[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 5424 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
2d Session
S. 5424
To prohibit gender transition procedures on minors, to authorize the
Secretary of Health and Human Services to impose civil penalties on
persons who perform gender transition procedures on minors, and for
other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
December 4, 2024
Mr. Marshall introduced the following bill; which was read twice and
referred to the Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To prohibit gender transition procedures on minors, to authorize the
Secretary of Health and Human Services to impose civil penalties on
persons who perform gender transition procedures on minors, and for
other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Safeguarding The Overall Protection
of Minors Act'' or the ``STOP Act''.
SEC. 2. DEFINITIONS.
In this Act:
(1) Cross-sex hormones.--The term ``cross-sex hormones''
means--
(A) testosterone or other androgens given to
females at doses that are profoundly larger or more
potent than would normally occur naturally in healthy
females; and
(B) estrogen given to males at doses that are
profoundly larger or more potent than would normally
occur naturally in healthy males.
(2) Detransition.--The term ``detransition'' means to halt
or reverse gender transition procedures, including exploration
and seeking medical advice about reversing gender transition
procedures.
(3) Employer.--The term ``employer'' includes an individual
or entity that engages a person in the performance of work as
an independent contractor.
(4) Employment.--The term ``employment'' includes work as
an independent contractor.
(5) Female.--The term ``female'', when used to refer to a
natural person, means an individual who naturally has, had,
will have, or would have, but for a congenital anomaly or
intentional or unintentional disruption, the reproductive
system that at some point produces, transports, and utilizes
eggs for fertilization.
(6) Gender.--
(A) In general.--Subject to subparagraph (B), the
term ``gender,'' when used alone to refer to males,
females, or the natural differences between males and
females--
(i) is a synonym for sex; and
(ii) shall not be considered a synonym or
short-hand expression for gender identity,
experienced gender, gender expression, or
gender role.
(B) Exception.--Subparagraph (A) shall not apply
when the term ``gender'' is used in conjunction with
other words or as an adjective to modify other words,
or when context or explicit definition in law indicates
otherwise.
(7) Gender identity.--The term ``gender identity'' does not
mean sex or gender.
(8) Gender transition.--The term ``gender transition''
means the process in which an individual goes from identifying
with or presenting as his or her sex to identifying with or
presenting a self-proclaimed identity that does not correspond
with or is different from his or her sex, and may be
accompanied with social, legal, or physical changes.
(9) Gender transition procedure.--
(A) In general.--The term ``gender transition
procedure'' means any hormonal or surgical service that
seeks--
(i) to alter or remove physical or
anatomical characteristics or features that are
typical for the individual's sex, as determined
by the sex organs, chromosomes, and endogenous
profiles of the individual; or
(ii) to change the body of such individual
to no longer correspond to their sex.
(B) Inclusions.--The term ``gender transition
procedure'' includes the following:
(i) Providing, prescribing, administering,
dispensing, or otherwise conveying any of the
following prescription drugs that induce
transient or permanent infertility:
(I) Puberty suppression drugs or
puberty-blocking drugs to stop or delay
normal puberty.
(II) Cross-sex hormones, including
supraphysiologic doses of testosterone
to females or supraphysiologic doses of
estrogen to males.
(ii) Genital gender transition surgery.
(iii) Non-genital gender transition
surgery.
(iv) The removal of any otherwise healthy
or non-diseased body part or tissue.
(C) Exclusions.--The term ``gender transition
procedure'' does not include--
(i) services to individuals born with a
medically verifiable disorder of sex
development, including an individual with
external sex characteristics that are
irresolvably ambiguous, such as an individual
born with 46 XX chromosomes with virilization,
an individual born with 46 XY chromosomes with
undervirilization, or an individual born having
both ovarian and testicular tissue;
(ii) services provided when a physician has
otherwise diagnosed a disorder of sexual
development in which the physician has
determined through genetic or biochemical
testing that the individual does not have
normal sex chromosome structure, sex steroid
hormone production, or sex steroid hormone
action for a male or female;
(iii) 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 funding for the gender
transition procedure is permissible under this
section;
(iv) 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 or treatment is performed for the
purpose of a gender transition or for the
alleviation of psychological, physical, or
mental distress;
(v) puberty suppression or blocking
prescription drugs for the purpose of
normalizing puberty for a minor experiencing
precocious puberty; or
(vi) male circumcision.
