H.F. _____ 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 nor 19 refer a minor to another health care professional to perform 20 any of the following practices on a minor if the practice is 21 performed for the purpose of attempting to alter the appearance 22 of, or affirm the minor’s perception of, the minor’s gender or 23 sex, if that appearance or perception is inconsistent with the 24 minor’s sex. 25 (1) Prescribing or administering gonadotropin-releasing 26 hormone analogues or other synthetic drugs used to stop 27 luteinizing hormone and follicle-stimulating hormone secretion, 28 synthetic antiandrogen drugs used to block the androgen 29 receptor, or any drug to suppress or delay normal puberty. 30 (2) Prescribing or administering testosterone, estrogen, 31 or progesterone to a minor in an amount greater than would 32 normally be produced endogenously in a healthy individual of 33 that individual’s age and sex. 34 (3) Performing surgeries that sterilize, including 35 -1- LSB 1930YC (1) 90 pf/rh 1/ 6

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

H.F. _____ function unless surgery is performed. 1 d. A violation of the prohibitions under paragraph “a” or 2 “b” by a health care professional is considered unprofessional 3 conduct and subject to licensee discipline by the appropriate 4 licensing board or entity. 5 3. a. A person may assert an actual or threatened violation 6 of this section as a claim or defense in a judicial or 7 administrative proceeding and may obtain compensatory damages, 8 injunctive relief, declaratory relief, or any other appropriate 9 relief. 10 b. An action brought for a violation of this section shall 11 be brought within two years after the cause of action accrues. 12 However, a minor may bring an action during the minor’s 13 minority through a parent or legal guardian, and may bring an 14 action in the minor’s own name upon reaching majority and for 15 twenty years after reaching majority. 16 c. Notwithstanding any other law to the contrary, an 17 action under this section may be commenced, and relief may be 18 granted, in a judicial proceeding without regard to whether the 19 person commencing the action has sought or exhausted available 20 administrative remedies. In an action or proceeding to 21 enforce this section, a prevailing party may recover reasonable 22 attorney fees. 23 d. The attorney general may bring an action to enforce this 24 section. 25 e. Nothing in this section shall be construed to deny, 26 impair, or otherwise affect any right or authority of the 27 attorney general, the state, or any agency, officer, or 28 employee of the state to institute or intervene in any 29 proceeding. 30 Sec. 2. EFFECTIVE DATE. This Act, being deemed of immediate 31 importance, takes effect upon enactment. 32 Sec. 3. APPLICABILITY. The following applies one hundred 33 eighty days after the effective date of this Act: 34 The provisions of the section of this Act enacting section 35 -3- LSB 1930YC (1) 90 pf/rh 3/ 6

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

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

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