Georgia General Assembly

Article 1 of Chapter 7 of Title 31 of the Official Code of Georgia Annotated, relating to regulation of hospitals and related institutions, is amended by adding a new Code section to read as follows: 
31-7-3.5. 
(a) Except as provided in subsection (b) of this code section, none of the following irreversible procedures or therapies shall be performed on a minor for the treatment of gender dysphoria in an institution licensed pursuant to this article: 
(1) Sex reassignment surgeries, or any other surgical procedures, that are performed for the purpose of altering primary or secondary sexual characteristics; or 
(2) Hormone replacement therapies.

Article 1 of Chapter 34 of Title 43 of the Official Code of Georgia Annotated, relating to the Georgia Composite Medical Board, is amended by adding a new Code section to read as follows: 
43-34-15.
(a) Except as otherwise provided in subsection (b) of this Code section, the following irreversible procedures and therapies performed on a minor for the treatment of gender dysphoria are prohibited in this state: 
(1) Sex reassignment surgeries, or any other surgical procedures, that are performed for the purpose of altering primary or secondary sexual characteristics; and 
(2) Hormone replacement therapies.

Tennessee General Assembly

Section 1. Tennessee Code Annotated, is amended by adding the following as a new chapter:
68-33-101. Findings.
(a)-(m): [Reference text]
(n) Therefore, it is the purpose of this chapter to prohibit medical procedures from being administered to or performed on minors when the purpose of the medical procedure is to: 
(1) Enable a minor to identify with, or live as, a purported identity inconsistent with the minor's sex; or 
(2) Treat purported discomfort or distress from a discordance between the minor's sex and asserted identity.

 68-33-103. Prohibitions.
(a) A healthcare provider shall not perform or offer to perform on a minor, or administer or offer to administer to a minor, a medical procedure if the performance or administration of the procedure is for the purpose of: 
(1) Enabling a minor to identify with, or live as, a purported identity inconsistent with the minor's sex; or  
(2) Treating purported discomfort or distress from a discordance between the minor's sex and asserted identity.

 68-33-103. Prohibitions.
(b)(1)-(3): [Reference Text]
(b)(4) The exception in subdivision (b)(1)(B) does not allow a healthcare provider to perform or administer a medical procedure that is different from the medical procedure performed prior to the effective date of this act when the sole purpose of the different medical procedure is to: 
(A) Enable the minor to identify with, or live as, a purported identity inconsistent with the minor's sex; or  
(B) Treat purported discomfort or distress from a discordance between the minor's sex and asserted identity.

68-33-103. Prohibitions.
(c)(1): [Reference Text]
(c)(2) This section supersedes any common law rule regarding a minor's ability to consent to a medical procedure that is performed or administered for the purpose of:  
(A) Enabling the minor to identify with, or live as, a purported identity inconsistent with the minor's sex; or  
(B) Treating purported discomfort or distress from a discordance between the minor's sex and asserted identity.

Utah State Legislature

Section 2. Section 58-1-603 is enacted to read: 
58-1-603. Hormonal transgender treatment on minors -- Requirements.
(1)(a-j) & (2)(a-c): [Reference text]
(d) Beginning January 1, 2024, providing a hormonal transgender treatment to a minor without a transgender treatment certification is unprofessional conduct.

Section 3. Section 58-1-603.1 is enacted to read: 
58-1-603.1. Hormonal transgender treatment moratorium.
(1): [Reference text]
(2) A health care provider may not provide a hormonal transgender treatment to a patient who: 
(a) Is a minor as defined in Section 58-1-603; and 
(b) Is not diagnosed with gender dysphoria before the effective date of this bill.

Alabama State Legislature

Section 5.
No nurse, counselor, teacher, principal, or other administrative official at a public or private school attended by a minor shall do either of the following: 
(1) Encourage or coerce a minor to withhold from the minor’s parent or legal guardian the fact that the minor’s perception of his or her gender or sex is inconsistent with the minor’s sex. 
(2) Withhold from a minor’s parent or legal guardian information related to a minor's perception that his or her gender or sex is inconsistent with his or her sex.

