‘‘(i) Performing any surgery for the 
purpose of changing the body of such indi-
vidual to no longer correspond to the indi-
vidual’s sex, including— 
‘‘(I) castration; 
‘‘(II) orchiectomy; 
‘‘(III) scrotoplasty; 
‘‘(IV) vasectomy; 
‘‘(V) hysterectomy; 
‘‘(VI) oophorectomy; 
‘‘(VII) ovariectomy; 
‘‘(VIII) metoidioplasty; 
‘‘(IX) penectomy; 
‘‘(X) phalloplasty; 
‘‘(XI) vaginoplasty; 
‘‘(XII) vaginectomy; 
‘‘(XIII) vulvoplasty; 
‘‘(XIV) 
reduction 
thyrochondroplasty; 
‘‘(XV) chondrolaryngoplasty, or 
any plastic surgery that feminizes or 
masculinizes the facial features; 
‘‘(XVI) 
mastectomy, 
or 
any 
placement of chest implants to create 
feminine breasts; and 
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‘‘(XVII) Any placement of fat or 
artificial implants in the gluteal re-
gion. 
‘‘(ii) Administering, supplying, pre-
scribing, dispensing, distributing, or other-
wise conveying to an individual medications 
for the purposes described in clause (i), in-
cluding gonadotrophin releasing hormone 
(GnRH) analogues or other puberty-block-
ing drugs to stop or delay normal puberty, 
and estrogen, testosterone, progesterone, 
or other androgens to an individual in an 
amount greater than would normally be 
produced endogenously in a healthy indi-
vidual of that individual’s age and sex. 
‘‘(B) 
EXCEPTION.—Subparagraph 
(A) 
shall not apply to the provision by a physician 
or health care provider, with the consent of the 
child’s parent or legal guardian, of— 
‘‘(i) puberty suppression or blocking 
prescription drugs for the purpose of nor-
malizing puberty for a minor experiencing 
precocious puberty; 
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‘‘(ii) appropriate and medically nec-
essary procedures or treatments to correct 
for— 
‘‘(I) a medically verifiable genetic 
disorder of sex development, includ-
ing— 
‘‘(aa) 46,XX chromosomes 
with virilization; 
‘‘(bb) 46,XY chromosomes 
with undervirilization; and 
‘‘(cc) both ovarian and tes-
ticular tissue; or 
‘‘(II) sex chromosome structure, 
sex steroid hormone production, or 
sex hormone action, if determined to 
be abnormal by a physician through 
genetic or biochemical testing; 
‘‘(iii) infection, disease, injury, or dis-
order caused or exacerbated by previous 
medical procedures as defined in sub-
section (g)(4)(A); or 
‘‘(iv) a physical disorder, physical in-
jury, or physical illness that would, as cer-
tified by a physician, place the individual 
in imminent danger of death or impair-
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ment of a major bodily function unless the 
procedure is performed, not including if 
the procedure or drug is for the purpose 
described in subsection (g)(4)(A)(i). 
‘‘(C) SEX.—For purposes of subparagraph 
(A), the term ‘sex’ means the indication of male 
or female sex by reproductive potential or ca-
pacity, sex chromosomes, naturally occurring 
sex hormones, gonads, or internal or external 
genitalia present at birth.’’. 
Æ 
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