II 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Safeguarding The 

5 Overall Protection of Minors Act’’ or the ‘‘STOP Act’’. 

6 SEC. 2. DEFINITIONS. 

7 In this Act: 


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1 (1) CROSS-SEX HORMONES.—The term ‘‘cross2 sex hormones’’ means— 

3 (A) testosterone or other androgens given 

4 to females at doses that are profoundly larger 

5 or more potent than would normally occur natu6 rally in healthy females; and 

7 (B) estrogen given to males at doses that 

8 are profoundly larger or more potent than 

9 would normally occur naturally in healthy 

10 males. 

11 (2) DETRANSITION.—The term ‘‘detransition’’ 

12 means to halt or reverse gender transition proce13 dures, including exploration and seeking medical ad14 vice about reversing gender transition procedures. 

15 (3) EMPLOYER.—The term ‘‘employer’’ includes 

16 an individual or entity that engages a person in the 

17 performance of work as an independent contractor. 

18 (4) EMPLOYMENT.—The term ‘‘employment’’ 

19 includes work as an independent contractor. 

20 (5) FEMALE.—The term ‘‘female’’, when used 

21 to refer to a natural person, means an individual 

22 who naturally has, had, will have, or would have, but 

23 for a congenital anomaly or intentional or uninten24 tional disruption, the reproductive system that at 


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1 some point produces, transports, and utilizes eggs 

2 for fertilization. 

3 (6) GENDER.— 

4 (A) IN GENERAL.—Subject to subpara5 graph (B), the term ‘‘gender,’’ when used alone 

6 to refer to males, females, or the natural dif7 ferences between males and females— 

8 (i) is a synonym for sex; and 

9 (ii) shall not be considered a synonym 

10 or short-hand expression for gender iden11 tity, experienced gender, gender expression, 

12 or gender role. 

13 (B) EXCEPTION.—Subparagraph (A) shall 

14 not apply when the term ‘‘gender’’ is used in 

15 conjunction with other words or as an adjective 

16 to modify other words, or when context or ex17 plicit definition in law indicates otherwise. 

18 (7) GENDER IDENTITY.—The term ‘‘gender 

19 identity’’ does not mean sex or gender. 

20 (8) GENDER TRANSITION.—The term ‘‘gender 

21 transition’’ means the process in which an individual 

22 goes from identifying with or presenting as his or 

23 her sex to identifying with or presenting a self-pro24 claimed identity that does not correspond with or is 


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1 different from his or her sex, and may be accom2 panied with social, legal, or physical changes. 

3 (9) GENDER TRANSITION PROCEDURE.— 

4 (A) IN GENERAL.—The term ‘‘gender tran5 sition procedure’’ means any hormonal or sur6 gical service that seeks— 

7 (i) to alter or remove physical or ana8 tomical characteristics or features that are 

9 typical for the individual’s sex, as deter10 mined by the sex organs, chromosomes, 

11 and endogenous profiles of the individual; 

12 or 

13 (ii) to change the body of such indi14 vidual to no longer correspond to their sex. 

15 (B) INCLUSIONS.—The term ‘‘gender tran16 sition procedure’’ includes the following: 

17 (i) Providing, prescribing, admin18 istering, dispensing, or otherwise conveying 

19 any of the following prescription drugs 

20 that induce transient or permanent infer21 tility: 

22 (I) Puberty suppression drugs or 

23 puberty-blocking drugs to stop or 

24 delay normal puberty. 


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1 (II) Cross-sex hormones, includ2 ing supraphysiologic doses of testos3 terone to females or supraphysiologic 

4 doses of estrogen to males. 

5 (ii) Genital gender transition surgery. 

6 (iii) Non-genital gender transition 

7 surgery. 

8 (iv) The removal of any otherwise 

9 healthy or non-diseased body part or tis10 sue. 