(D) Genital gender transition surgery.--For
purposes of subparagraph (B), the term ``genital gender
transition surgery'' means a surgical procedure
performed for the purpose of assisting an individual
with a gender transition, including--
(i) for male patients, castration, a
vasectomy, penectomy, orchiectomy,
vaginoplasty, clitoroplasty, and vulvoplasty;
and
(ii) for female patients, a mastectomy,
hysterectomy/ovariectomy, reconstruction of the
fixed part of the urethra with or without a
metoidioplasty or a phalloplasty, vaginectomy,
scrotoplasty, and implantation of erection or
testicular prostheses.
(E) Non-genital gender transition surgery.--For
purposes of subparagraph (B), the term ``non-genital
gender transition surgery'' means a surgical procedure
performed for the purpose of assisting an individual
with a gender transition, including--
(i) for male patients, augmentation
mammoplasty, facial feminization surgery,
liposuction, lipofilling, voice surgery,
thyroid cartilage reduction, gluteal
augmentation (implants/lipofilling), hair
reconstruction, and various aesthetic
procedures; and
(ii) for female patients, subcutaneous
mastectomy, voice surgery, liposuction,
lipofilling, pectoral implants, and various
aesthetic procedures.
(10) Male.--The term ``male'', when used to refer to a
natural person, means an individual who naturally has, had,
will have, or would have, but for a congenital anomaly or
intentional or unintentional disruption, the reproductive
system that at some point produces, transports, and utilizes
sperm for fertilization.
(11) Minor.--The term ``minor'' means an individual under
the age of 18.
(12) Puberty-blocking drugs.--The term ``puberty-blocking
drugs'' means--
(A) gonadotropin-releasing hormone (GnRH) analogues
or other synthetic drugs used in males to stop
luteinizing hormone secretion and therefore
testosterone secretion; and
(B) synthetic drugs used in females that stop the
production of estrogen and progesterone, when used to
delay or suppress pubertal development in children for
the purpose of assisting an individual with a gender
transition.
(13) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(14) Sex.--The term ``sex'', when referring to an
individual's sex, means to refer to either male or female, as
biologically determined and defined in this section.
SEC. 3. GENDER TRANSITION PROCEDURES ON MINORS.
(a) Prohibition.--
(1) In general.--No person may, in any circumstance
described in paragraph (2), knowingly perform, attempt to
perform, conspire to perform, or provide a referral for any
gender transition procedure on a minor.
(2) Circumstances described.--A circumstance referred to in
paragraph (1) is any the following:
(A) The person, or the minor on whom the gender
transition procedure was performed, attempted to be
performed, conspired to be performed, or for whom a
referral for any gender transition procedure was
provided, traveled in interstate or foreign commerce,
or traveled using a means, channel, facility, or
instrumentality of interstate or foreign commerce, in
furtherance of or in connection with the conduct
described in paragraph (1).
(B) The person, or the minor on whom the gender
transition procedure was performed, attempted to be
performed, conspired to be performed, or for whom a
referral for any gender transition procedure was
provided, used a means, channel, facility, or
instrumentality of interstate or foreign commerce in
furtherance of or in connection with the conduct
described in paragraph (1).
(C) A payment of any kind was made, directly or
indirectly, in furtherance of or in connection with the
conduct described in paragraph (1), using any means,
channel, facility, or instrumentality of interstate or
foreign commerce or in or affecting interstate or
foreign commerce.
