West Virginia has become at least the 11th state to enact legislation banning or severely restricting access to gender-affirming care for minors, with Republican Gov. Jim Justice signing a bill that bans transgender youth from being prescribed puberty blockers or hormone therapy on Wednesday. Under the measure, minors will also be barred from receiving gender-affirming surgery. The bill’s reach was curtailed slightly by a last-minute amendment—pushed through by Senate Majority Leader Tom Takubo (R)—that allows underage patients access to blockers and therapy with parental consent and a diagnosis of severe gender dysphoria by two physicians. “These kids struggle. They have incredible difficulties,” said Takubo, who serves on the medical faculty for West Virginia University. Natalie Frazier, a regional Planned Parenthood clinician supervisor, told the Associated Press that the bill was “better than it could have been,” but still “an unnecessary barrier that is going to end up harming people.”