberty-blockers—which can temporarily pause the onset of puberty—lowered suicidal thoughts in trans youth by 15%.

In a media statement, LGBTQ suicide prevention organization The Trevor Project said the bill poses a grave threat to trans and non-binary youth in South Dakota.

“This bill actively contradicts evidence-based medical recommendations and restricts parents' ability to support their child with best-practice care, which has been shown to decrease suicide risk,” said Dr. Alexis Chavez, medical director for The Trevor Project. “Medical decisions should be made between doctors and their families—politicians have no role in this intensely personal process.”

National and local LGBTQ organizations are combating a flurry of anti-LGBTQ measures from coast to coast. At last count, Freedom for All Americans tracked 26 anti-trans bills pending in state legislatures, many of them aimed at regulating medical care for trans youth, or barring trans youth from competing in athletics in their lived genders.

Tennessee became the first state to pass an anti-LGBTQ law this year by signing into law a measure that allows adoption and foster care agencies to turn away LGBTQ couples.

South Dakota gained the distinction of being the first to introduce legislation barring trans kids from using bathrooms and locker rooms that aligned with their gender in 2016. That measure cleared both chambers, but was ultimately vetoed by former Gov. Dennis Daugaard after he met with transgender students and their parents, according to NPR.

Many also feared that the state would face boycotts and lawsuits. North Carolina’s infamous anti-trans bathroom law from 2016 jeopardized so much business that the Associated Press calculated it would cost the state a whopping $3.76 billion in lost revenue over 12 years.

On Wednesday, seasoned LGBTQ field organizers were already making their way to South Dakota, where a ground campaign against HB 1057 is ramping up. ACLU attorney Chase Strangio vowed to fight the bill at every turn, promising that if it becomes law the organization will sue.

Alphonso David, president of HRC, called on the state's Senate to reject the bill, adding that chief sponsor Rep. Fred Deutsch and the bill’s proponents are aiming only to discriminate.

“If HB 1057 were to become law, it would send a strong message to trans youth that they are less than their peers and that lawmakers in the Capitol know better than doctors, parents and trans youth,” he said in a media statement.