A federal appeals court opened the door for Arkansas’s ban on gender-affirming medical care for transgender youth to take full effect with Tuesday’s decision reversing what had been a four-year hold on the first state law of its kind.

Arkansas became the first state to ban hormone therapy and puberty blockers for people under the age of 18 in 2021, when a supermajority Republican Legislature passed the controversial ban. Lawmakers pushed it into law despite an unlikely veto from then-Gov. Asa Hutchinson, a conservative who said the law was well-intended but misguided, and let the state override patients, parents and health care experts.

Opponents of the ban moved quickly to secure an injunction that kept the law from taking effect while the courts considered whether it was constituti

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