Senate File 129 - IntroducedA Bill ForAn Act 1relating to actions relative to treatment or
2intervention regarding the discordance between a minor’s sex
3and gender identity, and providing civil penalties.
1   Section 1.  FINDINGS.  The general assembly finds all of the
   31.  “Sex” is the biological state of being female or male,
4based on sex organs, chromosomes, and endogenous hormone
5profiles. An individual’s sex is genetically encoded into
6an individual at the moment of conception, and it cannot be
   82.  Some individuals, including minors, may experience
9discordance between their sex and their internal sense
10of gender identity. Individuals who experience severe
11psychological distress as a result of this discordance may be
12diagnosed with gender dysphoria.
   133.  The cause of the individual’s impression of discordance
14between sex and gender identity is unknown. Diagnosis is based
15exclusively on the individual’s self-report of feelings and
   174.  This internal sense of discordance is not permanent or
18fixed. To the contrary, numerous studies have shown that a
19substantial majority of children who experience discordance
20between their sex and gender identity will outgrow the
21discordance once they go through puberty and will eventually
22have a gender identity that aligns with their sex.
   235.  As a result, taking a wait-and-see approach to children
24who reveal signs of gender nonconformity results in a large
25majority of such children resolving to a gender identity
26congruent with their sex by late adolescence.
   276.  Some in the medical community are aggressively pushing
28for interventions on children that medically alter a child’s
29hormonal balance and remove healthy external and internal sex
30organs when the child expresses a desire to appear as a sex
31different from the child’s own.
   327.  This course of treatment for children commonly begins
33with encouraging and assisting a child to socially transition
34to dressing and presenting as the opposite sex. In the case
35of prepubertal children, as puberty begins, doctors then
-1-1administer long-acting gonadotropin-releasing hormone (GnRH)
2agonists or puberty blockers that suppress the pubertal
3development of the child. This use of puberty blockers for
4gender nonconforming children is experimental and not approved
5by the United States food and drug administration.
   68.  After puberty is blocked, the child is administered
7cross-sex hormonal treatments that induce the development
8of secondary sex characteristics of the other sex, such as
9causing the development of breasts and wider hips in male
10children taking estrogen and greater muscle mass, bone density,
11body hair, and a deeper voice in female children taking
12testosterone. Some children are administered these hormones
13independent of any prior pubertal blockade.
   149.  The final phase of treatment is for the child to undergo
15cosmetic and other surgical procedures, often to create an
16appearance similar to that of the opposite sex. These surgical
17procedures may include a mastectomy to remove a female child’s
18breasts and bottom surgery that removes a child’s healthy
19reproductive organs and creates an artificial form aiming to
20approximate the appearance of the genitals of the opposite sex.
   2110.  For children who are placed on puberty blockers that
22inhibit their bodies from experiencing the natural process of
23sexual development, the overwhelming majority will continue
24down a path toward cross-sex hormones and cosmetic surgery.
   2511.  This unproven, poorly studied series of interventions
26results in numerous harmful effects for children, as well as
27risks of effects simply unknown due to the new and experimental
28nature of these interventions.
   2912.  Among the known harms from puberty blockers are
30diminished bone density. The full effect of puberty blockers
31on brain development and cognition are yet unknown, though
32reason for concern is now present. There is no research on the
33long-term risks to children of persistent exposure to puberty
34blockers. With the administration of cross-sex hormones comes
35increased risks of cardiovascular disease, thromboembolic
-2-1stroke, asthma, chronic obstructive pulmonary disease, and
   313.  Puberty blockers prevent gonadal maturation and thus
4render children taking these drugs infertile. Introducing
5cross-sex hormones to children with immature gonads as a
6direct result of pubertal blockade is expected to cause
7irreversible sterility. Sterilization is also permanent for
8those who undergo surgery to remove reproductive organs,
9and such children are likely to suffer through a lifetime
10of complications from the surgery, infections, and other
11difficulties requiring yet more medical intervention.
   1214.  Several studies demonstrate that hormonal and surgical
13interventions often do not resolve the underlying psychological
14issues affecting the individual. For example, individuals
15who undergo cross-sex cosmetic surgical procedures have been
16found to suffer from elevated mortality rates from medical
17and psychological conditions. Their suicide rate is nineteen
18times higher than the general population. They experience
19significantly higher rates of substance abuse, depression, and
20psychiatric hospitalizations.
   2115.  Children, and often their parents, are unable to
22comprehend and fully appreciate the risk and life implications,
23including permanent sterility, that result from the use of
24puberty blockers, cross-sex hormones, and surgical procedures.
   2516.  For these reasons, the decision to pursue a course of
26hormonal and surgical interventions to address a discordance
27between an individual’s sex and sense of gender identity
28should not be presented to or determined for children who
29are incapable of comprehending the negative implications and
30life-course difficulties resulting from these interventions.
31   Sec. 2.  NEW SECTION.  147.164  Definitions.
   32As used in this chapter, unless the context otherwise
   341.  “Gender dysphoria” means discomfort or distress over a
35marked incongruence between an individual’s sex and the gender
-3-1with which the individual identifies.
