One mother in Tennessee, who spoke on the condition on anonymity to protect her transgender child’s identity, described a roller coaster of anger and sadness once the family heard the ruling. It was difficult, she said, to explain to her child why lawmakers and the court were opposed to treatment that felt so essential.

The U.S. Supreme Court upheld a Republican-backed ban in Tennessee on gender-affirming medical care for transgender minors on Wednesday in a setback for transgender rights that could bolster efforts by states to defend other measures targeting transgender people.

The court’s decision allows the law in Tennessee and has implications for the 23 other states that have banned similar treatments in recent years.