Parents who are fighting to overturn Alabama’s ban on some types of gender-affirming care have been ordered by a federal judge to turn over their children’s medical records.

Boe v. Marshall was brought by five parents who argue a 2022 state law strips them of the right to make important decisions about their children’s healthcare. All of the children involved in the case are transgender, according to court documents, though not all have been formally diagnosed with gender dysphoria or chosen to take medication.

The Vulnerable Child Compassion and Protection Act (SB184) bans puberty blockers, hormone therapy and gender-affirming surgeries for minors. The law punishes not only doctors, but also “any other individual” who “prescribes or administers” the treatments with a felony conviction and up to 10 years in jail.

Read more: Alabama teens worry about future as anti-trans bathroom, medical bills pass.

Read more: What do Alabama’s new laws mean for transgender children, doctors?

Puberty blockers and hormone therapy are considered safe and effective “evidence-based care” for children and adults, in appropriate situations, according to the American Academy of Pediatrics.

Gender-affirming surgeries for minors were not performed in Alabama prior to the passage of the law.

Last year, a district court judge blocked parts of the law from taking effect; state officials appealed that decision up to the 11th Circuit Court of Appeals. In the meantime, some aspects of the original lawsuit are still being considered by U.S. District Judge Liles Burke.

Defendants, including Alabama Attorney General Steve Marshall, have asked for medical and mental health records that relate to treatment for gender dysphoria, including documents, notes and forms.

Burke ruled Monday that the records are relevant to the case since the plaintiffs have argued that the treatments their children receive are medically necessary.

“The Parent Plaintiffs claim that any disruption in their children’s care, whether it is the care they are currently receiving or the care they intend to seek in the future, would have devastating effects on their mental health, possibly including self-harm and suicide,” wrote Burke in the ruling. “Ultimately, the Plaintiffs have the burden to prove the allegations in their complaint.”

His ruling concluded that because the plaintiffs have centered their case on the argument that injury and emotional distress would be caused by a lack of treatment, psychotherapist-patient privilege has been effectively waived.

The judge noted one parent’s testimony that “if April had to go through male puberty that she would attempt to harm herself and that her mental health would decline.”

In their response to the defendant’s initial request for medical records, plaintiff’s stated that such records are protected and confidential medical information. They also argued that, under the new law, evidence that such treatments have been offered in the state could possibly lead to criminal charges.

Over 20 medical organizations have filed briefs in support of the plaintiffs claims that the treatments are essential medical care, including the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry.

Burke noted that all records that are turned over must be confidential. Both parties entered into a protective order in July that restricts use and access to any children’s personal health information.