Tennessee General Assembly

Section 1. Tennessee Code Annotated, Title 68, is amended by adding the following as a new chapter:
68-33-103. Prohibitions.
(a): [Reference text]
(1) It is not a violation of subsection (a) if a healthcare provider performs, or offers to perform, a medical procedure on or administers, or offers to administer, a medical procedure to a minor if:
(A) The performance or administration of the medical procedure is to treat a minor's congenital defect, disease, or physical injury; or 
(B) The performance or administration of the medical procedure on the minor began prior to the effective date of this act.

Mississippi State Legislature

Section 2.
For the purposes of this act, the following terms shall have the meanings ascribed herein:
(a-e) & (f)(i): [Reference text]
(f)(ii)  "Gender transition procedures" do not include:                    
1.  Services to persons born with a medically verifiable disorder of sex development, including a person with external sex characteristics that are irresolvably ambiguous, such as those born with forty-six (46) XX chromosomes with virilization, forty-six (46) XY chromosomes with undervirilization, or having both ovarian and testicular tissue;                    
2.  Services provided when a physician has otherwise diagnosed a disorder of sexual development that the physician has determined through genetic or biochemical testing that the person does not have normal sex chromosome structure, sex steroid hormone production, or sex steroid hormone action;                   
 3.  The treatment of any infection, injury, disease, or disorder that has been caused by or exacerbated by the performance of gender transition procedures, whether or not the gender transition procedure was performed in accordance with state and federal law or whether or not the funding for the gender transition procedure is permissible under this act; or                    
4.  Any procedure for a male circumcision;

South Dakota State Legislature

Section 3. That chapter 34-24 be amended with a NEW SECTION:
The prohibitions of section 2 of this Act do not limit or restrict the provision of services to:
(1) A minor born with a medically verifiable disorder of sex development, including external biological sex characteristics that are irresolvably ambiguous;
(2) A minor diagnosed with a disorder of sexual development, if a healthcare provider has determined, through genetic or biochemical testing, that the minor does not have a sex chromosome structure, sex steroid hormone production, or sex steroid hormone action, that is normal for a biological male or biological female; or 
(3) A minor needing treatment for an infection, injury, disease, or disorder that has been caused or exacerbated by any action or procedure prohibited by section 2 of this Act.

Section 6. The Chapter 34-24 be amended with a NEW SECTION:
If, prior to July 1, 2023, a healthcare professional has initiated a course of treatment, for a minor, which includes the prescription or administration of any drug or hormone prohibited by section 2 of this Act, and if the healthcare professional determines and documents in the minor's medical record that immediately terminating the minor's use of the drug or hormone would cause harm to the minor, the healthcare professional may institute a period during which the minor's use of the drug or hormone is systematically reduced. That period may not extend beyond December 31, 2023.

Alabama State Legislature

Section 3. For the purposes of this act, the following terms shall have the following meanings: 
(1-5): [Reference text]
(6) Removing any healthy or non-diseased body part or tissue, except for a male circumcision.
(b) Subsection (a) does not apply to a procedure undertaken to treat a minor born with a medically verifiable disorder of sex development, including either of the following: 
(1) An individual born with external biological sex characteristics that are irresolvably ambiguous, including an individual born with 46 XX chromosomes with virilization, 46 XY chromosomes with undervirilization, or having both ovarian and testicular tissue. 
(2) An individual whom a physician has otherwise diagnosed with a disorder of sexual development, in which the physician has determined through genetic or biochemical testing that the person does not have normal sex chromosome structure, sex steroid hormone production, or sex steroid hormone action for a male or female.

Utah State Legislature

Section 2. Section 58-1-603 is enacted to read: 
58-1-603. Hormonal transgender treatment on minors -- Requirements.
(1)-(a-e)(A-B): [Reference text]
(C) A puberty inhibition drug. 
(ii) “Hormonal transgender treatment” does not include administering, prescribing, or supplying a substance described in Subsection (1)(e)(i) to an individual if the treatment is medically necessary as a treatment for: 
(A) Precocious puberty; 
(B) Endometriosis;       
(C) A menstrual, ovarian, or uterine disorder      
(D) A sex-hormone stimulated cancer; or      
(E) A disorder of sexual development.
(3) (a) A health care provider may provide a hormonal transgender treatment to a minor only if the health care provider has been treating the minor for gender dysphoria for at least six months.

