H.F. 623 Section 1. NEW SECTION . 147.164 Gender transition 1 procedure-related activities —— minors —— prohibitions. 2 1. As used in this section: 3 a. “Gender” means the psychological, behavioral, social, and 4 cultural aspects of being male or female. 5 b. “Health care professional” means a person who is 6 licensed, certified, or otherwise authorized or permitted by 7 the law of this state to administer health care in the ordinary 8 course of business or in the practice of a profession. 9 c. “Minor” means an unemancipated person under eighteen 10 years of age. 11 d. “Sex” means the biological indication of male and 12 female, including sex chromosomes, naturally occurring sex 13 hormones, gonads, and nonambiguous internal and external 14 genitalia present at birth without regard to an individual’s 15 psychological, chosen, or subjective experience of gender. 16 2. a. Except as otherwise provided in paragraph “c” , a 17 health care professional shall not knowingly engage in or cause 18 any of the following practices to be performed on a minor if 19 the practice is performed for the purpose of attempting to 20 alter the appearance of, or affirm the minor’s perception of, 21 the minor’s gender or sex, if that appearance or perception is 22 inconsistent with the minor’s sex. 23 (1) Prescribing or administering gonadotropin-releasing 24 hormone analogues or other synthetic drugs used to stop 25 luteinizing hormone and follicle-stimulating hormone secretion, 26 synthetic antiandrogen drugs used to block the androgen 27 receptor, or any drug to suppress or delay normal puberty. 28 (2) Prescribing or administering testosterone, estrogen, 29 or progesterone to a minor in an amount greater than would 30 normally be produced endogenously in a healthy individual of 31 that individual’s age and sex. 32 (3) Performing surgeries that sterilize, including 33 castration, vasectomy, hysterectomy, oophorectomy, orchiectomy, 34 and penectomy. 35 -1- LSB 1930HV (2) 90 pf/rh 1/ 6

H.F. 623 (4) Performing surgeries that artificially construct 1 tissue with the appearance of genitalia that differs from the 2 individual’s sex, including metoidioplasty, phalloplasty, and 3 vaginoplasty. 4 (5) Removing any healthy or nondiseased body part or tissue. 5 b. A health care professional shall not knowingly engage in 6 conduct that aids or abets the practices described in paragraph 7 “a” . This paragraph shall not be construed to impose liability 8 on any speech protected by federal or state law. 9 c. Paragraphs “a” and “b” do not apply to any of the 10 following: 11 (1) Services provided to a minor born with a medically 12 verifiable disorder of sex development, including a minor 13 with external biological sex characteristics that are 14 irresolvably ambiguous, such as a minor born with forty-six 15 XX chromosomes with virilization, forty-six XY chromosomes 16 with undervirilization, or having both ovarian and testicular 17 tissue. 18 (2) Services provided to a minor who has otherwise 19 been diagnosed with a disorder of sexual development by a 20 physician, when the physician has determined through genetic 21 or biochemical testing that the minor does not have a normal 22 sex chromosome structure, sex steroid hormone production, or 23 sex steroid hormone action for a biological male or biological 24 female. 25 (3) The treatment of any infection, injury, disease, or 26 disorder that has been caused or exacerbated by the performance 27 of gender transition procedures, whether or not the procedures 28 were performed in accordance with state and federal law. 29 (4) Any procedure undertaken because a minor suffers from a 30 physical disorder, physical injury, or physical illness that 31 is certified by a physician and that would place the minor 32 in imminent danger of death or impairment of a major bodily 33 function unless surgery is performed. 34 d. A violation of the prohibitions under paragraph “a” or 35 -2- LSB 1930HV (2) 90 pf/rh 2/ 6

H.F. 623 “b” by a health care professional is considered unprofessional 1 conduct and subject to licensee discipline by the appropriate 2 licensing board or entity. 3 3. a. A person may assert an actual or threatened violation 4 of this section as a claim or defense in a judicial or 5 administrative proceeding and may obtain compensatory damages, 6 injunctive relief, declaratory relief, or any other appropriate 7 relief. 8 b. An action brought for a violation of this section shall 9 be brought within two years after the cause of action accrues. 10 However, a minor may bring an action during the minor’s 11 minority through a parent or legal guardian, and may bring an 12 action in the minor’s own name upon reaching majority and for 13 twenty years after reaching majority. 14 c. Notwithstanding any other law to the contrary, an 15 action under this section may be commenced, and relief may be 16 granted, in a judicial proceeding without regard to whether the 17 person commencing the action has sought or exhausted available 18 administrative remedies. In an action or proceeding to 19 enforce this section, a prevailing party may recover reasonable 20 attorney fees. 21 d. The attorney general may bring an action to enforce this 22 section. 23 e. Nothing in this section shall be construed to deny, 24 impair, or otherwise affect any right or authority of the 25 attorney general, the state, or any agency, officer, or 26 employee of the state to institute or intervene in any 27 proceeding. 28 f. Compliance with, or enforcement or implementation of, 29 this section shall not constitute a violation of any provision 30 of chapter 216. 31 Sec. 2. EFFECTIVE DATE. This Act, being deemed of immediate 32 importance, takes effect upon enactment. 33 Sec. 3. APPLICABILITY. The following applies one hundred 34 eighty days after the effective date of this Act: 35 -3- LSB 1930HV (2) 90 pf/rh 3/ 6