Arizona State Legislature

Section 1. Title 32, chapter 32, article 1, Arizona Revised Statutes, is amended by adding section 32-3230, to read:
32-3230. Prohibitions of gender transition procedures for minors; public monies prohibited; enforcement; definitions
A. A physician or other health care professional may not provide gender transition procedures to any individual who is under eighteen years of age. A physician or other health care professional may not refer any individual who is under eighteen years of age to any health care professional for gender transition procedures.
‍B. Public monies may not be directly or indirectly used, granted, paid or distributed to any entity, organization or individual that provides gender transition procedures to an individual who is under eighteen years of age.

Iowa General Assembly

Section 1. NEW SECTION. 147.164 Gender transition procedure-related activities -- minors -- prohibitions.
(1): [Reference text]
2. a. Except as otherwise provided in paragraph “c”, a health care professional shall not knowingly engage in or cause any of the following practices to be performed on a minor if the practice is performed for the purpose of attempting to alter the appearance of, or affirm the minor’s perception of, the minor’s gender or sex, if that appearance or perception is inconsistent with the minor’s sex. 
(1) Prescribing or administering gonadotropin-releasing hormone analogues or other synthetic drugs used to stop luteinizing hormone and follicle-stimulating hormone secretion, synthetic antiandrogen drugs used to block the androgen receptor, or any drug to suppress or delay normal puberty. 
(2) Prescribing or administering testosterone, estrogen, or progesterone to a minor in an amount greater than would normally be produced endogenously in a healthy individual of that individual’s age and sex. 
(3) Performing surgeries that sterilize, including castration, vasectomy, hysterectomy, oophorectomy, orchiectomy, and penectomy. 
(4) Performing surgeries that artificially construct tissue with the appearance of genitalia that differs from the individual’s sex, including metoidioplasty, phalloplasty, and vaginoplasty. 
(5) Removing any healthy or non diseased body part or tissue.

Florida State Legislature

Section 1. Subsection (1) of section 61.517, Florida Statutes, is amended to read:
61.517 Temporary emergency jurisdiction. --
(a)-(b): [Reference text]
(c) It is necessary in an emergency to protect the child because the child has been subjected to or is threatened with being subjected to sex-reassignment prescriptions or procedures, as defined in s. 456.001.

Section 2. Subsection (1) of section 61.534, Florida Statutes, is amended to read:
61.534 Warrant to take physical custody of child. --
(1) Upon the filing of a petition seeking enforcement a child custody determination, the petitioner may file a verified application for the issuance of a warrant to take physical custody of the child if the child is likely to imminently suffer serious physical harm or removal from this state. Serious physical harm includes, but is not limited to, being subjected to sex-reassignment prescriptions or procedures as defined in s. 456.001.

Oklahoma State Legislature

SECTION 3.
NEW LAW A new section of law to be codified in the Oklahoma Statutes as Section 519.12 of Title 59, unless there is created a duplication in numbering, reads as follows:
Unprofessional conduct by a physician assistant shall include, but not be limited to, knowingly providing gender transition procedures as defined in Section 1 of this act to a child.

Texas State Legislature

Section 2. Chapter 161, Health and Safety Code, is amended by adding subchapter X to read as follows: 
Subchapter X. Gender transitioning and gender reassignment procedures and treatments for certain children
Sec. 161.702. Prohibited provision of gender transitioning or gender reassignment procedures and treatments to certain children. For the purpose of transitioning a child’s biological sex as determined by the sex organs, chromosomes, and endogenous profiles of the child or affirming the child’s perception of the child’s sex if that perception is inconsistent with the child’s biological sex, a physician or health care provider may not knowingly: 
(1) Perform a surgery that sterilizes the child, including: 
(A) Castration; 
(B) Vasectomy; 
(C) Hysterectomy; 
(D) Oophorectomy; 
(E) Metoidioplasty; 
(F) Orchiectomy; 
(G) Penectomy; 
(H) Phalloplasty; and 
(I) Vaginoplasty; 
(2) Perform a mastectomy; 
(3) Provide, prescribe, administer, or dispense any of the following prescription drugs that induce transient or permanent infertility: 
(A) Puberty suppression or blocking prescription drugs to stop or delay normal puberty; 
(B) Supraphysiologic doses of testosterone to females; or 
(C) Supraphysiologic doses of estrogen to males; or
(4) Remove any otherwise healthy or non-diseased body part or tissue.