Iowa General Assembly

Section 1. New Section. 147-164 Gender transition procedure-related activities -- minors -- prohibitions.
(1)(a-b): [Reference text]
(2)c. Paragraphs “a” and “b” do not apply to any of the following: 
(1) Services provided to a minor born with a medically verifiable disorder of sex development, including a minor with external biological sex characteristics that are irresolvably ambiguous, such a minor born with forty-six XX chromosomes with virilization, forty-six XY chromosomes with undervirilization, or having both ovarian and testicular tissue. 
(2) Services provided to a minor who has otherwise been diagnosed with a disorder of sexual development by a physician, when the physician has determined through genetic or biochemical testing that the minor does not have a normal sex chromosome structure, sex hormone production, or sex steroid hormone action for a biological male or biological female. 
(3) The treatment of any infection, injury, disease, or disorder that has been caused or exacerbated by the performance of gender transition procedures, whether or not the procedures were performed in accordance with state and federal law.

Oklahoma State Legislature

Section 1. -- New law -- A new section of law to be codified in the Oklahoma Statues as Section 2607.1 of Title 63, unless there is created a duplication in numbering, reads as follows: 
(A)(1) & (2)(a): [Reference text]
b. Gender transition procedures do not include: 
(1) behavioral health care services or mental health counseling, 
(2) medications to treat depression and anxiety, 
(3) medications prescribed, dispensed, oradministered specifically for the purpose of treating precocious puberty or delayed puberty in that patient, 
(4) services provided to individuals born with ambiguous genitalia, incomplete genitalia, or both male and female anatomy, or biochemically verifiable disorder of sex development (DSD), including but not limited to: 
(a) 46,XX DSD, 
(b) 46,XY DSD,       
(c)  sex chromosomes DSDs,      
(d) XX or XY sex reversal, and      
(e) ovotesticular disorder,      
(5) the treatment of any infection, injury, disease, or disorder that has been caused by or exacerbated by the performance of gender transition procedures, whether or not the gender transition procedure was performed in accordance with state and federal law,      
(6) the treatment of any physical injury or illness that would, as certified by a physician, place the individual in imminent danger of death orimpairment of a major bodily function unless such treatment is performed, or     
(7) the provision of puberty-blocking drugs or crosssex hormones to a minor currently receiving such drugs or hormones as of the effective date of this act for a period of not more than six (6) months solely for the purpose of assisting the minor with gradually decreasing and discontinuing use of the drugs or hormones.

Texas State Legislature

Section 2. Chapter 161, Health and Safety Code, is amended by adding Subchapter X to read as follows: 
Sec. 161.703. Exceptions. (a) Section 161.702 does not apply to the provision by a physician or health care provider, with the consent of the child’s parent or legal guardian, of: 
(1) Puberty suppression or blocking prescription drugs for the purpose of normalizing puberty for a minor experiencing precocious puberty; or 
(2) Appropriate and medically necessary procedures or treatments to a child who: 
(A) Is born with a medically verifiable genetic disorder of sex development, including: 
(i) 46, XX chromosomes with virilization; 
(ii) 46, XY chromosomes with undervirilization; or 
(iii) Both ovarian and testicular tissue; or 
(B) Does not have the normal sex chromosome structure for male or female as determined by a physician through genetic testing.

Kentucky State Legislature

Section 4. A new Section of KRS Chapter 311 is Created to read as follows: 
(1-2): [Reference text]
(3) The prohibitions of subsection (2) this section shall not limit or restrict the provision of services to: 
(a) A minor born with a medically verifiable disorder of sex development, including external biological sex characteristics that are irresolvable ambiguous; 
(b) A minor diagnosed with a disorder or sexual development, if a health care provider has determined, through genetic or biochemical testing, that the minor does not have a sex chromosome structure, sex steroid hormone production, or sex steroid hormone action, that is normal for a biological male or biological female; or      
(c) A minor needing treatment for an infection, injury disease, or disorder that has been caused or exacerbated by any action or procedure by subsection (2) of this section.

