I 
118TH CONGRESS 
1ST SESSION H. R. 3329 
To prohibit taxpayer-funded gender transition procedures, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 15, 2023 
Mr. LAMALFA (for himself, Mrs. BOEBERT, Mr. LAMBORN, Mr. GOSAR, Mr. 
BANKS, Mr. DUNCAN, Mr. BABIN, Mr. ROUZER, Mr. BARR, Mr. 
ROSENDALE, Mr. WEBER of Texas, Mr. BRECHEEN, Mr. NORMAN, Mrs. 
MILLER of Illinois, Mr. GROTHMAN, Mr. WILSON of South Carolina, Mr. 
MILLS, Mr. BURLISON, Mr. SMITH of New Jersey, Mr. ADERHOLT, Mrs. 
MCCLAIN, Mrs. LESKO, Mrs. HARSHBARGER, Mr. NEHLS, Mr. KELLY of 
Mississippi, Mr. OGLES, Mr. FALLON, Mr. LATURNER, Mr. DAVIDSON, 
Mr. GAETZ, Ms. TENNEY, Mr. ALLEN, Mr. ROY, and Mr. MOONEY) in-
troduced the following bill; which was referred to the Committee on En-
ergy and Commerce, and in addition to the Committees on the Judiciary, 
and Ways and Means, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall within 
the jurisdiction of the committee concerned 
A BILL 
To prohibit taxpayer-funded gender transition procedures, 
and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘End Taxpayer Funding of Gender Experimentation Act 
of 2023’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act are as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—PROHIBITING FEDERALLY FUNDED GENDER 
TRANSITION PROCEDURES 
Sec. 101. Prohibiting taxpayer-funded gender transition procedures. 
Sec. 102. Amendment to table of chapters. 
TITLE II—APPLICATION UNDER THE AFFORDABLE CARE ACT 
Sec. 201. Clarifying application of prohibition to premium credits and cost- 
sharing reductions under ACA. 
TITLE I—PROHIBITING FEDER-
ALLY FUNDED GENDER TRAN-
SITION PROCEDURES 
SEC. 101. PROHIBITING TAXPAYER-FUNDED GENDER TRAN-
SITION PROCEDURES. 
Title 1, United States Code, is amended by adding 
at the end the following new chapter: 
‘‘CHAPTER 
4—PROHIBITING 
TAXPAYER- 
FUNDED GENDER TRANSITION PROCE-
DURES 
‘‘301. Prohibition on funding for gender transition procedures. 
‘‘302. Prohibition on funding for health benefits plans that cover gender transi-
tion procedures. 
‘‘303. Limitation on Federal facilities and employees. 
‘‘304. Construction relating to separate coverage. 
‘‘305. Construction relating to the use of non-Federal funds for health coverage. 
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‘‘306. Construction relating to complications arising from gender transition pro-
cedures. 
‘‘307. Definitions. 
‘‘§ 301. Prohibition on funding for gender transition 
procedures 
‘‘No funds authorized or appropriated by Federal 
law, and none of the funds in any trust fund to which 
funds are authorized or appropriated by Federal law, shall 
be expended for any gender transition procedures. 
‘‘§ 302. Prohibition on funding for health benefits 
plans that cover gender transition proce-
dures 
‘‘No funds authorized or appropriated by Federal 
law, and none of the funds in any trust fund to which 
funds are authorized or appropriated by Federal law, shall 
be expended for health benefits coverage that includes cov-
erage of gender transition procedures. 
‘‘§ 303. Limitation on Federal facilities and employees 
‘‘No health care service furnished— 
‘‘(1) by or in a health care facility owned or op-
erated by the Federal Government; or 
‘‘(2) by any physician or other individual em-
ployed by the Federal Government to provide health 
care services within the scope of the physician’s or 
individual’s employment, 
may include gender transition procedures. 
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‘‘§ 304. Construction relating to separate coverage 
‘‘Nothing in this chapter shall be construed as pro-
hibiting any individual, entity, State, or locality from pur-
chasing separate coverage for gender transition procedures 
or health benefits coverage that include gender transition 
procedures so long as such coverage is paid for entirely 
with funds not authorized or appropriated by Federal law, 
and such coverage shall not be purchased using matching 
funds required for a federally subsidized program, includ-
ing a State or locality’s contribution of Medicaid matching 
funds. 
‘‘§ 305. Construction relating to the use of non-Fed-
eral funds for health coverage 
‘‘Nothing in this chapter shall be construed as re-
stricting the ability of any non-Federal health benefits cov-
erage provider from offering coverage for gender transi-
tion procedures, or the ability of a State or locality to con-
tract separately with such a provider for such coverage, 
so long as only funds not authorized or appropriated by 
Federal law are used, and such coverage shall not be pur-
chased using matching funds required for a federally sub-
sidized program, including a State or locality’s contribu-
tion of Medicaid matching funds. 
