[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 435 Introduced in Senate (IS)]

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118th CONGRESS
  1st Session
                                 S. 435

 To provide requirements related to the eligibility of individuals who 
       identify as transgender from serving in the Armed Forces.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           February 15, 2023

 Mr. Rubio (for himself, Mrs. Blackburn, Mr. Budd, Mr. Tuberville, and 
  Mr. Braun) introduced the following bill; which was read twice and 
              referred to the Committee on Armed Services

_______________________________________________________________________

                                 A BILL


 
 To provide requirements related to the eligibility of individuals who 
       identify as transgender from serving in the Armed Forces.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Ensuring Military Readiness Act of 
2023''.

SEC. 2. LIMITATIONS ON MILITARY SERVICE BY INDIVIDUALS WHO IDENTIFY AS 
              TRANSGENDER.

    Not later than 90 days after the date of the enactment of this Act, 
the Secretary of Defense shall prescribe regulations regarding service 
of individuals who identify as transgender as follows:
            (1) Persons who identify as transgender with a history of 
        diagnosis of gender dysphoria are disqualified from military 
        service except under the following limited circumstances:
                    (A) Individuals may serve in the Armed Forces if 
                they have been stable for 36 consecutive months in 
                their biological sex prior to accession.
                    (B) Members of the Armed Forces diagnosed with 
                gender dysphoria after entering into service may be 
                retained if they do not undergo gender transition 
                procedures and remain deployable within applicable 
                retention standards for their biological sex.
                    (C) Members of the Armed Forces serving as of the 
                date of the enactment of this Act who have been 
                diagnosed with gender dysphoria may continue to serve 
                only in their biological sex, irrespective of any 
                changes previously made to their gender marker in the 
                Defense Enrollment Eligibility Reporting System 
                (DEERS), and receive medically necessary treatment for 
                gender dysphoria. Such treatment may not include gender 
                transition procedures.
            (2) Persons who identify as transgender who seek or have 
        undergone gender transition are disqualified from military 
        service.
            (3) Persons who identify as transgender without a history 
        or diagnosis of gender dysphoria, who are otherwise qualified 
        for service and meet all physical and mental requirements, may 
        serve in the Armed Forces in their biological sex.

SEC. 3. REVISED REGULATIONS REGARDING GENDER MARKINGS.

    Not later than 90 days after the date of the enactment of this Act, 
the Secretary of Defense shall prescribe regulations updating the 
Defense Enrollment Eligibility Reporting System (DEERS) to require the 
gender markers for members of the Armed Forces to match their 
biological sex, irrespective of any previous changes allowed.

SEC. 4. DEFINITIONS.

    In this Act:
            (1) Cross-sex hormones.--The term ``cross-sex hormones'' 
        means testosterone or other androgens given to biological 
        females at doses that are profoundly larger or more potent than 
        would normally occur naturally in healthy biological females, 
        or estrogen given to biological males at doses that are 
        profoundly larger or more potent than would normally occur 
        naturally in healthy biological males.
            (2) Gender.--The term ``gender'' means the psychological, 
        behavioral, social, and cultural aspects of being male or 
        female.
            (3) Gender dysphoria.--The term ``gender dysphoria'' means 
        a marked incongruence between one's experienced or expressed 
        gender and biological sex.
            (4) Gender transition.--The term ``gender transition'' 
        means the process by 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 physical changes.
            (5) Gender transition procedures.--The term ``gender 
        transition procedures''--
                    (A) means--
                            (i) any medical or surgical intervention, 
                        including physician's services, inpatient and 
                        outpatient hospital services, or prescribed 
                        drugs related to gender transition, that seeks 
                        to alter or remove physical or anatomical 
                        characteristics or features that are typical 
                        for the individual's biological sex or to 
                        instill or create physiological or anatomical 
                        characteristics that resemble a sex different 
                        from the individual's birth sex, including 
                        medical services that provide puberty-blocking 
                        drugs, cross-sex hormones, or other mechanisms 
                        to promote the development of feminizing or 
                        masculinizing features (in the opposite sex); 
                        and
                            (ii) genital or non-genital gender 
                        transition surgery performed for the purpose of 
                        assisting an individual with a gender 
                        transition; and
                    (B) does not include--
                            (i) services to those born with a medically 
                        verifiable disorder of sex development, 
                        including a person with external biological 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 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 person does not have normal 
                        sex chromosome structure, sex steroid hormone 
                        production, or sex steroid hormone action for a 
                        biological male or biological female; or
                            (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.
            (6) Gender transition surgery.--The term ``gender 
        transition surgery'' means any medical or surgical service that 
        seeks to surgically alter or remove healthy physical or 
        anatomical characteristics or features that are typical for the 
        individual's biological sex in order to instill or create 
        physiological or anatomical characteristics that resemble a sex 
        different from the individual's birth sex, including genital or 
        non-genital gender reassignment surgery performed for the 
        purpose of assisting an individual with a gender transition.
            (7) Genital gender transition surgery.--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 
        performed for the purpose of assisting an individual with a 
        gender transition.
            (8) Non-genital gender transition surgery.--The term ``non-
        genital gender transition surgery''--
                    (A) includes, when performed for the purpose of 
                assisting an individual with a gender transition--
                            (i) surgical procedures such as 
                        augmentation mammoplasty, facial feminization 
                        surgery, liposuction, lipofilling, voice 
                        surgery, thyroid cartilage reduction, gluteal 
                        augmentation (implants or lipofilling), hair 
                        reconstruction, or various aesthetic procedures 
                        for biologically male patients; or
                            (ii) subcutaneous mastectomy, voice 
                        surgery, liposuction, lipofilling, pectoral 
                        implants or various aesthetic procedures for 
                        biologically female patients; and
                    (B) does not include 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 is performed, 
                unless the procedure is for the purpose of a gender 
                transition.
            (9) Puberty-blocking drugs.--The term ``puberty-blocking 
        drugs'' means, when used to delay or suppress pubertal 
        development in children for the purpose of assisting an 
        individual with a gender transition--
                    (A) Gonadotropin-releasing hormone (GnRH) analogues 
                or other synthetic drugs used in biological males to 
                stop luteinizing hormone secretion and therefore 
                testosterone secretion; and
                    (B) synthetic drugs used in biological females that 
                stop the production of estrogen and progesterone.
            (10) Sex; birth sex; biological sex.--The terms ``sex'', 
        ``birth sex,'' and ``biological sex'' refer to the biological 
        indication of male and female in the context of reproductive 
        potential or capacity, such as sex chromosomes, naturally 
        occurring sex hormones, gonads, and non-ambiguous internal and 
        external genitalia present at birth, without regard to an 
        individual's psychological, chosen, or subjective experience of 
        gender.
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