Maine lawmakers gave preliminary approval Tuesday to legislation that would allow a minor who is at least 16 years old to receive gender-affirming hormone therapy without parental consent.

All but one Democrat on the Judiciary Committee supported the bill sponsored by Rep. Erin Sheehan of Biddeford. Only one Republican, Sen. Eric Brakey of Auburn was present for the vote, and he voted yes. The rest had already left by the time the vote was cast after 7:30 p.m.

The matter now goes to the full House and Senate for further votes and likely additional debate.

Although the bill, L.D. 535, would allow care for older teens without their parents’ consent, there are certain conditions that would have to be met.

First, they must be diagnosed with gender dysphoria, a term for when a person’s biological sex and gender identity do not align. Second, they must be experiencing or are expected to experience harm from not receiving gender-affirming hormone therapy. And third, the minor must receive certain detailed information and counseling from a health care professional prior to providing written consent.

“The issues we are considering here are highly sensitive, even in the best of times,” Sheehan said during a public hearing on the bill this month. “But today, transgender health care is being politicized and stigmatized in the press and on social media. Transgender people, including youth, are being explicitly vilified and branded a threat to their peers by grownups – even by leaders in their communities.”

Sheehan’s legislation was among a handful of Democratic proposals designed to protect gender-affirming care in Maine. Such care is under attack from Republicans across the country, who are enacting and proposing bans on gender-affirming care for minors and taking steps to consider allowing consent for such care for a minor to qualify as child abuse or neglect.

Fifteen states already restrict gender-affirming care for people under 18, and 18 other states, including New Hampshire and New Jersey, are considering bans on gender-affirming care for minors, according to Human Rights Watch.

That comes even as age-appropriate, gender-affirming care has been endorsed by major medical associations across the country, including the American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics and the American Public Health Association.

Most of the substantive debate on the bill Tuesday happened “off mic,” a procedure by which lawmakers from the respective parties go to separate rooms to talk outside of public scrutiny.

Brakey, prior to his vote Tuesday, said he’s thought about the implications of the bill a lot, and although he respects parents’ rights, he believes someone who has reached the age of 16 “has a certain amount of self-determination.” He also said he knows people who have benefited from gender-affirming care and repeated a point that was made during the public hearing, that “waiting is not a neutral act.”

Rep. Stephen Moriarty of Cumberland was the only Democrat on the Judiciary Committee to vote against the bill. He said he’s not opposed to 16- or 17-year-olds getting care, he just doesn’t think parents should be kept in the dark about it.

The final committee vote on Tuesday was 7-1. The committee members who were absent have 48 hours to cast a vote, but with only 13 members in total, the bill will move forward either way.

During the public hearing, Dr. Joseph Anderson testified in support on behalf of the Maine Chapter of the American Academy of Pediatrics, saying gender dysphoria is “a well-recognized medical diagnosis with an established and effective treatment.”

Others argued that gender-affirming care can literally save lives, noting the higher rates of depression and suicidal thoughts among transgender and nonbinary young people. Not everyone grows up in a household where parents will be receptive to such care.

Nevertheless, a handful of people spoke in opposition to the bill during the public hearing. The criticisms ranged from accusing lawmakers of taking away parents’ rights to waging a “war on children,” to claiming gender-affirming care would “displease the Creator.”

“Not allowing parents to be the sole arbiter of a child’s health is wrong,” Penny Morrell, of Belgrade, said in written testimony. “Schools, the government, and the courts do not have the same concern for the welfare of a child as do the parent(s). In a civil society, the family, not the government, is the best environment for the care, nurture, and wellbeing of children.”

Many more advocates and individuals testified in support of the bill, including Equality Maine, MaineTransNet, Out Maine, the Maine Medical Association, the National Association of Social Workers and the Maine Coalition Against Sexual Assault.

“Research unequivocally demonstrates that gender-affirming care improves the mental health and overall well-being of gender diverse children and adolescents,” said Gia Drew, director of Equality Maine.