   22.  “Gender nonconformity” means behavior or gender
3expression by an individual that does not match gender norms
4for the individual’s sex.
   53.  “Government agency” means a state agency or an agent,
6employee, volunteer, or contractor of a state agency.
   74.  “Medical professional” means a physician or surgeon
8or osteopathic physician and surgeon licensed pursuant to
9chapter 148, a physician assistant licensed pursuant to
10chapter 148C, a nurse or advanced registered nurse practitioner
11licensed pursuant to chapter 152, a nurse or advanced practice
12registered nurse licensed pursuant to chapter 152E, or a
13psychiatrist licensed pursuant to chapter 148.
   145.  “Mental health professional” means the same as defined
15in section 228.1.
   166.  “Minor” or “minor child” means an unemancipated
17individual under eighteen years of age.
   187.  “Parent” means a parent, custodian, or guardian as
19defined in section 232.2.
   208.  “Political subdivision” means a city, county, township,
21school district, municipal corporation, special purpose
22district, board, department, commission, or any other division
23of local government, or an agent, employee, volunteer, or
24contractor of such entity.
   259.  “Sex” means the biological state of being female or
26male, based on sex organs, chromosomes, and endogenous hormone
   2810.  “State agency” means the same as defined in section
30   Sec. 3.  NEW SECTION.  147.165  Prohibited practices.
   311.  Notwithstanding any other provision of law to the
32contrary, it shall be unlawful for a medical professional to
33engage in any of the following practices upon a minor, or to
34cause such practice to be performed to facilitate a minor’s
35desire to present or appear in a manner that is inconsistent
-4-1with the minor’s sex:
   2a.  Performing a surgery that sterilizes, including
3castration, vasectomy, hysterectomy, oophorectomy,
4metoidioplasty, orchiectomy, penectomy, phalloplasty, and
   6b.  Performing a mastectomy.
   7c.  Administering or supplying the following medications that
8induce transient or permanent infertility:
   9(1)  Puberty-blocking medication to stop or delay normal
   11(2)  Supraphysiologic doses of testosterone or other
12androgens to members of the female sex.
   13(3)  Supraphysiologic doses of estrogen or synthetic
14compounds with estrogenic activity to members of the male sex.
   15d.  Removing any otherwise healthy or nondiseased body part
16or tissue.
   172.  A medical professional who engages in any of the
18practices prohibited under this section or who causes such
19practices to be performed shall be subject to revocation of
20licensure and other appropriate discipline by the medical
21professional’s licensing board. A medical professional who
22violates this section shall also be subject to a civil penalty
23of up to one thousand dollars per occurrence of a violation.
   243.  This section shall not apply to the good faith medical
25decision of a parent of a minor born with a medically
26verifiable genetic disorder of sexual development, including
27any of the following:
   28a.  A minor with external biological sex characteristics that
29are irresolvably ambiguous, such as a minor born with forty-six
30XX chromosomes with virilization, forty-six XY chromosomes with
31undervirilization, or with both ovarian and testicular tissue.
   32b.  When a medical professional has otherwise diagnosed
33a disorder of sexual development in which the medical
34professional has determined through genetic testing that the
35minor does not have the normal sex chromosome structure for a
-5-1male or female.
2   Sec. 4.  NEW SECTION.  147.166  Counseling.
   3A government agency, political subdivision, or any
4organization with authority to license or discipline the
5members of a profession shall not prohibit, impose any
6penalty, or take any adverse action against any member of such
7profession who gives or receives counsel, advice, guidance,
8or any other communication however described, and whether or
9not in exchange for a fee, in accordance with this chapter and
10consistent with the professional’s conscience or religious
12   Sec. 5.  NEW SECTION.  147.167  Protection of parental rights.
   131.  A parent, in exercising the fundamental right to care
14for the parent’s minor child, may withhold consent for any
15treatment, activity, or mental health service that is designed
16and intended to form the minor child’s conception of sex and
17gender or to treat gender dysphoria or gender nonconformity. A
18government agency or political subdivision shall not infringe
19upon or impede the exercise of this right.
   202.  Notwithstanding any provision to the contrary, a
21government agency or political subdivision shall not encourage
22or coerce a minor to withhold information from the minor’s
23parent, and shall not withhold information from a minor’s
24parent that is relevant to the physical or mental health of
25the minor exhibiting symptoms of gender dysphoria, gender
26nonconformity, or otherwise demonstrating a desire to be
27treated in a manner incongruent with the minor’s sex.
   283.  Notwithstanding any provision to the contrary, if a
29government agency or political subdivision has knowledge that
30a minor under the care or supervision of a government agency
31or political subdivision has exhibited symptoms of gender
32dysphoria, gender nonconformity, or has otherwise demonstrated
33a desire to be treated in a manner incongruent with the minor’s
34sex, the government agency or political subdivision shall
35immediately notify, in writing, any parent of the minor. The
-6-1notice shall describe all of the relevant circumstances with
2reasonable specificity.
3   Sec. 6.  NEW SECTION.  147.168  Whistleblower protection.
   41.  An individual shall not be discriminated against in any
5manner because the individual does any of the following:
   6a.  Provides or causes to be provided to the individual’s
7employer, the office of the attorney general, the civil rights
8commission, or any applicable federal agency, information
9relating to any violation of this chapter.
