Minors will be barred from receiving transgender-affirming procedures in Tennessee and Kentucky, a federal appeals court upheld in a ruling Thursday.

Judge Jeffrey Sutton's recent decision overturns previous summer rulings, affirming Tennessee’s law implemented in January that restricts puberty blockers, hormone therapy and transgender surgeries for minors. Kentucky has an identical law.

Tennessee Attorney General Jonathan Skrmetti called it a "big win for democracy" in a statement following the ruling.

"Decisions that are not clearly resolved by the Constitution should be resolved by the people through their elected representatives," he said. "I am so proud of our team who stood strong against the overwhelming resources arrayed against Tennessee in this case."

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Kentucky Attorney General Daniel Cameron agreed with Skrmetti in a separate statement.

"These gender interventions, billed as medical care, cause permanent harm to vulnerable children and their health," he said in a press release. "Despite full-throated denials by Governor (Andy) Beshear and his far-left activists, our children would still be under attack without SB 150."

Following lawsuits from families with transgender children in both states, two federal judges granted preliminary injunction motions, but the recent appeals opinion means the bans can resume enforcement. 

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"As doctors, legislators, and citizens work through the risks and benefits of various treatments for children with gender dysphoria, lawyers and litigants debate the right standard for reviewing such constitutional challenges," Sutton wrote in the opinion. "When the Constitution is not neutral about the issue, skeptical judicial review applies to the law from the start."

Sutton later added: "The government has the power to reasonably limit the use of drugs, as just shown. If that’s true for adults, it’s assuredly true for their children, as also just shown."

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So far, more than 20 states have adopted laws prohibiting transgender surgeries, puberty blockers and hormone therapy for minors, including Florida, Alabama and Montana. Last month, the Texas Supreme Court permitted the state's ban on transgender medical procedures for minors to take effect.