Ensuring Military Readiness Act of 2023

To provide requirements related to the eligibility of individuals who identify as transgender from serving in the Armed Forces. 1. Short title This Act may be cited as the Ensuring Military Readiness Act of 2023 2. Limitations on military service by individuals who identify as transgender Not later than 90 days after the date of the enactment of this Act, the Secretary of Defense shall prescribe regulations regarding service of individuals who identify as transgender as follows: (1) Persons who identify as transgender with a history of diagnosis of gender dysphoria are disqualified from military service except under the following limited circumstances: (A) Individuals may serve in the Armed Forces if they have been stable for 36 consecutive months in their biological sex prior to accession. (B) Members of the Armed Forces diagnosed with gender dysphoria after entering into service may be retained if they do not undergo gender transition procedures and remain deployable within applicable retention standards for their biological sex. (C) Members of the Armed Forces serving as of the date of the enactment of this Act who have been diagnosed with gender dysphoria may continue to serve only in their biological sex, irrespective of any changes previously made to their gender marker in the Defense Enrollment Eligibility Reporting System (DEERS), and receive medically necessary treatment for gender dysphoria. Such treatment may not include gender transition procedures. (2) Persons who identify as transgender who seek or have undergone gender transition are disqualified from military service. (3) Persons who identify as transgender without a history or diagnosis of gender dysphoria, who are otherwise qualified for service and meet all physical and mental requirements, may serve in the Armed Forces in their biological sex. 3. Revised regulations regarding gender markings Not later than 90 days after the date of the enactment of this Act, the Secretary of Defense shall prescribe regulations updating the Defense Enrollment Eligibility Reporting System (DEERS) to require the gender markers for members of the Armed Forces to match their biological sex, irrespective of any previous changes allowed. 4. Definitions In this Act: (1) Cross-Sex hormones The term cross-sex hormones (2) Gender The term gender (3) Gender dysphoria The term gender dysphoria (4) Gender transition The term gender transition (5) Gender transition procedures The term gender transition procedures (A) means— (i) any medical or surgical intervention, including physician's services, inpatient and outpatient hospital services, or prescribed drugs related to gender transition, that seeks to alter or remove physical or anatomical characteristics or features that are typical for the individual’s biological sex or to instill or create physiological or anatomical characteristics that resemble a sex different from the individual’s birth sex, including medical services that provide puberty-blocking drugs, cross-sex hormones, or other mechanisms to promote the development of feminizing or masculinizing features (in the opposite sex); and (ii) genital or non-genital gender transition surgery performed for the purpose of assisting an individual with a gender transition; and (B) does not include— (i) services to those born with a medically-verifiable disorder of sex development, including a person with external biological sex characteristics that are irresolvably ambiguous, such as those born with 46 XX chromosomes with virilization, 46 XY chromosomes with undervirilization, or 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 person does not have normal sex chromosome structure, sex steroid hormone production, or sex steroid hormone action for a biological male or biological female; or (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. (6) Gender transition surgery The term gender transition surgery (7) Genital gender transition surgery The term genital gender transition surgery (8) Non-genital gender transition surgery The term non-genital gender transition surgery (A) includes, when performed for the purpose of assisting an individual with a gender transition— (i) surgical procedures such as augmentation mammoplasty, facial feminization surgery, liposuction, lipofilling, voice surgery, thyroid cartilage reduction, gluteal augmentation (implants or lipofilling), hair reconstruction, or various aesthetic procedures for biologically male patients; or (ii) subcutaneous mastectomy, voice surgery, liposuction, lipofilling, pectoral implants or various aesthetic procedures for biologically female patients; and (B) does not include 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 is performed, unless the procedure is for the purpose of a gender transition. (9) Puberty-Blocking drugs The term puberty-blocking drugs (A) Gonadotropin-releasing hormone (GnRH) analogues or other synthetic drugs used in biological males to stop luteinizing hormone secretion and therefore testosterone secretion; and (B) synthetic drugs used in biological females that stop the production of estrogen and progesterone. (10) Sex; birth sex; biological sex The terms sex birth sex, biological sex

Summary: Ensuring Military Readiness Act of 2023 This bill requires the Department of Defense (DOD) to prescribe regulations regarding military service by individuals who identify as transgender. Under the regulations, individuals who identify as transgender with a history or diagnosis of gender dysphoria must be disqualified from military service, with some exceptions. (The bill defines gender dysphoria as a marked incongruence between one's experienced or expressed gender and biological sex.) The regulations must provide exceptions for such individuals if they have been stable for 36 consecutive months in their biological sex prior to accession, or diagnosed with gender dysphoria after entering into service if they do not undergo transition procedures and remain deployable within applicable retention standards for their biological sex. Under the regulations, members of the Armed Forces who have been diagnosed with gender dysphoria may continue to serve in their biological sex (regardless of any changes previously made to their gender marker in the Defense Enrollment Eligibility Reporting System, or DEERS) and receive medically necessary treatment for gender dysphoria. However, such treatment may not include gender transition procedures. Individuals who identify as transgender and who seek or have undergone gender transition are disqualified from military service. Additionally, individuals who identify as transgender, do not have a history or diagnosis of gender dysphoria, and are otherwise qualified for service may serve in the Armed Forces in their biological sex. DOD must prescribe regulations updating DEERS to require the gender markers for members of the Armed Forces to match their biological sex, regardless of any previous changes.