H.F. 623 The provisions of the section of this Act enacting section 1 147.164, subsection 2, that prohibit a health care professional 2 from knowingly engaging in or causing certain practices to 3 be performed on a minor if the practice is performed for the 4 purpose of attempting to alter the appearance of, or affirm 5 the minor’s perception of, the minor’s gender or sex, if that 6 appearance or perception is inconsistent with the minor’s sex. 7 EXPLANATION 8 The inclusion of this explanation does not constitute agreement with 9 the explanation’s substance by the members of the general assembly. 10 This bill relates to prohibitions regarding gender 11 transition procedure-related activities relating to minors. 12 The bill provides definitions used in the bill including 13 “gender”, “health care professional”, “minor”, and “sex”. 14 The bill prohibits, with some exceptions, a health care 15 professional from knowingly engaging in or causing specified 16 practices to be performed on a minor if the practice is 17 performed for the purpose of attempting to alter the appearance 18 of, or affirm the minor’s perception of, the minor’s gender or 19 sex, if that appearance or perception is inconsistent with the 20 minor’s sex. These prohibited practices include prescribing 21 or administering gonadotropin-releasing hormone analogues or 22 other synthetic drugs used to stop luteinizing hormone and 23 follicle-stimulating hormone secretion, synthetic antiandrogen 24 drugs used to block the androgen receptor, or any drug to 25 suppress or delay normal puberty; prescribing or administering 26 testosterone, estrogen, or progesterone to a minor in an amount 27 greater than would normally be produced endogenously in a 28 healthy individual of that individual’s age and sex; performing 29 surgeries that sterilize, including castration, vasectomy, 30 hysterectomy, oophorectomy, orchiectomy, and penectomy; 31 performing surgeries that artificially construct tissue with 32 the appearance of genitalia that differs from the individual’s 33 sex, including metoidioplasty, phalloplasty, and vaginoplasty; 34 and removing any healthy or nondiseased body part or tissue. 35 -4- LSB 1930HV (2) 90 pf/rh 4/ 6

H.F. 623 The bill also prohibits a health care professional from 1 knowingly engaging in conduct that aids or abets the specified 2 prohibited practices. However, this prohibition is not to 3 be construed to impose liability on any speech protected by 4 federal or state law. 5 The bill specifies services to which the prohibitions 6 of the bill do not apply including: services provided to 7 a minor born with a medically verifiable disorder of sex 8 development, including a minor with external biological sex 9 characteristics that are irresolvably ambiguous, such as a 10 minor born with 46 XX chromosomes with virilization, 46 XY 11 chromosomes with undervirilization, or having both ovarian 12 and testicular tissue; services provided to a minor who has 13 otherwise been diagnosed with a disorder of sexual development 14 by a physician, when the physician has determined through 15 genetic or biochemical testing that the minor does not have 16 a normal sex chromosome structure, sex steroid hormone 17 production, or sex steroid hormone action for a biological male 18 or biological female; the treatment of any infection, injury, 19 disease, or disorder that has been caused or exacerbated by 20 the performance of gender transition procedures, whether or 21 not the procedures were performed in accordance with state and 22 federal law; any procedure undertaken because a minor suffers 23 from a physical disorder, physical injury, or physical illness 24 that is certified by a physician and that would place the minor 25 in imminent danger of death or impairment of a major bodily 26 function unless surgery is performed. 27 A violation of the prohibitions under the bill by a health 28 care professional is considered unprofessional conduct and 29 subject to licensee discipline by the appropriate licensing 30 board or entity. 31 The bill provides that a person may assert an actual 32 or threatened violation of the bill as a claim or defense 33 in a judicial or administrative proceeding and may obtain 34 compensatory damages, injunctive relief, declaratory relief, or 35 -5- LSB 1930HV (2) 90 pf/rh 5/ 6

H.F. 623 any other appropriate relief. An action for a violation of the 1 bill must be brought within two years after the cause of action 2 accrues. However, a minor may bring an action during the 3 minor’s minority through a parent or legal guardian, and may 4 bring an action in the minor’s own name upon reaching majority 5 and for 20 years after reaching majority. 6 An action may be commenced, and relief may be granted, in 7 a judicial proceeding without regard to whether the person 8 has sought or exhausted available administrative remedies. A 9 prevailing party may recover reasonable attorney fees in an 10 action brought under the bill. 11 The attorney general may bring an action to enforce the bill. 12 The bill is not to be construed to deny, impair, or otherwise 13 affect any right or authority of the attorney general, the 14 state, or any agency, officer, or employee of the state to 15 institute or intervene in any proceeding. 16 Compliance with, or enforcement or implementation of, the 17 bill shall not constitute a violation of Code chapter 216 18 (civil rights commission). 19 The bill takes effect upon enactment. 20 The provisions of the bill prohibiting certain practices 21 by a health care professional performed on a minor if the 22 practice is performed for the purpose of attempting to alter 23 the appearance of, or affirm the minor’s perception of, the 24 minor’s gender or sex, if that appearance or perception is 25 inconsistent with the minor’s sex, are applicable 180 days 26 after the effective date of the bill. 27 -6- LSB 1930HV (2) 90 pf/rh 6/ 6