West Virginia State Legislature

Article 3. West Virginia Medical Practice Act.
30-3-20. Prohibited practice.
(a-b): [Reference text]
(c) A physician may provide any of the following to a person who us under 18 years of age: 
(1) Services provided to an individual born with a medically verifiable disorder of sex development, including, but not limited to, a person with external biological sex characteristics that are irresolvably ambiguous, such as an individual born with forty-six xx chromosomes with virilization, forty-six xy chromosomes with undervirilization, or having both ovarian and testicular tissue; 
(2) Services provided to an individual when a physician has otherwise diagnosed a disorder of sexual development and in which the physician has determined through genetic or biochemical testing that the individual does not have normal sex structure, sex steroid hormone production, or sex steroid hormone action; 
(3) The treatment of any infection, injury, disease, or disorder that has been caused by or exacerbated by the performance of gender transition procedures, whether or not these procedures were performed in accordance with state and federal law; and 
(4) Any procedure undertaken because the individual suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the person in imminent danger of death, or impairment of a major bodily function unless surgery is performed. 
(5) Pubertal modulating and hormonal therapy for severe gender dysphoria if: 
(A) The minor has been diagnosed as suffering from severe gender dysphoria by no fewer than two medical or mental health providers with at least one being a mental health provider or adolescent medicine specialist, and both having relevant training in the diagnosis and treatment of severe gender dysphoria in adolescents; 
(B) The diagnosing medical professionals express in written opinions that treatment with pubertal modulating and hormonal therapy is medically necessary to treat the minor’s psychiatric symptoms and limit self-harm, or the possibility of self-harm, by the minor;        
(C) The minor, the minor’s parents, legal guardians, or person or other persons charged with medical decision-making for the minor, and the minor’s primary physician agree in writing with the treatment with pubertal modulating and hormonal therapy for the minor;        
(D) Any use of gender altering medication is for purposes of pubertal modulating and hormonal therapy limited to the lowest titratable dosage necessary to treat the psychiatric condition and not for purposes of gender transition; and

Missouri General Assembly

Section A. Chapter 191, RSMo, is amended thereto one section, to be known as section 191.1720, to read as follows:
191.1720.
(1-5): [Reference text]
(6)(b) The term “gender transition procedures” shall not include: 
a. Services to individuals born with a medically-verifiable disorder of sex development, including, but not limited to, an individual with external biological sex characteristics that are irresolvably ambiguous, such as those born with forty-six XX chromosomes with virilization, forty-six XY chromosomes with undervirilization, or having both ovarian and testicular tissue; 
b. Serivices provided when a physician has otherwise diagnosed an individual with a disorder of sexual development through genetic or biochemical testing that the individual does not have normal sex chromosome structure, sex steroid hormone production, or sex steroid hormone action; 
c. The treatment of any infection, injury, disease, or disorder that has been caused by or exacerbated by the performance of gender transition procedures regardless of whether the gender transition procedure was performed in accordance with state and federal law; or 
d. Any procedure undertaken because the individual suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the individual in imminent danger of death or impairment of major bodily function unless surgery is performed;

North Dakota Legislative Assembly

Section 1. Chapter 12.1-36.1 of the North Dakota Century Code is created and enacted as follows:
12.1-36.1-03. Exceptions. 
Section 12.1-36.1-02. does not apply: 
1. To the good-faith medical decision of a parent or guardian of a minor born with a medically verifiable genetic disorder of sex development, including: 
a. A minor with external biological sex characteristics that are irresolvably ambiguous, including having forty-six, xx chromosomes with virilization, forty-six, xy chromosomes with undervirilization, or having both ovarian and testicular tissue; or 
b. When a physician otherwise has diagnosed a disorder of sexual development in which the physician, through genetic testing, ha determined the minor does not have the normal sex chromosome structure for a male or female; or        
2. If performed or administration of the medial procedure on the minor began before the effective date of this Act.

Montana State Legislature

Section 4. Prohibitions.
(1)(a-b): [Reference text]
(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. Subsections (1)(a) and (1)(b) do not apply for other purposes, including:
(i) treatment for a person born with a medically verifiable disorder of sex development, including: 
(A) a person born with external biological sex characteristics that are irresolvably ambiguous, including an individual born with 46 XX chromosomes with virilization, 46 XY chromosomes with undervirilization, or having both ovarian and testicular tissue; and 
(B) a person whom a physician has otherwise diagnosed with a disorder of sexual development in which the physician has determined through genetic or biochemical testing that the person does not have normal sex chromosome structure, sex steroid hormone production, or sex steroid hormone action for a male or female; and
(ii) treatment of any infection, injury, disease, or disorder that has been caused or exacerbated by a medical treatment listed in subsection (1)(a) or (1)(b), whether or not the medical treatment was performed in accordance with state and federal law and whether or not funding for the medical treatment is permissible under state and federal law.

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.
(1-3): [Reference text]
(4) The provisions of subsection (2) of this section shall not apply to a person acting in accordance with the good faith medical decision of a parent or guardian of a child born with a medically verifiable genetic disorder of sex development, including: 
(a) A child with external biological sex characteristics that are ambiguous and irresolvable, such as a child born having 46, XX chromosomes with virilization, 46, XY chromosomes with undervirilization, or with both ovarian and testicular tissue; 
(b) When a physician has otherwise diagnosed a disorder of sexual development in which the physician has determined through genetic testing that the child does not have the normal sex chromosome structure, sex steroid hormone production, or sex steroid hormone action for a male or female; or        
(c) The treatment of any infection, injury, disease, or disorder that has been caused or exacerbated by the performance of gender transition procedures, whether or not the procedures were performed in accordance with the state and federal law.