ical or surgical service, including physician’s serv-
ices, practitioner’s services, inpatient and outpatient 
hospital services, or prescribed drugs related to gen-
der transition, other than an excepted service, that 
seeks to: 
(A) Alter or remove physical or anatomical 
characteristics or features that are typical for 
the individual’s sex; or 
(B) Instill or create physiological or ana-
tomical characteristics that resemble a sex dif-
ferent from the individual’s sex, including med-
ical services that provide puberty blocking 
drugs, gender transition hormone therapy, or 
genital gender reassignment surgery or nongen-
ital gender reassignment surgery knowingly per-
formed for the purpose of assisting an indi-
vidual with a gender transition. 
(2) SEX.—The term ‘‘sex’’ means the biological 
indication of being male or female, including sex 
chromosomes, and naturally occurring sex hormones, 
gonads, and nonambiguous internal and external 
genitalia present at birth. 
(3) GENDER
TRANSITION
HORMONE
THER-
APY.—The term ‘‘gender transition hormone ther-
apy’’ means testosterone, estrogen, or progesterone 
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given to an individual in an amount greater than 
would normally be produced endogenously in a 
healthy individual of that individual’s age and sex. 
(4) GENDER.—The term ‘‘gender’’ means the 
psychological, behavioral, social, and cultural aspects 
of being male or female. 
(5) GENDER
REASSIGNMENT
SURGERY.—The 
term ‘‘gender reassignment surgery’’ means any 
medical or surgical service that seeks to surgically 
alter or remove healthy physical or anatomical char-
acteristics or features that are typical for the indi-
vidual’s sex, in order to instill or create physiological 
or anatomical characteristics that resemble a sex dif-
ferent from the individual’s sex, including genital 
gender reassignment surgery or nongenital gender 
reassignment surgery knowingly performed for the 
purpose of assisting an individual with a gender 
transition. 
(6) GENDER TRANSITION.—The term ‘‘gender 
transition’’ means the process in which an individual 
shifts from identifying with and living as a gender 
that corresponds to his or her sex to identifying with 
and living as a gender different from his or her sex, 
and may involve social, legal, or physical changes. 
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(7) GENITAL
GENDER
REASSIGNMENT
SUR-
GERY.—The term ‘‘genital gender reassignment sur-
gery’’ means a medical procedure knowingly per-
formed for the purpose of assisting an individual 
with a gender transition, including the following: 
(A) 
Surgical 
procedures, 
including 
a 
penectomy, 
orchiectomy, 
vaginoplasty, 
clitoroplasty, or vulvoplasty for a male sex pa-
tient or hysterectomy or ovariectomy for a fe-
male sex patient. 
(B) Reconstruction of the fixed part of the 
urethra with or without a metoidioplasty. 
(C) 
Phalloplasty, 
vaginectomy, 
scrotoplasty, or implantation of erection or tes-
ticular prostheses for a female sex patient. 
(8) NONGENITAL GENDER REASSIGNMENT SUR-
GERY.—The term ‘‘nongenital gender reassignment 
surgery’’ means medical procedures knowingly per-
formed for the purpose of assisting an individual 
with a gender transition, including the following: 
(A) Surgical procedures for a male sex pa-
tient, including augmentation mammoplasty, fa-
cial feminization surgery, liposuction, lipofilling, 
voice surgery, thyroid cartilage reduction, glu-
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teal augmentation, hair reconstruction, or asso-
ciated aesthetic procedures. 
(B) Surgical procedures for a female sex 
patient, including subcutaneous mastectomy, 
voice surgery, liposuction, lipofilling, pectoral 
implants, or associated aesthetic procedures. 
(9) PUBERTY
BLOCKING
DRUGS.—The term 
‘‘puberty blocking drugs’’ means the following when 
used for the purpose of assisting an individual with 
a gender transition. 
(A) Gonadotropin releasing hormone ana-
logues or other synthetic drugs used to stop 
luteinizing hormone and follicle stimulating hor-
mone secretion; or 
(B) Synthetic antiandrogen drugs used to 
block the androgen receptor. 
(10) EXCEPTED SERVICE.—The term ‘‘excepted 
service’’ means any of the following: 
(A) Medical or surgical services furnished 
to an individual born with a medically verifiable 
disorder of sex development, including an indi-
vidual with: 
(i) External sex characteristics that 
are irresolvably ambiguous; 
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(ii) Forty-six XX chromosomes with 
virilization; 
(iii) Forty-six XY chromosomes with 
undervirilization; or 
(iv) Both ovarian and testicular tis-
sue. 
(B) Medical or surgical services provided 
when a physician or practitioner has diagnosed 
a disorder or condition of sexual development 
that the physician or practitioner has deter-
mined through genetic or biochemical testing 
that the individual does not have normal sex 
chromosome structure, sex steroid hormone pro-
duction, or sex steroid hormone action. 
(C) The treatment of any infection, injury, 
disease, or disorder that has been caused by or 
exacerbated by the performance of sex-trait al-
tering treatments. 
(D) Any medical or surgical service under-
taken because the individual suffers from a 
physical disorder, physical injury, or physical 
illness that would, as certified by a physician or 
practitioner, place the individual in imminent 
danger of death or impairment of major bodily 
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function unless the medical or surgical service 
is performed. 
(E) Mental health or social services, other 
than sex-trait altering treatments. 
(F) Services for a disorder or condition of 
sexual development that is unrelated to a diag-
nosis of gender dysphoria or gender identity 
disorder. 
(11) MINOR.—The term ‘‘minor’’ means an in-
dividual under 18 years of age. 
Æ 
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