United States Catholic bishops have issued guidelines that seek to stop Catholic hospitals from providing gender transition care, a move LGBTQ advocates say could harm the physical and emotional health of transgender people within the church.

The 14-page doctrinal note, titled “Moral Limits to the Technological Manipulation of the Human Body,” sets forth guidelines for changing a person’s sex, specifically with youth. The document, issued Monday, says Catholic hospitals “must not perform interventions, whether surgical or chemical, that aim to transform the sexual characteristics of a human body into those of the opposite sex, or take part in the development of such procedures.”

Transgender Catholics have received a mixed response across the U.S. church. Some have found acceptance in specific parishes and rejection in certain dioceses, including those that bar church personnel from using trans people’s preferred gender pronouns. The bishops’ latest guidance to Catholic medical centers could prevent trans people from getting the health care they need, said Francis DeBernardo, executive director of New Ways Ministry, which advocates for greater LGBTQ acceptance in the church.

Catholic hospitals make up a sizeable portion of the U.S. health care system and in some communities they are the only option. The Catholic Health Association, which comprises more than 600 hospitals and 1,400 long-term care and other health facilities in the United States, says more than one in seven U.S. hospital patients is cared for in a Catholic facility.