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On Nov. 12 in Baltimore, the United States Conference of Catholic Bishops overwhelmingly approved a rule banning gender-affirming care at all its church facilities, The Advocate reported.

The rule was approved even though the American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics and the World Health Organization (among other groups) have stated that gender-affirming care is evidence-based and medically necessary for minors and adults. 

The development affects everything from hormone therapy and gender-affirming surgeries to talk therapy and other mental-health services—for individuals of all ages. While facilities run by the Catholic Church typically have not offered the care, the vote makes things official.

The Catholic Health Association said the decision was “consistent with Catholic health care practice,” but said in a statement that “Catholic providers will continue to welcome those who seek medical care from us and identify as transgender.”

New Ways Ministry Executive Director Francis DeBernardo said that for many trans Catholics he knows, “the transition process was not just a biological necessity, but a spiritual imperative. That if they were going to be living as authentic people in the way that they believe God made them, then transition becomes a necessary thing,” NPR noted. New Ways Ministry advocates for LGBTQ+ inclusion in the Catholic Church.