Transgender residents of South Carolina have sued the state over its ban on their healthcare, challenging one of the most restrictive anti-trans laws in the nation, which has stripped youth and adults of access to critical medical treatments.

The complaint filed by the ACLU on Thursday challenges a bill enacted by Republicans in May, which prohibited gender-affirming treatments for trans youth under 18 and banned public funds from being used for all trans healthcare.

The law prompted the Medical University of South Carolina (MUSC), the state’s only public, statewide hospital system, to cancel gender-affirming treatment for youth and adults in July. LGBTQ+ rights advocates said the abrupt loss of care illustrated how the Republican party’s attacks on trans rights under the guise of “protecting children” were also interfering with trans adults’ private medical decisions.

“We’ve been watching and waiting for how these politicians were going to escalate beyond transgender youth to telling transgender adults what we can do with our bodies,” said Gillian Branstetter, communications strategist with the ACLU’s LGBTQ & HIV Project. “Now we’re seeing how these limitations on funding are shuttering access.”

South Carolina is one of 26 GOP-controlled states that have adopted prohibitions on trans healthcare, part of a wave of anti-LGBTQ+ laws seeking to restrict sports participation, bathroom use, students’ rights, and queer literature and culture.

The ACLU is challenging South Carolina’s H4624, which banned physicians from providing puberty blockers and hormone therapy to youth. Those treatments facilitate medical transition and are options families can consider when trans children are persistent about their identities. They are part of the care model endorsed by major US medical associations, which have opposed the bans, citing research linking the treatment to improved mental health.

The law also banned affirming surgeries for minors, which are rare in the US, and blocked public funding for adult care, including hormones and surgeries.

Representative David Hiott, H4624’s lead sponsor, promoted the bill by stating: “When God created us, he created us male and female … There is no other choice, and all these other folks that want to change that … we need to stand up against that.”

A spokesperson for the state attorney general declined to comment on the suit, but said in an email: “We will vigorously defend the state’s laws.” Spokespeople for Hiott and governor Henry McMaster did not immediately respond to requests for comment on Thursday afternoon.

“I’m an adult. It is ridiculous that the state has the ability to have any say over the healthcare I’m receiving,” Sterling Misanin, a 32-year-old Charleston man and one of the ACLU’s plaintiffs, said in an interview.

Misanin, a trans man, had been an MUSC patient for years and had a long-planned gender-affirming surgery, a hysterectomy, scheduled this summer. But days before his surgery, he said he got a call announcing it was canceled due to the law. “It was really hard to process,” he said. “There was a lot of frustration and anger mixed with this fear that I would never be able to get this.” He said he contacted the ACLU because he was feeling “desperate to try anything in my power”.

Misanin said he jumped through many hoops to secure his surgery appointment appointment, including getting insurance approvals, and was devastated to have to scramble for an alternative. The operation is a vital part of his transition, he said, recounting how a previous affirming procedure, top surgery, had such a positive impact on his gender dysphoria. “It was like an immediate weight lifted off of my shoulders – this feeling like I’ve been holding my breath, hoping I can hide this thing, and now I don’t have to anymore. The moment you start to feel a little bit of reprieve, you want to feel the rest of the reprieve … It’s hard for me to see a future if I can’t have this kind of care.”

He was recently able to schedule his surgery through a privately funded provider, but it’s not with the center where he had long established care. “I’m still reeling”, he added.

Misanin, who works as a manager at a shipping company, said he felt obligated to challenge the law. “I’ve got the mental, financial and social stability to speak out against what’s happening to me, and I know that’s not true for a lot of people in similar situations in South Carolina.”

The plaintiffs in the class action suit include two other adults who have suffered healthcare disruptions and parents of trans children.

Similar lawsuits have found some success. A federal appeals court recently ruled against funding restrictions for trans healthcare in North Carolina and West Virginia, saying the policies were “obviously discriminatory”.

Sruti Swaminathan, an ACLU staff attorney, noted that South Carolina’s law prohibits care for trans youth, but allows cisgender youth to continue accessing the same treatments. Some cis youth, for example, are prescribed puberty blockers when they experience early puberty, and that care remains uninterrupted.

“A law like this sets a pretty dangerous double standard for medical care that is clearly discriminatory,” they said. “There is no mistake here that this law violates the constitutional rights of transgender people.”