11 (C) EXCLUSIONS.—The term ‘‘gender 

12 transition procedure’’ does not include— 

13 (i) services to individuals born with a 

14 medically verifiable disorder of sex develop15 ment, including an individual with external 

16 sex characteristics that are irresolvably 

17 ambiguous, such as an individual born with 

18 46 XX chromosomes with virilization, an 

19 individual born with 46 XY chromosomes 

20 with undervirilization, or an individual 

21 born having both ovarian and testicular 

22 tissue; 

23 (ii) services provided when a physician 

24 has otherwise diagnosed a disorder of sex25 ual development in which the physician has 


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1 determined through genetic or biochemical 

2 testing that the individual does not have 

3 normal sex chromosome structure, sex ster4 oid hormone production, or sex steroid hor5 mone action for a male or female; 

6 (iii) the treatment of any infection, in7 jury, disease, or disorder that has been 

8 caused by or exacerbated by the perform9 ance of gender transition procedures, 

10 whether or not the gender transition proce11 dure was performed in accordance with 

12 State and Federal law or whether or not 

13 funding for the gender transition proce14 dure is permissible under this section; 

15 (iv) any procedure undertaken be16 cause the individual suffers from a physical 

17 disorder, physical injury, or physical illness 

18 that would, as certified by a physician, 

19 place the individual in imminent danger of 

20 death or impairment of major bodily func21 tion, unless surgery or treatment is per22 formed for the purpose of a gender transi23 tion or for the alleviation of psychological, 

24 physical, or mental distress; 


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1 (v) puberty suppression or blocking 

2 prescription drugs for the purpose of nor3 malizing puberty for a minor experiencing 

4 precocious puberty; or 

5 (vi) male circumcision. 

6 (D) GENITAL GENDER TRANSITION SUR7 GERY.—For purposes of subparagraph (B), the 

8 term ‘‘genital gender transition surgery’’ means 

9 a surgical procedure performed for the purpose 

10 of assisting an individual with a gender transi11 tion, including— 

12 (i) for male patients, castration, a 

13 vasectomy, penectomy, orchiectomy, 

14 vaginoplasty, clitoroplasty, and vulvoplasty; 

15 and 

16 (ii) for female patients, a mastectomy, 

17 hysterectomy/ovariectomy, reconstruction 

18 of the fixed part of the urethra with or 

19 without a metoidioplasty or a phalloplasty, 

20 vaginectomy, scrotoplasty, and implanta21 tion of erection or testicular prostheses. 

22 (E) NON-GENITAL GENDER TRANSITION

23 SURGERY.—For purposes of subparagraph (B), 

24 the term ‘‘non-genital gender transition sur25 gery’’ means a surgical procedure performed for 


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1 the purpose of assisting an individual with a 

2 gender transition, including— 

3 (i) for male patients, augmentation 

4 mammoplasty, facial feminization surgery, 

5 liposuction, lipofilling, voice surgery, thy6 roid cartilage reduction, gluteal augmenta7 tion (implants/lipofilling), hair reconstruc8 tion, and various aesthetic procedures; and 

9 (ii) for female patients, subcutaneous 

10 mastectomy, voice surgery, liposuction, 

11 lipofilling, pectoral implants, and various 

12 aesthetic procedures. 

13 (10) MALE.—The term ‘‘male’’, when used to 

14 refer to a natural person, means an individual who 

15 naturally has, had, will have, or would have, but for 

16 a congenital anomaly or intentional or unintentional 

17 disruption, the reproductive system that at some 

18 point produces, transports, and utilizes sperm for 

19 fertilization. 

20 (11) MINOR.—The term ‘‘minor’’ means an in21 dividual under the age of 18. 

22 (12) PUBERTY-BLOCKING DRUGS.—The term 

23 ‘‘puberty-blocking drugs’’ means— 

24 (A) gonadotropin-releasing hormone 

25 (GnRH) analogues or other synthetic drugs 


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1 used in males to stop luteinizing hormone secre2 tion and therefore testosterone secretion; and 

3 (B) synthetic drugs used in females that 

4 stop the production of estrogen and progester5 one, when used to delay or suppress pubertal 

6 development in children for the purpose of as7 sisting an individual with a gender transition. 

8 (13) SECRETARY.—The term ‘‘Secretary’’ 

9 means the Secretary of Health and Human Services. 

