The Texas Supreme Court allowed a 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 Thursday “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 in a joint statement.