(D) The person, or the minor on whom the gender
transition procedure was performed, attempted to be
performed, conspired to be performed, or for whom a
referral for any gender transition procedure was
provided, transmitted in interstate or foreign commerce
any communication relating to or in furtherance of the
conduct described in paragraph (1) using any means,
channel, facility, or instrumentality of interstate or
foreign commerce or in or affecting interstate or
foreign commerce by any means or in manner, including
by computer, mail, wire, or electromagnetic
transmission.
(E) Any instrument, item, substance, or other
object that has traveled in interstate or foreign
commerce was used to perform the conduct described in
paragraph (1).
(F) The conduct described in paragraph (1) occurred
within the special maritime and territorial
jurisdiction of the United States or any territory or
possession of the United States.
(G) The conduct described in paragraph (1)
otherwise occurred in or affected interstate or foreign
commerce.
(3) Knowingly.--For purposes of paragraph (1), a person
acts knowingly when--
(A) the person has actual knowledge of the facts
giving rise to the violation; or
(B) a reasonable person acting in the circumstances
and exercising reasonable care would have that
knowledge.
(4) Application to employers.--
(A) In general.--A violation of paragraph (1) by a
person acting in the scope of their employment for an
employer shall also be considered a violation of such
paragraph by such employer.
(B) Liability.--In the case of a violation
described in subparagraph (A), the person and the
employer shall be jointly and severally liable for any
civil penalty under subsection (b) and any private
right of action under subsection (c).
(b) Civil Penalties.--
(1) In general.--The Secretary may impose a civil penalty
on any person upon making a determination, after written notice
and an opportunity for a hearing, that the person has violated
a requirement of subsection (a)(1).
(2) Amount of civil penalties.--
(A) In general.--The amount of a civil penalty
under paragraph (1) shall be not less than $100,000 for
each violation.
(B) Penalty considerations.--In determining the
amount of a civil penalty under this subsection, the
Secretary shall consider--
(i) the nature, circumstances, extent, and
gravity of the violation;
(ii) with respect to the violator, the
degree of culpability, any history of prior
violations, and any effect on the ability to
continue to do business; and
(iii) other matters that justice requires.
(3) Civil action to collect.--
(A) In general.--The Attorney General may bring a
civil action in an appropriate district court of the
United States to collect a civil penalty under this
subsection and any accrued interest on the civil
penalty as assessed by the Secretary. In such a civil
action, the amount and appropriateness of the civil
penalty shall not be subject to review.
(B) Compromise.--The Secretary may compromise the
amount of a civil penalty imposed under this subsection
before referral to the Attorney General under
subparagraph (A), on the condition that such amount
shall be not less than $100,000.
(4) Liability for procedures required as a matter of
standard practice.--It shall not be a defense in a hearing
under this subsection that gender transition procedures are
required as a matter of standard practice.
(5) Prohibition on imposition of civil penalty on a person
on whom procedures are performed.--No person on whom a gender
transition procedure is performed in violation of subsection
(a)(1), and no parent, guardian, or caretaker of such a person,
may be held liable for a civil penalty under this subsection.
(6) Depositing amounts collected.--
(A) In general.--Amounts collected under this
subsection shall be deposited in the fund established
under subparagraph (B).
(B) Establishment of fund.--
(i) In general.--There is established in
the Treasury of the United States a fund, to be
known as the ``Justice for Victims Fund'',
which shall consist of amounts deposited in the
fund pursuant to subparagraph (A).
(ii) Availability of funds.--Amounts in the
fund established under clause (i) shall be made
available for expenditure for fiscal year 2025
and each fiscal year thereafter, without
further appropriation or fiscal year limitation
for expenditure by the Secretary to carry out
section 4.
(c) Private Civil Action.--A person on whom a gender transition
procedure is performed in violation of subsection (a)(1), or the
parent, guardian, or caretaker of such a person if such person is a
minor, may bring a civil action in an appropriate district court of the
United States for appropriate relief against any person in violation of
subsection (a)(1).