10 (14) SEX.—The term ‘‘sex’’, when referring to 

11 an individual’s sex, means to refer to either male or 

12 female, as biologically determined and defined in this 

13 section. 

14 SEC. 3. GENDER TRANSITION PROCEDURES ON MINORS. 

15 (a) PROHIBITION.— 

16 (1) IN GENERAL.—No person may, in any cir17 cumstance described in paragraph (2), knowingly 

18 perform, attempt to perform, conspire to perform, or 

19 provide a referral for any gender transition proce20 dure on a minor. 

21 (2) CIRCUMSTANCES DESCRIBED.—A cir22 cumstance referred to in paragraph (1) is any the 

23 following: 

24 (A) The person, or the minor on whom the 

25 gender transition procedure was performed, atVerDate Sep 11 2014 02:26 Dec 11, 2024 Jkt 059200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S5424.IS S5424

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1 tempted to be performed, conspired to be per2 formed, or for whom a referral for any gender 

3 transition procedure was provided, traveled in 

4 interstate or foreign commerce, or traveled 

5 using a means, channel, facility, or instrumen6 tality of interstate or foreign commerce, in fur7 therance of or in connection with the conduct 

8 described in paragraph (1). 

9 (B) The person, or the minor on whom the 

10 gender transition procedure was performed, at11 tempted to be performed, conspired to be per12 formed, or for whom a referral for any gender 

13 transition procedure was provided, used a 

14 means, channel, facility, or instrumentality of 

15 interstate or foreign commerce in furtherance of 

16 or in connection with the conduct described in 

17 paragraph (1). 

18 (C) A payment of any kind was made, di19 rectly or indirectly, in furtherance of or in con20 nection with the conduct described in paragraph 

21 (1), using any means, channel, facility, or in22 strumentality of interstate or foreign commerce 

23 or in or affecting interstate or foreign com24 merce. 


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1 (D) The person, or the minor on whom the 

2 gender transition procedure was performed, at3 tempted to be performed, conspired to be per4 formed, or for whom a referral for any gender 

5 transition procedure was provided, transmitted 

6 in interstate or foreign commerce any commu7 nication relating to or in furtherance of the 

8 conduct described in paragraph (1) using any 

9 means, channel, facility, or instrumentality of 

10 interstate or foreign commerce or in or affect11 ing interstate or foreign commerce by any 

12 means or in manner, including by computer, 

13 mail, wire, or electromagnetic transmission. 

14 (E) Any instrument, item, substance, or 

15 other object that has traveled in interstate or 

16 foreign commerce was used to perform the con17 duct described in paragraph (1). 

18 (F) The conduct described in paragraph 

19 (1) occurred within the special maritime and 

20 territorial jurisdiction of the United States or 

21 any territory or possession of the United States. 

22 (G) The conduct described in paragraph 

23 (1) otherwise occurred in or affected interstate 

24 or foreign commerce. 


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1 (3) KNOWINGLY.—For purposes of paragraph 

2 (1), a person acts knowingly when— 

3 (A) the person has actual knowledge of the 

4 facts giving rise to the violation; or 

5 (B) a reasonable person acting in the cir6 cumstances and exercising reasonable care 

7 would have that knowledge. 

8 (4) APPLICATION TO EMPLOYERS.— 

9 (A) IN GENERAL.—A violation of para10 graph (1) by a person acting in the scope of 

11 their employment for an employer shall also be 

12 considered a violation of such paragraph by 

13 such employer. 

14 (B) LIABILITY.—In the case of a violation 

15 described in subparagraph (A), the person and 

16 the employer shall be jointly and severally liable 

17 for any civil penalty under subsection (b) and 

18 any private right of action under subsection (c). 

19 (b) CIVIL PENALTIES.— 

20 (1) IN GENERAL.—The Secretary may impose a 

21 civil penalty on any person upon making a deter22 mination, after written notice and an opportunity for 

23 a hearing, that the person has violated a require24 ment of subsection (a)(1). 