   10b.  Testifies in a proceeding concerning a violation of this
   12c.  Assists or participates in a proceeding concerning
13violation of this chapter.
   142.  Unless the disclosure is otherwise specifically
15prohibited by law, an individual shall not be discriminated
16against in any manner because the individual disclosed
17information under this chapter that the individual believes
18evinces any of the following:
   19a.  A violation of any law, rule, or regulation.
   20b.  A violation of any standard of care or other ethical
21guidelines for the provision of any health care service.
   22c.  Gross mismanagement, a gross waste of funds, an abuse
23of authority, or a substantial and specific danger to public
24health or safety.
25   Sec. 7.  NEW SECTION.  147.169  Judicial relief.
   261.  A person harmed by a violation of section 147.165 may
27bring an action for injunctive relief, compensatory and special
28damages, and any other relief available under law against any
29person responsible for the violation.
   302.  A person harmed by a violation of section 147.166,
31147.167, or 147.168 may bring an action for injunctive relief,
32compensatory and special damages, and any other relief
33available under law against a government agency, political
34subdivision, or any other person who is responsible for the
   13.  a.  Unless paragraph “b” applies, an action under this
2chapter is barred unless the action is commenced within two
3years after the cause of action accrues.
   4b.  Notwithstanding any provision to the contrary, including
5sections 614.8 and 614.8A, a minor injured by practices
6prohibited under section 147.165 may bring an action during the
7minor’s minority through a parent or guardian, and may bring an
8action in the minor’s own name upon reaching majority and for
9twenty years after reaching majority.
   104.  A person shall have standing to assert a claim or defense
11under this section if the person is adversely affected by an
12alleged violation or the alleged failure to perform a duty or
13act under this chapter.
   145.  A person who prevails on a claim brought pursuant to
15this section shall be entitled to monetary damages, including
16for all psychological, emotional, and physical harm suffered,
17reasonable attorney fees and costs, and any other appropriate
19   Sec. 8.  NEW SECTION.  147.170  Preemption — immunity.
   201.  A political subdivision is preempted from enacting,
21adopting, maintaining, or enforcing any order, ordinance, rule,
22regulation, policy, or other similar measure that prohibits,
23restricts, limits, controls, directs, or otherwise interferes
24with the professional conduct and judgment of a mental health
25professional, including speech, undertaken under this chapter
26within the course of treatment and communication with clients,
27patients, other persons, or the public, including but not
28limited to therapies, counseling, referrals, and education.
   292.  The attorney general or a mental health professional
30adversely affected may bring an action for injunctive relief
31to prevent or restrain a violation of this section. A mental
32health professional may recover reasonable costs and attorney’s
33fees incurred in obtaining injunctive relief under this
   353.  Sovereign and governmental immunity from a civil action
-8-1or from liability do not apply to violations of this chapter.
2   Sec. 9.  CODE EDITOR DIRECTIVE.  The Code editor may create
3a new subchapter in chapter 147, codifying sections 147.164
4through 147.170, as enacted in this Act, entitled “Gender and
5Sexual Discordance — Minors”.
7The inclusion of this explanation does not constitute agreement with
8the explanation’s substance by the members of the general assembly.
   9This bill includes provisions relating to practices
10undertaken to cause a minor to physically appear more like
11a person of the opposite sex and less like the minor’s own
12sex, or to conform to a gender identity incongruent with the
13minor’s sex. The bill contains findings regarding the harms
14and ineffectiveness of such practices and contains definitions
15used in the bill.
   16The bill makes it unlawful for a medical professional to
17perform interventions or surgical procedures specified in
18the bill on a minor, and subjects a medical professional to
19disciplinary action and civil penalties for providing the
20prohibited treatments to or performing surgical procedures on
21a minor, unless the treatment occurs based on the good faith
22medical decision of a parent of a minor born with a medically
23verifiable genetic disorder of sexual development.
   24The bill protects the freedom of members of a profession to
25provide counseling, in accordance with the bill and consistent
26with the individual’s conscience or religious belief.
   27The bill includes protections for parents to decline
28treatment, activity, or mental health care services intended
29to form their minor child’s conception of sex and gender or
30to treat gender dysphoria or gender nonconformity. The bill
31also requires government agencies and political subdivisions
32to inform parents of any information relevant to the physical
33or mental health of a minor exhibiting symptoms of gender
34dysphoria, gender nonconformity, or otherwise demonstrating a
35desire to be treated in a manner incongruent with the minor’s
   2The bill includes protections for individuals who provide
3information relating to violations of the bill.
   4The bill provides a private right of action against any
5person who violates the bill, and creates a statute of
6limitations for minors to bring certain claims within 20 years
7of reaching majority.
   8The bill preempts political subdivisions from having
9measures in place that interfere with the professional conduct
10and judgment of a mental health professional undertaken
11under the bill within a course of treatment or communication;
12provides for injunctive relief for a violation of this
13provision; and provides that sovereign and governmental
14immunity from a civil action or from liability do not apply to
15violations of the bill.