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‘‘§ 306. Construction relating to complications arising 
from gender transition procedures 
‘‘Nothing in this chapter shall be construed to apply 
to the treatment of any infection, injury, disease, or dis-
order that has been caused by or exacerbated by the per-
formance of a gender transition procedure. 
‘‘§ 307. Definitions 
‘‘For purposes of this chapter: 
‘‘(1) BIOLOGICAL
SEX.—The term ‘biological 
sex’ means the biological indication of male or fe-
male in the context of reproductive potential or ca-
pacity, such as sex chromosomes, naturally occurring 
sex hormones, gonads, and non-ambiguous internal 
and external genitalia present at birth, without re-
gard to an individual’s psychological, chosen, or sub-
jective experience of gender. 
‘‘(2) CROSS-SEX HORMONES.—The term ‘cross- 
sex hormones’ means— 
‘‘(A) testosterone or other androgens given 
to biological females at doses that are pro-
foundly larger or more potent than would natu-
rally occur in healthy biological females; or 
‘‘(B) estrogen given to biological males at 
doses that are profoundly larger or more potent 
than would naturally occur in healthy biological 
males. 
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‘‘(3) GENDER.—The term ‘gender’ means the 
psychological, behavioral, social, and cultural aspects 
of being male or female. 
‘‘(4) GENDER TRANSITION.—The term ‘gender 
transition’ means the process in which a person goes 
from identifying with and living as a gender that 
corresponds to his or her biological sex to identifying 
with and living as a gender different from his or her 
biological sex, and may involve social, legal, or phys-
ical changes. 
‘‘(5) GENDER TRANSITION PROCEDURE.— 
‘‘(A) IN
GENERAL.—The term ‘gender 
transition procedure’ means any medical or sur-
gical service, including physician’s services, in-
patient and outpatient hospital services, or pre-
scribed drugs related to gender transition, that 
seek to alter or remove physical or anatomical 
characteristics or features that are typical for 
an individual’s biological sex, or to instill or cre-
ate physiological or anatomical characteristics 
that resemble a sex different from an individ-
ual’s birth sex, including, without limitation, 
medical services that provide puberty-blocking 
drugs, cross-sex hormones, or other mechanisms 
to promote the development of feminizing or 
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masculinizing features (in the opposite sex), or 
genital gender transition surgery or nongenital 
gender transition surgery performed for the 
purpose of assisting an individual with a gender 
transition. 
‘‘(B) EXCEPTIONS.—The term ‘gender 
transition procedure’ does not include— 
‘‘(i) services to those born with a 
medically-verifiable disorder of sex develop-
ment, including a person with external bio-
logical 
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 tis-
sue; or services provided when a physician 
has otherwise diagnosed a disorder of sex-
ual development, in which such physician 
has determined through genetic or bio-
chemical 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 bi-
ological female; or 
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‘‘(ii) the treatment of any infection, 
injury, disease, or disorder that has been 
caused by or exacerbated by the perform-
ance of a gender transition procedure, 
whether or not such procedure was per-
formed in accordance with State or Fed-
eral law, or whether funding for such pro-
cedure was permissible under this chapter. 
‘‘(6) GENDER TRANSITION SURGERY.— 
‘‘(A) IN
GENERAL.—The term ‘gender 
transition surgery’ means any medical or sur-
gical service that seeks to surgically alter or re-
move healthy physical or anatomical character-
istics or features that are typical for an individ-
ual’s biological sex in order to instill or create 
physiological or anatomical characteristics that 
resemble a sex different from an individual’s 
birth sex, including, without limitation, genital 
gender reassignment surgery or non-genital 
gender reassignment surgery performed for the 
purpose of assisting an individual with a gender 
transition. 
‘‘(B) EXCEPTION.—Gender transition sur-
gery does not include any procedure undertaken 
because the individual suffers from a physical 
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disorder, physical injury, or physical illness that 
would, as certified by a physician, place the in-
dividual in imminent danger of death or impair-
ment of major bodily function unless surgery is 
performed. 
‘‘(7) GENITAL
GENDER
TRANSITION
SUR-
GERY.—The term ‘genital gender transition surgery’ 
includes surgical procedures such as penectomy, 
orchiectomy, 
vaginoplasty, 
clitoroplasty, 
or 
vulvoplasty 
for 
biologically 
male 
patients, 
or 
hysterectomy/ovariectomy, 
reconstruction 
of 
the 
fixed part of the urethra with or without a 
metoidioplasty 
or 
a 
phalloplasty, 
vaginectomy, 
scrotoplasty, or implantation of erection or testicular 
prostheses for biologically female patients when per-
formed for the purpose of assisting an individual 
with a gender transition. 
‘‘(8) NON-GENITAL GENDER TRANSITION SUR-
GERY.—The term ‘non-genital gender transition sur-
gery’ means surgical procedures including augmenta-
tion mammoplasty, facial feminization surgery, 
liposuction, lipofilling, voice surgery, thyroid car-
tilage reduction, gluteal augmentation (implants or 
lipofilling), hair reconstruction, or other aesthetic 
procedures for biologically male patients or subcuta-
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