(1)
Caretaker— The term caretaker means an adult, who is not a parent of a child, with whom a child resides and who provides that child with the care, maintenance, and supervision consistent with the duties and responsibilities of a parent of the child.
(2)
Detransition treatment— The term detransition treatment means any treatment, including mental health services, medical intervention, or surgery, that does any of the following:
(A)
Stops or reverses the effects of a gender transition procedure.
(B)
Helps an individual cope with the effects of a prior gender transition procedure.
(3)
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.
(4)
Gender transition— The term gender transition means the process, which may be accompanied with social, legal, or physical changes—
(A)
in which an individual—
(i)
intentionally halts the natural development of the individual’s body so that the body no longer corresponds to the individual’s sex; or
(ii)
intentionally transforms the individual’s physical appearance to confirm the individual’s physical appearance to be of the alternate sex; or
(B)
that alters or removes sexual organs as part of chemical or surgical mutilation.
(5)
Gender transition procedure—
(A)
In general— The term gender transition procedure means any hormonal, pharmaceutical, or surgical intervention for the purpose of gender transition, including—
(i)
gonadotropin-releasing hormone (GnRH) agonists or other puberty-blocking or suppressing drugs to stop or delay normally timed puberty;
(ii)
testosterone, estrogen, progesterone, androgen blockers, or other sex hormones to an individual at doses that are supraphysiologic to what would normally be produced endogenously in a healthy individual of the same age and sex;
(iii)
procedures that attempt to transform an individual’s physical appearance to confirm the individual's physical appearance to be of the alternate sex, or that alter or remove sexual organs as part of chemical or surgical mutilation;
(vii)
implantation of erection or testicular prostheses;
(xii)
reconstruction of the fixed part of the urethra with or without a metoidioplasty or a phalloplasty;
(xx)
reduction thyrochondroplasty;
(xxi)
chondrolaryngoplasty;
(xxv)
any plastic, cosmetic, or aesthetic surgery that feminizes or masculinizes the facial or other physiological features of an individual;
(xxvi)
any placement of chest implants to create feminine breasts;
(xxvii)
any placement of fat or artificial implants in the gluteal region;
(xxxiv)
the removal of any otherwise healthy or non-diseased body part or tissue.
(B)
Exclusions— The term gender transition procedure does not include the following when furnished to an individual by a health care provider with the consent of such individual or, if applicable, such individual’s parents or legal guardian:
(i)
Services to individuals who have been diagnosed with a disorder of sex development by a licensed health care provider operating within their scope of practice, 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 health care professional has otherwise diagnosed a disorder of sexual development in which the health care professional 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 healthy individual of the same sex and age.
(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 (but not mental, behavioral, or emotional distress or a mental, behavioral, or emotional disorder) that would, as certified by a health care professional, place the individual in imminent danger of death or impairment of major bodily function, unless the procedure is performed, which may include the following:
(I)
Traumatic bodily injuries (such as fractures, organ rupture, or penetrating trauma).
(II)
Congenital structural anomalies of major organs or systems, including the cardiovascular, respiratory, renal, hepatic, neurological, or musculoskeletal systems.
(III)
Acute illnesses with a high probability of imminent mortality.
(v)
Any procedure to restore or reconstruct the body of the individual in order to correspond to the individual’s sex after one or more previous gender transition procedures, which may include the removal of a pseudo phallus or breast augmentation.
(vi)
Puberty suppression or blocking prescription drugs for the purpose of normalizing puberty for a minor experiencing precocious puberty.
(6)
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.
(7)
Minor— The term minor means an individual under the age of 18.
(8)
Secretary— The term Secretary means the Secretary of Health and Human Services.
(9)
Sex— The term sex, when referring to a natural person’s sex, means the person’s immutable biological classification as either male or female, as biologically determined and defined by this section.