Montana's House speaker on Thursday refused to allow a transgender lawmaker to speak about bills on the House floor until she apologizes for saying lawmakers would have "blood on their hands" if they supported a bill to ban gender-affirming medical care for transgender youth, the lawmaker said.

Rep. Zooey Zephyr, who was deliberately referred to using male pronouns by some conservative lawmakers demanding her censure, said she will not apologize, creating a standoff between the first-term state lawmaker and Republican legislative leaders.

Speaker Matt Regier refused to acknowledge Zephyr on Thursday when she wanted to comment on a bill seeking to put a binary definition of male and female into state code.

"It is up to me to maintain decorum here on the House floor, to protect the dignity and integrity," Regier said Thursday. "And any representative that I don't feel can do that will not be recognized."

Regier said the decision came after "multiple discussions" with other lawmakers and that previously there have been similar problems.

Democrats objected to Regier's decision, but the House Rules committee and the House upheld his decision on party-line votes.

"Hate-filled testimony has no place on the House floor," Republican Rep. Caleb Hinkle, a member of the Montana Freedom Caucus that demanded the censure, said in a statement.

Zephyr said she stands by what she said about the consequences of banning essential medical care for transgender youth.

The bill would ban transgender minors in Montana from receiving puberty blockers, cross-sex hormones or surgical procedures. Those are treatments for gender dysphoria, the clinically significant distress caused by feeling that one's gender identity does not match one's biological sex. Medical professionals who provided such care would lose their medical licenses for at least a year.

"When there are bills targeting the LGBTQ community, I stand up to defend my community," Zephyr said. "And I choose my words with clarity and precision and I spoke to the real harms that these bills bring."

Republican Gov. Greg Gianforte has indicated he will sign the bill.

Regier also declined to recognize Zephyr Thursday when she rang in to speak about another bill, which was unrelated to LGBTQ+ issues and seeks to reimburse hotels that provide shelter to victims of human trafficking.

"The speaker is refusing to allow me to participate in debate until I retract or apologize for my statements made during floor debate," Zephyr said.

The issue came to a head Tuesday when Zephyr, the first transgender woman to hold a position in the Montana legislature, referenced the floor session's opening prayer when she told lawmakers if they supported the bill, "I hope the next time there's an invocation, when you bow your heads in prayer, you see the blood on your hands."

She had made a similar comment when the House debated the bill the first time.

House Majority Leader Sue Vinton rebuked Zephyr on Tuesday, calling her comments inappropriate, disrespectful and uncalled for.

Later, the Montana Freedom Caucus issued its censure demand in a letter that called for a "commitment to civil discourse" in the same sentence in which it deliberately misgendered her in the same sentence. The caucus also misgendered Zephyr in a Tweet while posting the letter online.

"It is disheartening that the Montana Freedom Caucus would stoop so low as to misgender me in their letter, further demonstrating their disregard for the dignity and humanity of transgender individuals," Zephyr said in a statement Wednesday.

Zephyr also spoke emotionally and directly to transgender Montanans in February in opposing a bill to ban minors from attending drag shows.

"I have one request for you: Please stay alive," Zephyr said then, assuring them she and others would keep fighting and challenge the bills in court.

The legislature has also passed a bill stating a student misgendering or deadnaming a fellow student is not illegal discrimination, unless it rises to the level of bullying. Deadnaming is calling a transgender person by their previous name when they have changed their name as part of their gender transition.

At the end of Thursday's House session, Democratic Rep. Marilyn Marler asked that the House majority allow Zephyr to speak on the floor going forward.

"This body is denying the representative ... the chance to do her job," Marler said.

Majority Leader Vinton, before moving for adjournment, said: "I will let the body know that the representative ... has every opportunity to rectify the situation."

The House meets again Friday afternoon.