North Carolina lawmakers this week upheld bans on sex changes for kids, granted parents more rights in the public school system, and set athletic standards that require students to participate in programs that align with their biological sex.

The Republican-dominated state House and Senate approved the measures during a veto session on Aug. 16. Lawmakers narrowly surpassed the 60% threshold to override Democratic Gov. Roy Cooper’s vetoes.

The House voted 74-45, and the Senate 27-18, to override Cooper’s veto on legislation that prohibits medical professionals from providing sex change surgeries or sex change drugs for children. The legislation had support from Republican leadership and opposition from Democrats.

As a result of the measures, doctors in the state will be prohibited from performing “gender reassignment” surgeries on minors, which is defined as any surgery designed to alter or remove a healthy part of the child’s body to create anatomical characteristics that would resemble the opposite sex. This includes both genital and nongenital surgeries.

Genital surgeries include removing a child’s genitals to facilitate a so-called “gender transition” or altering the genitals to make them resemble the genitals of the opposite sex. Other procedures include the removal or addition of breasts, facial and vocal surgeries, and hair reconstruction.

The prohibition on gender transition drugs for children applies to puberty-blocking drugs, which seeks to delay or suppress normal physiological development during puberty. It also applies to hormone therapy when meant to change estrogen or testosterone to levels that would not be normal in a child for his or her given sex and age.

Although the law does not establish any criminal penalties for a medical professional who violates the law, any person found in violation will have his or her medical license revoked.

The law also establishes civil remedies that will allow a patient to sue any person who facilitated a gender transition in violation of this law when the person was a minor.

The legislation further prohibits any state funds from being used to facilitate gender transitions for minors through surgery or drugs.

State law will provide an exception when a child has a sex development issue, such as when the gender of the child is ambiguous or the child is born with both ovarian and testicular tissue. The law also allows such treatments and surgeries when not meant to facilitate a gender transition, such as for the treatment of any infection, injury, disease, or disorder or a breast reduction surgery to resolve a physical disorder.

Parental rights in education, athletic standards also upheld

In addition to the gender procedure votes, the House voted 72-47 and the Senate 27-18 to override the governor’s veto on a new Parents’ Bill of Rights, which will ensure that parents maintain certain rights over their children while they are enrolled in public schools.

Per the legislation, a parent has the right “to direct the education and care of his or her child” and “to direct the upbringing and moral or religious training of his or her child.”

The law prohibits policies that disallow or discourage school employees from notifying parents about the “mental, emotional, or physical health or well-being” of the child or changes related to services or monitoring.

Other stipulations include the right of a parent to make health care decisions for his or her child and the right to access a child’s medical records.

The legislation also requires that schools provide age-appropriate instruction for students in kindergarten through fourth grade. These rules ban curricula that include instruction on gender identity, sexual activity, or sexuality for students in these grades.

By votes of 74-45 and 27-18 the two houses further overrode the governor’s veto of a bill that will require student athletes in middle school through college to participate on teams that match their biological sex even if it does not match with the person’s self-proclaimed “gender identity.”

Per the legislation, schools will need to classify athletic activities as male, female, or co-ed. It requires that male-only teams and female-only teams must recognize the person as either male or female based solely on the person’s reproductive biology and genetics at birth.

The law applies to public institutions and private institutions that engage in interscholastic athletic activities.