(d) Penalty for Obstruction of Investigations.--
(1) In general.--The Secretary may impose a civil penalty
on any person who obstructs or prevents the Secretary from
carrying out an investigation into an alleged violation of
subsection (a)(1).
(2) Definition of obstruct.--In this subsection, the term
``obstruct'' means to take an action that was known, or
reasonably should have been known, to prevent, hinder, or
impede an investigation.
(e) Severability.--If any provision of this Act, or the application
of such provision to any person or circumstance, is held to be or made
invalid, the remainder of this Act, and the application of the
provision to any other person or circumstance, shall not be affected.
SEC. 4. OPENING AVENUES FOR VICTIMS.
(a) Purpose.--The purpose of this section is to support, encourage,
and assist individuals in their efforts to reverse gender transition
procedures.
(b) Establishment of Grant Program.--The Secretary shall establish
a grant program under which the Secretary shall award grants to
eligible entities to carry out the activities described in subsection
(d).
(c) Eligibility.--
(1) Eligible entities.--To be eligible for a grant under
this section, an entity shall--
(A) be a nonprofit organization;
(B) support, encourage, and assist individuals in
their efforts to reverse gender transition procedures;
(C) agree to be subject to such monitoring and
review as the Secretary may require under subsection
(g);
(D) agree to not charge individuals for services
provided through the grant;
(E) provide each individual counseled through the
grant with accurate information on the proper medical
procedures to reverse gender transition procedures; and
(F) have a privacy policy and procedures in place
to ensure that--
(i) the name, address, telephone number, or
any other information that might identify any
individual seeking services supported through
the grant is not made public or shared with any
other entity without the written consent of the
individual; and
(ii) the grantee adheres to requirements
comparable to those applicable under the HIPAA
privacy regulation (as defined in section
1180(b)(3) of the Social Security Act (42
U.S.C. 1320d-9(b)(3))) to covered entities (as
defined for purposes of such regulation).
(2) Ineligible entities.--An entity shall be ineligible to
receive a grant under this section if the entity or any
affiliate, subsidiary, successor, or clinic thereof--
(A) performs, induces, refers for, or counsels in
favor of gender transition procedures; or
(B) provides financial support to any other entity
that conducts any activity described in subparagraph
(A).
(3) Financial records.--As a condition on receipt of a
grant under this section, an eligible entity shall agree to
maintain and make available to the Secretary records, including
financial records, that demonstrate that the entity satisfies
the requirements of paragraph (1) and is not ineligible by
operation of paragraph (2).
(d) Use of Grant Funds.--
(1) Required information and referral.--For the purpose
described in subsection (a), an eligible entity receiving a
grant under this section shall use the grant funds to provide
to individuals who are exploring detransition information on,
and referral to, each of the following services:
(A) Medical advice and care.
(B) Nutritional services.
(C) Education and employment assistance, including
services that support the continuation and completion
of high school.
(D) Parenting education and support services.
(E) Voluntary substance abuse counseling and
treatment.
(2) Permissible direct provision of services.--For the
purpose described in subsection (a), in addition to using grant
funds under this section as described in paragraph (1), an
eligible entity receiving a grant under this section may use
the grant funds for the direct provision of one or more
services described in paragraph (1).
(e) Prohibited Uses of Funds.--None of the funds made available
under this section shall be used for gender transition procedures.
(f) Consideration.--In selecting the recipients of grants under
this section, the Secretary shall consider each applicant's
demonstrated capacity in providing services to assist individuals who
are exploring and seeking medical advice in their efforts to reverse
gender transition procedures.
(g) Monitoring and Review.--The Secretary shall--
(1) monitor and review each program funded through a grant
under this section to ensure that the grantee carefully adheres
to--
(A) the purpose described in subsection (a); and
(B) the requirements of this section; and
(2) cease to fund a program under this section if the
grantee fails to adhere to such purpose and requirements.
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