LINCOLN, Neb. (AP) — Regulations tied to a Nebraska law passed last year restricting gender-affirming care for minors were approved Tuesday by Gov. Jim Pillen, and they largely mirror temporary regulations adopted last October — including a seven-day waiting period to start puberty-blocking medications or hormone treatments.

Other regulations require transgender patients under the age of 19 — the age of majority in Nebraska — to meet several therapy benchmarks. They include undergoing at least 40 hours of therapy that could push back on a person’s gender identity before they can receive any medical treatments meant to affirm their gender identities. Minor patients must also receive at least one hour of therapy every 90 days while on gender-affirming medication to evaluate the patient’s mental health.

Health care providers also are required to obtain three hours of continuing education before they can prescribe puberty blockers or hormones.

The regulations approved by Pillen were those recommended by Nebraska Chief Medical Officer Timothy Tesmer, who was appointed to that post by Pillen last year, following a public hearing in November. The recommendation and approval came despite dozens of families, medical providers and advocates testifying for hours at the hearing opposing the restrictions and regulations.

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“State officials have decided to flatly ignore the serious concerns raised by impacted young people as well as their family members and their medical and mental health providers,” said Grant Friedman, a legal fellow for the American Civil Liberties Union of Nebraska. “To be clear, we are talking about gender-affirming care that is endorsed by major medical organizations and recognized as often life-saving care.”

The new law was authored by state Sen. Kathleen Kauth of Omaha and passed last session. It took effect Oct. 1 and bans gender-affirming surgeries for trans youth under 19. It also required the state’s chief medical officer to spell out when and how those youth can receive other care. The state Department of Health and Human Services issued temporary regulations on Oct. 1.

“As a state, we must protect children from making potentially irreversible and regrettable decisions — decisions for which they may not completely understand the consequences,” Pillen said in a news release announcing his approval of the regulations.

At least 23 states have enacted laws restricting or banning gender-affirming medical care for transgender minors, and most of those states face lawsuits — including Nebraska. A federal judge struck down Arkansas’ ban as unconstitutional. Judges’ orders are in place temporarily blocking the enforcement of the bans in Idaho and Montana.