II 118th CONGRESS 2d Session S. 5424 IN THE SENATE OF THE UNITED STATES December 4, 2024 Mr. Marshall introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To prohibit gender transition procedures on minors, to authorize the Secretary of Health and Human Services to impose civil penalties on persons who perform gender transition procedures on minors, and for other purposes.

1. Short title This Act may be cited as the Safeguarding The Overall Protection of Minors Act or the STOP Act . 2. Definitions In this Act: (1) Cross-sex hormones The term cross-sex hormones means— (A) testosterone or other androgens given to females at doses that are profoundly larger or more potent than would normally occur naturally in healthy females; and (B) estrogen given to males at doses that are profoundly larger or more potent than would normally occur naturally in healthy males. (2) Detransition The term detransition means to halt or reverse gender transition procedures, including exploration and seeking medical advice about reversing gender transition procedures. (3) Employer The term employer includes an individual or entity that engages a person in the performance of work as an independent contractor. (4) Employment The term employment includes work as an independent contractor. (5) Female The term female , when used to refer to a natural person, means an individual who naturally has, had, will have, or would have, but for a congenital anomaly or intentional or unintentional disruption, the reproductive system that at some point produces, transports, and utilizes eggs for fertilization. (6) Gender (A) In general Subject to subparagraph (B), the term gender, when used alone to refer to males, females, or the natural differences between males and females— (i) is a synonym for sex; and (ii) shall not be considered a synonym or short-hand expression for gender identity, experienced gender, gender expression, or gender role. (B) Exception Subparagraph (A) shall not apply when the term gender is used in conjunction with other words or as an adjective to modify other words, or when context or explicit definition in law indicates otherwise. (7) Gender identity The term gender identity does not mean sex or gender. (8) Gender transition The term gender transition means the process in which an individual goes from identifying with or presenting as his or her sex to identifying with or presenting a self-proclaimed identity that does not correspond with or is different from his or her sex, and may be accompanied with social, legal, or physical changes. (9) Gender transition procedure (A) In general The term gender transition procedure means any hormonal or surgical service that seeks— (i) to alter or remove physical or anatomical characteristics or features that are typical for the individual’s sex, as determined by the sex organs, chromosomes, and endogenous profiles of the individual; or (ii) to change the body of such individual to no longer correspond to their sex. (B) Inclusions The term gender transition procedure includes the following: (i) Providing, prescribing, administering, dispensing, or otherwise conveying any of the following prescription drugs that induce transient or permanent infertility: (I) Puberty suppression drugs or puberty-blocking drugs to stop or delay normal puberty. (II) Cross-sex hormones, including supraphysiologic doses of testosterone to females or supraphysiologic doses of estrogen to males. (ii) Genital gender transition surgery. (iii) Non-genital gender transition surgery. (iv) The removal of any otherwise healthy or non-diseased body part or tissue. (C) Exclusions The term gender transition procedure does not include— (i) services to individuals born with a medically verifiable disorder of sex development, including an individual with external sex characteristics that are irresolvably ambiguous, such as an individual born with 46 XX chromosomes with virilization, an individual born with 46 XY chromosomes with undervirilization, or an individual born 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 individual does not have normal sex chromosome structure, sex steroid hormone production, or sex steroid hormone action for a male or female; (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 under this section; (iv) 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 or treatment is performed for the purpose of a gender transition or for the alleviation of psychological, physical, or mental distress; (v) puberty suppression or blocking prescription drugs for the purpose of normalizing puberty for a minor experiencing precocious puberty; or (vi) male circumcision. (D) Genital gender transition surgery For purposes of subparagraph (B), the term genital gender transition surgery means a surgical procedure performed for the purpose of assisting an individual with a gender transition, including— (i) for male patients, castration, a vasectomy, penectomy, orchiectomy, vaginoplasty, clitoroplasty, and vulvoplasty; and (ii) for female patients, a mastectomy, hysterectomy/ovariectomy, reconstruction of the fixed part of the urethra with or without a metoidioplasty or a phalloplasty, vaginectomy, scrotoplasty, and implantation of erection or testicular prostheses. (E) Non-genital gender transition surgery For purposes of subparagraph (B), the term non-genital gender transition surgery means a surgical procedure performed for the purpose of assisting an individual with a gender transition, including— (i) for male patients, augmentation mammoplasty, facial feminization surgery, liposuction, lipofilling, voice surgery, thyroid cartilage reduction, gluteal augmentation (implants/lipofilling), hair reconstruction, and various aesthetic procedures; and (ii) for female patients, subcutaneous mastectomy, voice surgery, liposuction, lipofilling, pectoral implants, and various aesthetic procedures. (10) Male The term male , when used to refer to a natural person, means an individual who naturally has, had, will have, or would have, but for a congenital anomaly or intentional or unintentional disruption, the reproductive system that at some point produces, transports, and utilizes sperm for fertilization. (11) Minor The term minor means an individual under the age of 18. (12) Puberty-blocking drugs The term puberty-blocking drugs means— (A) gonadotropin-releasing hormone (GnRH) analogues or other synthetic drugs used in males to stop luteinizing hormone secretion and therefore testosterone secretion; and (B) synthetic drugs used in females that stop the production of estrogen and progesterone, when used to delay or suppress pubertal development in children for the purpose of assisting an individual with a gender transition. (13) Secretary The term Secretary means the Secretary of Health and Human Services. (14) Sex The term sex , when referring to an individual’s sex, means to refer to either male or female, as biologically determined and defined in this section. 3. Gender transition procedures on minors (a) Prohibition (1) In general No person may, in any circumstance described in paragraph (2), knowingly perform, attempt to perform, conspire to perform, or provide a referral for any gender transition procedure on a minor. (2) Circumstances described A circumstance referred to in paragraph (1) is any the following: (A) The person, or the minor on whom the gender transition procedure was performed, attempted to be performed, conspired to be performed, or for whom a referral for any gender transition procedure was provided, traveled in interstate or foreign commerce, or traveled using a means, channel, facility, or instrumentality of interstate or foreign commerce, in furtherance of or in connection with the conduct described in paragraph (1). (B) The person, or the minor on whom the gender transition procedure was performed, attempted to be performed, conspired to be performed, or for whom a referral for any gender transition procedure was provided, used a means, channel, facility, or instrumentality of interstate or foreign commerce in furtherance of or in connection with the conduct described in paragraph (1). (C) A payment of any kind was made, directly or indirectly, in furtherance of or in connection with the conduct described in paragraph (1), using any means, channel, facility, or instrumentality of interstate or foreign commerce or in or affecting interstate or foreign commerce. (D) The person, or the minor on whom the gender transition procedure was performed, attempted to be performed, conspired to be performed, or for whom a referral for any gender transition procedure was provided, transmitted in interstate or foreign commerce any communication relating to or in furtherance of the conduct described in paragraph (1) using any means, channel, facility, or instrumentality of interstate or foreign commerce or in or affecting interstate or foreign commerce by any means or in manner, including by computer, mail, wire, or electromagnetic transmission. (E) Any instrument, item, substance, or other object that has traveled in interstate or foreign commerce was used to perform the conduct described in paragraph (1). (F) The conduct described in paragraph (1) occurred within the special maritime and territorial jurisdiction of the United States or any territory or possession of the United States. (G) The conduct described in paragraph (1) otherwise occurred in or affected interstate or foreign commerce. (3) Knowingly For purposes of paragraph (1), a person acts knowingly when— (A) the person has actual knowledge of the facts giving rise to the violation; or (B) a reasonable person acting in the circumstances and exercising reasonable care would have that knowledge. (4) Application to employers (A) In general A violation of paragraph (1) by a person acting in the scope of their employment for an employer shall also be considered a violation of such paragraph by such employer. (B) Liability In the case of a violation described in subparagraph (A), the person and the employer shall be jointly and severally liable for any civil penalty under subsection (b) and any private right of action under subsection (c). (b) Civil penalties (1) In general The Secretary may impose a civil penalty on any person upon making a determination, after written notice and an opportunity for a hearing, that the person has violated a requirement of subsection (a)(1). (2) Amount of civil penalties (A) In general The amount of a civil penalty under paragraph (1) shall be not less than $100,000 for each violation. (B) Penalty considerations In determining the amount of a civil penalty under this subsection, the Secretary shall consider— (i) the nature, circumstances, extent, and gravity of the violation; (ii) with respect to the violator, the degree of culpability, any history of prior violations, and any effect on the ability to continue to do business; and (iii) other matters that justice requires. (3) Civil action to collect (A) In general The Attorney General may bring a civil action in an appropriate district court of the United States to collect a civil penalty under this subsection and any accrued interest on the civil penalty as assessed by the Secretary. In such a civil action, the amount and appropriateness of the civil penalty shall not be subject to review. (B) Compromise The Secretary may compromise the amount of a civil penalty imposed under this subsection before referral to the Attorney General under subparagraph (A), on the condition that such amount shall be not less than $100,000. (4) Liability for procedures required as a matter of standard practice It shall not be a defense in a hearing under this subsection that gender transition procedures are required as a matter of standard practice. (5) Prohibition on imposition of civil penalty on a person