ATLANTA (AP) — A year ago, Georgia lawmakers said they were striking a balance when they banned most gender-affirming surgeries and hormone replacement therapies for transgender people under 18, but let doctors continue prescribing puberty blockers and let minors then receiving hormone replacement therapies continue.

Now state Sen. Ben Watson, the Republican who led last year’s efforts, wants to tip that balance toward an outright ban. The Senate Health and Human Services Committee on Monday voted 8-5 to advance House Bill 1170, which would ban puberty blockers and end access to hormones for those already receiving therapy. The measure moves to the Senate for more debate.

Georgia is among at least 23 states that have enacted laws restricting or banning gender-affirming medical care for transgender minors, and most of those states face lawsuits.

A federal judge last year struck down Arkansas’ ban as unconstitutional and judges’ orders are in place temporarily blocking enforcement of bans in Idaho and Montana. A federal judge who had temporarily blocked Georgia’s ban said the state could resume enforcing the restriction after an appeals court panel in September allowed Alabama’s prohibition to be enforced.

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More recently, the Kansas House on Tuesday debated a gender-affirming care ban for minors that also includes puberty blockers. It expects to take a final vote tomorrow. The bill is expected to pass but be vetoed by Democratic Gov. Laura Kelly.

Watson, a physician, had said last year that allowing the use of puberty blockers was a way of letting transgender minors wait until adulthood before making decisions they couldn’t reverse. But Watson said Monday that he instead wants people to go through puberty in hopes their gender dysphoria will dissipate, calling puberty blockers a conveyor belt to gender transition.

“Really almost exclusively when they are used, (people) do go on to a sex change operation or surgery or sex change hormones,” Watson said.

Opponents, though, say Watson is trying to force transgender minors to go through puberty that doesn’t align with their gender identity and take away the rights of parents to decide what is best for their children.

“What about parents’ rights to take their child to a physician and seek appropriate treatment?” Sen. Nan Orrock, an Atlanta Democrat, asked during the hearing.

Research has shown that transgender youth and adults are prone to stress, depression and suicidal behavior when forced to live as the gender they were assigned at birth.

Watson inserted the proposed ban into an unrelated bill about providing opioid antidotes in public buildings, catching opponents off guard. But supporters of more restrictions were lined up to testify, including Chloe Cole, a nationally known conservative activist who opposes gender-affirming care for minors and spoke to lawmakers about her gender-transition reversal.

Democrats bristled at the sneak attack, noting opponents didn’t get a chance to testify. Because the Senate was amending a bill that already passed the House, it’s unlikely there will be another hearing on the matter.

“The only people we’ve heard from today are the people who clearly knew this (bill) was coming and support it, and we have not been able to hear testimony at all from anybody who would represent the opposing viewpoint,” said Sen. Sonya Halpern, at Atlanta Democrat.

The American Academy of Pediatrics reaffirmed its support for gender-affirming medical care for transgender children last year, calling the restrictions enacted by states “unprecedented government intrusion.”

The group also voted to provide additional documents to support pediatricians, including clinical and technical reports, and to conduct an external review of research regarding the care.

Georgia Equality, a group that lobbies for LGBTQ+ rights, echoed the call to let parents “make decisions about the health care that is right for their families and allows their kids to grow up healthy and safe.”

“This amendment puts politicians between parents and providers, and could ban access to essential medical care for transgender young people,” spokesperson Wes Sanders Han-Burgess said in a statement.

But Watson pointed to England, which decided to not routinely offer puberty-blocking drugs to children at gender identity clinics, saying more evidence is needed about the potential benefits and harms.

The move comes in an election year for Georgia lawmakers and with Watson facing a Republican primary opponent running to Watson’s right. It won him plaudits from Frontline Policy Action, a Christian conservative group that had criticized last year’s bill for allowing puberty blockers and creating exceptions for “medically necessary” procedures.