25 (2) AMOUNT OF CIVIL PENALTIES.— 


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1 (A) IN GENERAL.—The amount of a civil 

2 penalty under paragraph (1) shall be not less 

3 than $100,000 for each violation. 

4 (B) PENALTY CONSIDERATIONS.—In de5 termining the amount of a civil penalty under 

6 this subsection, the Secretary shall consider— 

7 (i) the nature, circumstances, extent, 

8 and gravity of the violation; 

9 (ii) with respect to the violator, the 

10 degree of culpability, any history of prior 

11 violations, and any effect on the ability to 

12 continue to do business; and 

13 (iii) other matters that justice re14 quires. 

15 (3) CIVIL ACTION TO COLLECT.— 

16 (A) IN GENERAL.—The Attorney General 

17 may bring a civil action in an appropriate dis18 trict court of the United States to collect a civil 

19 penalty under this subsection and any accrued 

20 interest on the civil penalty as assessed by the 

21 Secretary. In such a civil action, the amount 

22 and appropriateness of the civil penalty shall 

23 not be subject to review. 

24 (B) COMPROMISE.—The Secretary may 

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1 posed under this subsection before referral to 

2 the Attorney General under subparagraph (A), 

3 on the condition that such amount shall be not 

4 less than $100,000. 

5 (4) LIABILITY FOR PROCEDURES REQUIRED AS

6 A MATTER OF STANDARD PRACTICE.—It shall not be 

7 a defense in a hearing under this subsection that 

8 gender transition procedures are required as a mat9 ter of standard practice. 

10 (5) PROHIBITION ON IMPOSITION OF CIVIL PEN11 ALTY ON A PERSON ON WHOM PROCEDURES ARE

12 PERFORMED.—No person on whom a gender transi13 tion procedure is performed in violation of sub14 section (a)(1), and no parent, guardian, or caretaker 

15 of such a person, may be held liable for a civil pen16 alty under this subsection. 

17 (6) DEPOSITING AMOUNTS COLLECTED.— 

18 (A) IN GENERAL.—Amounts collected 

19 under this subsection shall be deposited in the 

20 fund established under subparagraph (B). 

21 (B) ESTABLISHMENT OF FUND.— 

22 (i) IN GENERAL.—There is established 

23 in the Treasury of the United States a 

24 fund, to be known as the ‘‘Justice for Vic25 tims Fund’’, which shall consist of 


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1 amounts deposited in the fund pursuant to 

2 subparagraph (A). 

3 (ii) AVAILABILITY OF FUNDS.— 

4 Amounts in the fund established under 

5 clause (i) shall be made available for ex6 penditure for fiscal year 2025 and each fis7 cal year thereafter, without further appro8 priation or fiscal year limitation for ex9 penditure by the Secretary to carry out 

10 section 4. 

11 (c) PRIVATE CIVIL ACTION.—A person on whom a 

12 gender transition procedure is performed in violation of 

13 subsection (a)(1), or the parent, guardian, or caretaker 

14 of such a person if such person is a minor, may bring 

15 a civil action in an appropriate district court of the United 

16 States for appropriate relief against any person in viola17 tion of subsection (a)(1). 

18 (d) PENALTY FOR OBSTRUCTION OF INVESTIGA19 TIONS.— 

20 (1) IN GENERAL.—The Secretary may impose a 

21 civil penalty on any person who obstructs or pre22 vents the Secretary from carrying out an investiga23 tion into an alleged violation of subsection (a)(1). 

24 (2) DEFINITION OF OBSTRUCT.—In this sub25 section, the term ‘‘obstruct’’ means to take an action 


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1 that was known, or reasonably should have been 

2 known, to prevent, hinder, or impede an investiga3 tion. 

4 (e) SEVERABILITY.—If any provision of this Act, or 

5 the application of such provision to any person or cir6 cumstance, is held to be or made invalid, the remainder 

7 of this Act, and the application of the provision to any 

8 other person or circumstance, shall not be affected. 

9 SEC. 4. OPENING AVENUES FOR VICTIMS. 

10 (a) PURPOSE.—The purpose of this section is to sup11 port, encourage, and assist individuals in their efforts to 

12 reverse gender transition procedures. 

