(The Hill) – Transgender Puerto Ricans under the age of 21 will no longer have access to gender-affirming hormone therapy or surgeries under legislation signed this week by the U.S. territory’s Republican Gov. Jenniffer González-Colón that threatens doctors with criminal penalties.

The law approved late Wednesday would punish health care professionals who provide gender-affirming care to minors and young adults with a $50,000 fine per violation and a determinate prison sentence of 15 years. Doctors would also lose their licenses and permits and be permanently barred from conducting business in Puerto Rico.

“Minors, having not yet reached the necessary emotional, cognitive, and physical maturity, are particularly vulnerable to making decisions that can have irreversible consequences,” reads the law, set to take effect in October. “Therefore, it is the State’s duty to ensure their comprehensive well-being.”

Under Puerto Rican law, the age of majority, or legal adulthood, begins at 21, making the island’s ban on gender-affirming care for minors one of the most restrictive of any U.S. state or territory. Roughly half the nation has adopted laws since 2021 that limit access to prescription medications, such as hormones and puberty blockers, and gender-affirming surgical procedures, typically for children and teens under 18.

Laws passed in Alabama and Nebraska restrict care up to 19 years old, similar to an executive order signed by President Trump in January that aims to end federal support for gender-affirming care for young people.

In June, the Supreme Court dealt a victory to supporters of such laws, upholding Tennessee’s ban on transition-related care for minors and ruling that the state’s law, contrary to the arguments of transgender civil rights advocates, does not discriminate based on sex or transgender status.

Major professional medical organizations criticized the court’s decision, maintaining that gender-affirming health care for both transgender adults and minors is medically necessary and can be lifesaving.

Conservative Puerto Rican officials applauded González’s approval of legislation restricting care, which also prohibits the use of public funds for transgender health care for minors.

“The protection of our children and the well-being of all minors is fundamental and non-negotiable!” Puerto Rican Senate President Thomas Rivera Schatz, the bill’s author, said Thursday on social media in a statement thanking González and the territory’s Legislature for approving the measure.

Schatz is affiliated with the New Progressive Party of Puerto Rico and the Republican Party.

“Now no minor will be able to be subjected to treatment for alleged ‘sex change,’” Sen. Joanne Rodríguez Veve, a member of the Proyecto Dignidad Party, wrote on Facebook. She added in an accompanying video, “This is great news for Puerto Rico!”

Organizations including the Puerto Rico Psychological Association, the American Civil Liberties Union (ACLU), the Puerto Rican Association of Professional Counseling and the Puerto Rico Bar Association had encouraged González to veto the bill.

In a statement on Thursday, Puerto Rico’s LGBTQ+ Federation said it would challenge the new law in court.

“Let there be no doubt: We will go to court to challenge the constitutionality of the governor’s cruel and inhumane signing of a law that criminalizes health professionals for caring for trans minors,” said Justin Jesús Santiago, the federation’s co-director.

“What a shame!” Pedro Julio Serrano, the federation’s president, said Thursday. “With her actions, Jennif[f]er González declares herself the most anti-equity governor in history.”