on whom procedures are performed No person on whom a gender transition procedure is performed in violation of subsection (a)(1), and no parent, guardian, or caretaker of such a person, may be held liable for a civil penalty under this subsection. (6) Depositing amounts collected (A) In general Amounts collected under this subsection shall be deposited in the fund established under subparagraph (B). (B) Establishment of Fund (i) In general There is established in the Treasury of the United States a fund, to be known as the Justice for Victims Fund , which shall consist of amounts deposited in the fund pursuant to subparagraph (A). (ii) Availability of funds Amounts in the fund established under clause (i) shall be made available for expenditure for fiscal year 2025 and each fiscal year thereafter, without further appropriation or fiscal year limitation for expenditure by the Secretary to carry out section 4. (c) Private civil action A person on whom a gender transition procedure is performed in violation of subsection (a)(1), or the parent, guardian, or caretaker of such a person if such person is a minor, may bring a civil action in an appropriate district court of the United States for appropriate relief against any person in violation of subsection (a)(1). (d) Penalty for obstruction of investigations (1) In general The Secretary may impose a civil penalty on any person who obstructs or prevents the Secretary from carrying out an investigation into an alleged violation of subsection (a)(1). (2) Definition of obstruct In this subsection, the term obstruct means to take an action that was known, or reasonably should have been known, to prevent, hinder, or impede an investigation. (e) Severability If any provision of this Act, or the application of such provision to any person or circumstance, is held to be or made invalid, the remainder of this Act, and the application of the provision to any other person or circumstance, shall not be affected. 4. Opening avenues for victims (a) Purpose The purpose of this section is to support, encourage, and assist individuals in their efforts to reverse gender transition procedures. (b) Establishment of grant program The Secretary shall establish a grant program under which the Secretary shall award grants to eligible entities to carry out the activities described in subsection (d). (c) Eligibility (1) Eligible entities To be eligible for a grant under this section, an entity shall— (A) be a nonprofit organization; (B) support, encourage, and assist individuals in their efforts to reverse gender transition procedures; (C) agree to be subject to such monitoring and review as the Secretary may require under subsection (g); (D) agree to not charge individuals for services provided through the grant; (E) provide each individual counseled through the grant with accurate information on the proper medical procedures to reverse gender transition procedures; and (F) have a privacy policy and procedures in place to ensure that— (i) the name, address, telephone number, or any other information that might identify any individual seeking services supported through the grant is not made public or shared with any other entity without the written consent of the individual; and (ii) the grantee adheres to requirements comparable to those applicable under the HIPAA privacy regulation (as defined in section 1180(b)(3) of the Social Security Act ( 42 U.S.C. 1320d–9(b)(3) )) to covered entities (as defined for purposes of such regulation). (2) Ineligible entities An entity shall be ineligible to receive a grant under this section if the entity or any affiliate, subsidiary, successor, or clinic thereof— (A) performs, induces, refers for, or counsels in favor of gender transition procedures; or (B) provides financial support to any other entity that conducts any activity described in subparagraph (A). (3) Financial records As a condition on receipt of a grant under this section, an eligible entity shall agree to maintain and make available to the Secretary records, including financial records, that demonstrate that the entity satisfies the requirements of paragraph (1) and is not ineligible by operation of paragraph (2). (d) Use of grant funds (1) Required information and referral For the purpose described in subsection (a), an eligible entity receiving a grant under this section shall use the grant funds to provide to individuals who are exploring detransition information on, and referral to, each of the following services: (A) Medical advice and care. (B) Nutritional services. (C) Education and employment assistance, including services that support the continuation and completion of high school. (D) Parenting education and support services. (E) Voluntary substance abuse counseling and treatment. (2) Permissible direct provision of services For the purpose described in subsection (a), in addition to using grant funds under this section as described in paragraph (1), an eligible entity receiving a grant under this section may use the grant funds for the direct provision of one or more services described in paragraph (1). (e) Prohibited uses of funds None of the funds made available under this section shall be used for gender transition procedures. (f) Consideration In selecting the recipients of grants under this section, the Secretary shall consider each applicant’s demonstrated capacity in providing services to assist individuals who are exploring and seeking medical advice in their efforts to reverse gender transition procedures. (g) Monitoring and review The Secretary shall— (1) monitor and review each program funded through a grant under this section to ensure that the grantee carefully adheres to— (A) the purpose described in subsection (a); and (B) the requirements of this section; and (2) cease to fund a program under this section if the grantee fails to adhere to such purpose and requirements.