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[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.
                                 <all>
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