II 

118TH CONGRESS 

1ST SESSION S. 435 

To provide requirements related to the eligibility of individuals who identify 

as transgender from serving in the Armed Forces. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 15, 2023 

Mr. RUBIO (for himself, Mrs. BLACKBURN, Mr. BUDD, Mr. TUBERVILLE, and 

Mr. BRAUN) introduced the following bill; which was read twice and referred to the Committee on Armed Services 

A BILL 

To provide requirements related to the eligibility of individuals who identify as transgender from serving in the 

Armed Forces. 

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 ‘‘Ensuring Military 

5 Readiness Act of 2023’’. 

6 SEC. 2. LIMITATIONS ON MILITARY SERVICE BY INDIVID7 UALS WHO IDENTIFY AS TRANSGENDER. 

8 Not later than 90 days after the date of the enact9 ment of this Act, the Secretary of Defense shall prescribe 


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1 regulations regarding service of individuals who identify 

2 as transgender as follows: 

3 (1) Persons who identify as transgender with a 

4 history of diagnosis of gender dysphoria are disquali5 fied from military service except under the following 

6 limited circumstances: 

7 (A) Individuals may serve in the Armed 

8 Forces if they have been stable for 36 consecu9 tive months in their biological sex prior to ac10 cession. 

11 (B) Members of the Armed Forces diag12 nosed with gender dysphoria after entering into 

13 service may be retained if they do not undergo 

14 gender transition procedures and remain 

15 deployable within applicable retention standards 

16 for their biological sex. 

17 (C) Members of the Armed Forces serving 

18 as of the date of the enactment of this Act who 

19 have been diagnosed with gender dysphoria may 

20 continue to serve only in their biological sex, ir21 respective of any changes previously made to 

22 their gender marker in the Defense Enrollment 

23 Eligibility Reporting System (DEERS), and re24 ceive medically necessary treatment for gender 


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1 dysphoria. Such treatment may not include gen2 der transition procedures. 

3 (2) Persons who identify as transgender who 

4 seek or have undergone gender transition are dis5 qualified from military service. 

6 (3) Persons who identify as transgender with7 out a history or diagnosis of gender dysphoria, who 

8 are otherwise qualified for service and meet all phys9 ical and mental requirements, may serve in the 

10 Armed Forces in their biological sex. 

11 SEC. 3. REVISED REGULATIONS REGARDING GENDER 

12 MARKINGS. 

13 Not later than 90 days after the date of the enact14 ment of this Act, the Secretary of Defense shall prescribe 

15 regulations updating the Defense Enrollment Eligibility 

16 Reporting System (DEERS) to require the gender mark17 ers for members of the Armed Forces to match their bio18 logical sex, irrespective of any previous changes allowed. 

19 SEC. 4. DEFINITIONS. 

20 In this Act: 

21 (1) CROSS-SEX HORMONES.—The term ‘‘cross22 sex hormones’’ means testosterone or other 

23 androgens given to biological females at doses that 

24 are profoundly larger or more potent than would 

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1 males, or estrogen given to biological males at doses 

2 that are profoundly larger or more potent than 

3 would normally occur naturally in healthy biological 

4 males. 

5 (2) GENDER.—The term ‘‘gender’’ means the 

6 psychological, behavioral, social, and cultural aspects 

7 of being male or female. 

8 (3) GENDER DYSPHORIA.—The term ‘‘gender 

9 dysphoria’’ means a marked incongruence between 

10 one’s experienced or expressed gender and biological 

11 sex. 

12 (4) GENDER TRANSITION.—The term ‘‘gender 

13 transition’’ means the process by which a person 

14 goes from identifying with and living as a gender 

15 that corresponds to his or her biological sex to iden16 tifying with and living as a gender different from his 

17 or her biological sex, and may involve social, legal, 

18 or physical changes. 

19 (5) GENDER TRANSITION PROCEDURES.—The 

20 term ‘‘gender transition procedures’’— 

21 (A) means— 

22 (i) any medical or surgical interven23 tion, including physician’s services, inpa24 tient and outpatient hospital services, or 

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1 tion, that seeks to alter or remove physical 

2 or anatomical characteristics or features 

3 that are typical for the individual’s biologi4 cal sex or to instill or create physiological 

5 or anatomical characteristics that resemble 

6 a sex different from the individual’s birth 

7 sex, including medical services that provide 

8 puberty-blocking drugs, cross-sex hor9 mones, or other mechanisms to promote 

10 the development of feminizing or 

11 masculinizing features (in the opposite 

12 sex); and 

13 (ii) genital or non-genital gender tran14 sition surgery performed for the purpose of 