Kentucky State Legislature

Section 1. A new Section of KRS Chapter 158 is Created to Read as Follows: 
(1) - (5)(a): [Reference text]
(5)(b) The Kentucky Board of Education or Kentucky Department of Education shall not require or recommend policies or procedures for the use of pronouns that do not conform to a student’s biological sex as indicated on the student’s original, unedited birth certificate issued at the time of birth pursuant to KRC 156.070(g)2. 
(c) A local school district shall not require personnel or students to use pronouns for students that do not conform to that particular student’s biological sex as referenced in paragraph (b) of this subsection.

Section 2. KRS 158.1415 is amended to read as follows: 
(1)(a-c): [Reference text]
(d) A policy to respect parental rights by ensuring that: 
1. Children in grade five (5) and below do not receive any instruction through curriculum or programs on human sexuality or sexually transmitted diseases; or 
2. Any child, regardless of grade level, enrolled in the district does not receive any instruction or presentation that has a goal or purpose of students studying or exploring gender identity, gender expression, or sexual orientation; and

Section 4. A new section of KRS chapter 311 is created to read as follows: 
(1): [Reference text]
(2) Except as provided in subsection (3) of this section, a health care provider shall not, for the purpose of attempting to alter the appearance of, or to validate a minor’s perception of, the minor’s sex, if that appearance or perception is inconsistent with the minor’s sex, knowingly: 
(a) Prescribe or administer any drug to delay or stop normal puberty; 
(b) Prescribe or administer testosterone, estrogen, or progesterone, in amounts greater than would normally be produced endogenously in a healthy person of the same age and sex; 
(c) Perform any sterilizing surgery, including castration, hysterectomy, oophorectomy, orchiectomy, penectomy, and vasectomy; 
(d) Perform any surgery that artificially constructs tissue having the appearance of genitalia differing from the minor’s sex, including metoidioplasty, phalloplasty, and vaginoplasty; or 
(e) Remove any healthy or non-diseased body part or tissue.

Indiana General Assembly

Section 1. IC 25-1-22 is Added to the Indiana Code as a New Chapter to Read as Follows [Effective July 1, 2023]:
Chapter 22. Gender Transition Procedures for Minors
Sec. (1-12): [Reference text]
Sec. 13. (a) Except as provided in subsections (c) and (d), a physician or other practitioner may not knowingly provide gender transition procedures to a minor.
(b) Except as provided in subsection (c), a physician or other practitioner may not aid or abet another physician or practitioner in the provision of gender transition procedures to a minor.

Missouri General Assembly

Section A. Chapter 191, RSMo, is amended by adding thereto one new section, to be known as section 191.1720, to read as follows:
191.1720. 1. This section shall be known and may be cited as the "Missouri Sace Adolescents from Experimentation (SAFE) Act".
(1-2): [Reference text]
3. A physician or other health care provider shall not provide gender transition procedures to any individual under eighteen years of age and shall not refer any individual under eighteen years of age to any health care provider for gender transition procedures. 
4. Any referral for or provision of gender transition procedures to an individual under eighteen years of age shall be considered unprofessional conduct and any health care provider doing so may be subjected to discipline by the appropriate licensing entity or disciplinary review board with competent jurisdiction in this state.

Nebraska State Legislature

Section 1. Section 38-179, Revised Statutes Cumulative Supplement, 2022, is amended to read: 
38-179 For the purposes of section 38-178, unprofessional conduct means any departure from or failure to conform to the standards of acceptable and prevailing practice of a profession or the ethics of the profession, regardless of whether a person, consumer, or entity is injured, or conduct that is likely to deceive or defraud the public or is detrimental to the public interest, including, but not limited to:
(1-14): [Reference text]
(15) Performing gender altering procedures for an individual younger than nineteen years of age in violation of section 5 of this act; and

Sec. 5. (1) No health care practitioner shall (a) perform gender altering procedures in this state for an individual younger than nineteen years of age or (b) refer an individual younger than nineteen years of age for gender altering procedures. 
(2) The intentional and knowing performance of or referral for gender altering procedures by a health care practitioner for an individual younger than nineteen years of age in violation of subsection (1) of this section shall be considered unprofessional conduct as defined in section 38-179.

