MOSCOW (AP) — Russian lawmakers on Friday adopted a bill outlawing gender-affirming procedures amid the Kremlin’s crusade to protect what it views as the country’s “traditional values.”

The toughened version of the bill was passed unanimously in its third and final reading in Russia’s lower house of parliament, the State Duma.

The bill bans any “medical interventions aimed at changing the sex of a person,” as well as changing one’s gender in official documents and public records.

The only exception will be medical intervention to treat congenital anomalies.

In its second reading on Thursday, clauses were added that annul marriages in which one person has “changed gender” and bar transgender people from becoming foster or adoptive parents.

The bill must be passed by the Federation Council, Russia’s Kremlin-controlled upper chamber that generally rubber-stamps legislation that the Duma has approved, before being signed into law by Russian President Vladimir Putin.

It has rattled the country’s transgender community and has drawn criticism not only from LGBTQ+ rights advocates but from medical personnel as well.

Lyubov Vinogradova, executive director of Russia’s Independent Psychiatric Association, called the bill “misanthropic” in a phone interview with The Associated Press before the final reading. Gender-affirming procedures “shouldn’t be banned entirely, because there are people for whom it is the only way to ... to exist normally and find peace with themselves,” Vinogradova said.

Lawmakers portray the measure as protecting Russia from “the Western anti-family ideology,” with some describing gender transitioning as “pure satanism.”

The crackdown on LGBTQ+ people started a decade ago when President Vladimir Putin first proclaimed a focus on “traditional family values,” a move ardently supported — and fueled, to a certain extent — by the Russian Orthodox Church.

In 2013, the Kremlin adopted the first legislation restricting LGBTQ+ rights, known as the “gay propaganda” law that banned any public endorsement of “nontraditional sexual relations” among minors. In 2020, Putin pushed through a constitutional reform that outlawed same-sex marriage.