15 assisting an individual with a gender tran16 sition; and 

17 (B) does not include— 

18 (i) services to those born with a medi19 cally verifiable disorder of sex development, 

20 including a person with external biological 

21 sex characteristics that are irresolvably 

22 ambiguous, such as those born with 46 XX 

23 chromosomes with virilization, 46 XY chro24 mosomes with undervirilization, or having 

25 both ovarian and testicular tissue; 


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1 (ii) services provided when a physician 

2 has otherwise diagnosed a disorder of sex3 ual development, in which the physician 

4 has determined through genetic or bio5 chemical testing that the person does not 

6 have normal sex chromosome structure, sex 

7 steroid hormone production, or sex steroid 

8 hormone action for a biological male or bi9 ological female; or 

10 (iii) the treatment of any infection, in11 jury, disease, or disorder that has been 

12 caused by or exacerbated by the perform13 ance of gender transition procedures, 

14 whether or not the gender transition proce15 dure was performed in accordance with 

16 State and Federal law or whether or not 

17 funding for the gender transition proce18 dure is permissible. 

19 (6) GENDER TRANSITION SURGERY.—The term 

20 ‘‘gender transition surgery’’ means any medical or 

21 surgical service that seeks to surgically alter or re22 move healthy physical or anatomical characteristics 

23 or features that are typical for the individual’s bio24 logical sex in order to instill or create physiological 

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1 ferent from the individual’s birth sex, including gen2 ital or non-genital gender reassignment surgery per3 formed for the purpose of assisting an individual 

4 with a gender transition. 

5 (7) GENITAL GENDER TRANSITION SURGERY.— 

6 The term ‘‘genital gender transition surgery’’ in7 cludes surgical procedures such as penectomy, 

8 orchiectomy, vaginoplasty, clitoroplasty, or 

9 vulvoplasty for biologically male patients or 

10 hysterectomy, ovariectomy, reconstruction of the 

11 fixed part of the urethra with or without a 

12 metoidioplasty or a phalloplasty, vaginectomy, 

13 scrotoplasty, or implantation of erection or testicular 

14 prostheses for biologically female patients, when per15 formed for the purpose of assisting an individual 

16 with a gender transition. 

17 (8) NON-GENITAL GENDER TRANSITION SUR18 GERY.—The term ‘‘non-genital gender transition 

19 surgery’’— 

20 (A) includes, when performed for the pur21 pose of assisting an individual with a gender 

22 transition— 

23 (i) surgical procedures such as aug24 mentation mammoplasty, facial feminiza25 tion surgery, liposuction, lipofilling, voice 


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1 surgery, thyroid cartilage reduction, gluteal 

2 augmentation (implants or lipofilling), hair 

3 reconstruction, or various aesthetic proce4 dures for biologically male patients; or 

5 (ii) subcutaneous mastectomy, voice 

6 surgery, liposuction, lipofilling, pectoral 

7 implants or various aesthetic procedures 

8 for biologically female patients; and 

9 (B) does not include any procedure under10 taken because the individual suffers from a 

11 physical disorder, physical injury, or physical 

12 illness that would, as certified by a physician, 

13 place the individual in imminent danger of 

14 death or impairment of major bodily function 

15 unless surgery is performed, unless the proce16 dure is for the purpose of a gender transition. 

17 (9) PUBERTY-BLOCKING DRUGS.—The term 

18 ‘‘puberty-blocking drugs’’ means, when used to delay 

19 or suppress pubertal development in children for the 

20 purpose of assisting an individual with a gender 

21 transition— 

22 (A) Gonadotropin-releasing hormone 

23 (GnRH) analogues or other synthetic drugs 

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1 mone secretion and therefore testosterone secre2 tion; and 

3 (B) synthetic drugs used in biological fe4 males that stop the production of estrogen and 

5 progesterone. 

6 (10) SEX; BIRTH SEX; BIOLOGICAL SEX.—The 

7 terms ‘‘sex’’, ‘‘birth sex,’’ and ‘‘biological sex’’ refer 

8 to the biological indication of male and female in the 

9 context of reproductive potential or capacity, such as 

10 sex chromosomes, naturally occurring sex hormones, 

11 gonads, and non-ambiguous internal and external 

12 genitalia present at birth, without regard to an indi13 vidual’s psychological, chosen, or subjective experi14 ence of gender. 

Æ 


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