North Dakota Legislative Assembly

Section 1. Chapter 12.1-36.1 of the North Dakota Century is created and enacted as follows:
12.1-36.1-02. Perception of a minor’s sex - Prohibited practices - Penalty. 
(1) Except as provided under section 12.1-36.1-03. if a minor’s perception of the minor’s sex is inconsistent with the minor’s sex, a health care provider may not engage in any of the following practices for the purpose of changing or affirming the minor’s perception of the minor’s sex: 
(a) Perform castration, vasectomy, hysterectomy, oophorectomy, metoidioplasty, orchiectomy, penectomy, phalloplasty, or vaginoplasty; 
(b) Perform a mastectomy; 
(c) Prescribe, dispense, administer, or otherwise supply any drug that has the purpose of aligning the minor’s sex with the minor’s perception of the minor’s sex when the perception is inconsistent with the minor’s sex, including: 
(1) Puberty-blocking medication to stop normal puberty;
(2) Supraphysiologic doses of testosterone to females; or 
(3) Supraphysiologic doses of estrogen to males; or 
(d) Remove an otherwise healthy or non diseased body part or tissue, except for a male circumcision. 2. A health care provider who willfully violates this section is guilty of a class B felony.

Montana State Legislature

Section 4. Prohibitions. (1) (a) Except as provided in subsection (1)(c), a person may not knowingly provide the following medical treatments to a female minor to address the minor's perception that her gender or sex is not female:
(i) surgical procedures, including a vaginectomy, hysterectomy, oophorectomy, ovariectomy, reconstruction of the urethra, metoidioplasty, phalloplasty, scrotoplasty, implantation of erection or testicular prosthesis, subcutaneous mastectomy, voice surgery, or pectoral implants;
(ii) supraphysiologic doses of testosterone or other androgens; or
(iii) puberty blockers such as GnRH agonists or other synthetic drugs that suppress the production of estrogen and progesterone to delay or suppress pubertal development in female minors.
(b) Except as provided in subsection (1)(c), a person may not knowingly provide the following medical treatments to a male minor to address the minor's perception that his gender or sex is not male:
(i) surgical procedures, including a penectomy, orchiectomy, vaginoplasty, clitoroplasty, vulvoplasty, augmentation mammoplasty, facial feminization surgery, voice surgery, thyroid cartilage reduction, or gluteal augmentation;
(ii) supraphysiologic doses of estrogen; or
(iii) puberty blockers such as GnRH agonists or other synthetic drugs that suppress the production of testosterone or delay or suppress pubertal development in male minors.
(c) The medical treatments listed in subsections (1)(a) and (1)(b) are prohibited only when knowingly provided to address a female minor's perception that her gender or sex is not female or a male minor's perception that his gender or sex is not male.

Idaho State Legislature

Section 1. That Section 18-1506B, Idaho Code, be, and the same is hereby amended to read as follows: 
18-1506B -- Genital Mutilation of a Child -- Exclusions -- Penalties -- Definition.
(1): [Reference text]
(2) Except as provided in subsection (4) of this section, any medical practitioner who knowingly engages in any of the following practices upon a child for the purposes of attempting to alter the appearance of or affirm the child’s perception of the child’s sex if that perception is inconsistent with the child’s biological sex shall be guilty of a felony: 
(a) Performing surgeries that sterilize or mutilate, or artificially construct tissue with the appearance of genitalia that differs from the child’s biological sex, including castration, vasectomy, hysterectomy, oophorectomy, metoidioplasty, orchiectomy, penectomy, phalloplasty, clitoroplasty, vaginoplasty, vulvoplasty, ovariectomy, or reconstruction of the fixed parts of the urethra with or without metoidioplasty, phalloplasty, scrotoplasty, or the implantation of erection or testicular prosthesis; 
(b) Performing a mastectomy; 
(c) Administering or supply the following medications that induce profound morphologic changes in the genitals of a child or induce transient or permanent infertility: 
(i) Puberty-blocking medication to stop or delay normal puberty; 
(ii) Supraphsyiological doses of testosterone to a female; or 
(iii) Supraphysiological doses of estrogen to a male; or 
(d) Removing any otherwise healthy or non diseased body part or tissue. 
(4) (3) A surgical operation or medical intervention shall ot be a violation of this section if the operation or intervention is: 
(a) Necessary to the health of the person on whom it is performed and is performed by a person licensed in the place of its performance as a medical practitioner, except that a medical intervention that results in the impairment and mutilation of the reproductive organs and parts of a child is never necessary to the health of the child on whom it is performed if it is for the sole purpose of attempting to alter the appearance of or affirm the child’s perception of the child’s sex if that perception if inconsistent with the child’s biological sex; or