13 (b) ESTABLISHMENT OF GRANT PROGRAM.—The 

14 Secretary shall establish a grant program under which the 

15 Secretary shall award grants to eligible entities to carry 

16 out the activities described in subsection (d). 

17 (c) ELIGIBILITY.— 

18 (1) ELIGIBLE ENTITIES.—To be eligible for a 

19 grant under this section, an entity shall— 

20 (A) be a nonprofit organization; 

21 (B) support, encourage, and assist individ22 uals in their efforts to reverse gender transition 

23 procedures; 


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1 (C) agree to be subject to such monitoring 

2 and review as the Secretary may require under 

3 subsection (g); 

4 (D) agree to not charge individuals for 

5 services provided through the grant; 

6 (E) provide each individual counseled 

7 through the grant with accurate information on 

8 the proper medical procedures to reverse gender 

9 transition procedures; and 

10 (F) have a privacy policy and procedures 

11 in place to ensure that— 

12 (i) the name, address, telephone num13 ber, or any other information that might 

14 identify any individual seeking services 

15 supported through the grant is not made 

16 public or shared with any other entity 

17 without the written consent of the indi18 vidual; and 

19 (ii) the grantee adheres to require20 ments comparable to those applicable 

21 under the HIPAA privacy regulation (as 

22 defined in section 1180(b)(3) of the Social 

23 Security Act (42 U.S.C. 1320d–9(b)(3))) 

24 to covered entities (as defined for purposes 

25 of such regulation). 


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1 (2) INELIGIBLE ENTITIES.—An entity shall be 

2 ineligible to receive a grant under this section if the 

3 entity or any affiliate, subsidiary, successor, or clinic 

4 thereof— 

5 (A) performs, induces, refers for, or coun6 sels in favor of gender transition procedures; or 

7 (B) provides financial support to any other 

8 entity that conducts any activity described in 

9 subparagraph (A). 

10 (3) FINANCIAL RECORDS.—As a condition on 

11 receipt of a grant under this section, an eligible enti12 ty shall agree to maintain and make available to the 

13 Secretary records, including financial records, that 

14 demonstrate that the entity satisfies the require15 ments of paragraph (1) and is not ineligible by oper16 ation of paragraph (2). 

17 (d) USE OF GRANT FUNDS.— 

18 (1) REQUIRED INFORMATION AND REFER19 RAL.—For the purpose described in subsection (a), 

20 an eligible entity receiving a grant under this section 

21 shall use the grant funds to provide to individuals 

22 who are exploring detransition information on, and 

23 referral to, each of the following services: 

24 (A) Medical advice and care. 

25 (B) Nutritional services. 


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1 (C) Education and employment assistance, 

2 including services that support the continuation 

3 and completion of high school. 

4 (D) Parenting education and support serv5 ices. 

6 (E) Voluntary substance abuse counseling 

7 and treatment. 

8 (2) PERMISSIBLE DIRECT PROVISION OF SERV9 ICES.—For the purpose described in subsection (a), 

10 in addition to using grant funds under this section 

11 as described in paragraph (1), an eligible entity re12 ceiving a grant under this section may use the grant 

13 funds for the direct provision of one or more services 

14 described in paragraph (1). 

15 (e) PROHIBITED USES OF FUNDS.—None of the 

16 funds made available under this section shall be used for 

17 gender transition procedures. 

18 (f) CONSIDERATION.—In selecting the recipients of 

19 grants under this section, the Secretary shall consider 

20 each applicant’s demonstrated capacity in providing serv21 ices to assist individuals who are exploring and seeking 

22 medical advice in their efforts to reverse gender transition 

23 procedures. 

24 (g) MONITORING AND REVIEW.—The Secretary 

25 shall— 


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1 (1) monitor and review each program funded 

2 through a grant under this section to ensure that 

3 the grantee carefully adheres to— 

4 (A) the purpose described in subsection 

5 (a); and 

6 (B) the requirements of this section; and 

7 (2) cease to fund a program under this section 

8 if the grantee fails to adhere to such purpose and re9 quirements. 

Æ 


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