(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
(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.