[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 4426 Introduced in Senate (IS)]
<DOC>
119th CONGRESS
2d Session
S. 4426
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.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
April 29, 2026
Mr. Marshall (for himself and Mr. Lee) 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.
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 ``Safeguarding The Overall Protection
of Minors Act'' or the ``STOP Act''.
SEC. 2. DEFINITIONS.
In this Act:
(1) Caretaker.--The term ``caretaker'' means an adult, who
is not a parent of a child, with whom a child resides and who
provides that child with the care, maintenance, and supervision
consistent with the duties and responsibilities of a parent of
the child.
(2) Detransition treatment.--The term ``detransition
treatment'' means any treatment, including mental health
services, medical intervention, or surgery, that does any of
the following:
(A) Stops or reverses the effects of a gender
transition procedure.
(B) Helps an individual cope with the effects of a
prior gender transition procedure.
(3) 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.
(4) Gender transition.--The term ``gender transition''
means the process, which may be accompanied with social, legal,
or physical changes--
(A) in which an individual--
(i) intentionally halts the natural
development of the individual's body so that
the body no longer corresponds to the
individual's sex; or
(ii) intentionally transforms the
individual's physical appearance to confirm the
individual's physical appearance to be of the
alternate sex; or
(B) that alters or removes sexual organs as part of
chemical or surgical mutilation.
(5) Gender transition procedure.--
(A) In general.--The term ``gender transition
procedure'' means any hormonal, pharmaceutical, or
surgical intervention for the purpose of gender
transition, including--
(i) gonadotropin-releasing hormone (GnRH)
agonists or other puberty-blocking or
suppressing drugs to stop or delay normally
timed puberty;
(ii) testosterone, estrogen, progesterone,
androgen blockers, or other sex hormones to an
individual at doses that are supraphysiologic
to what would normally be produced endogenously
in a healthy individual of the same age and
sex;
(iii) procedures that attempt to transform
an individual's physical appearance to confirm
the individual's physical appearance to be of
the alternate sex, or that alter or remove
sexual organs as part of chemical or surgical
mutilation;
(iv) castration;
(v) orchiectomy;
(vi) scrotoplasty;
(vii) implantation of erection or
testicular prostheses;
(viii) vasectomy;
(ix) hysterectomy;
(x) oophorectomy;
(xi) ovariectomy;
(xii) reconstruction of the fixed part of
the urethra with or without a metoidioplasty or
a phalloplasty;
(xiii) metoidioplasty;
(xiv) penectomy;
(xv) phalloplasty;
(xvi) vaginoplasty;
(xvii) clitoroplasty;
(xviii) vaginectomy;
(xix) vulvoplasty;
(xx) reduction thyrochondroplasty;
(xxi) chondrolaryngoplasty;
(xxii) mastectomy;
(xxiii) tubal ligation;
(xxiv) sterilization;
(xxv) any plastic, cosmetic, or aesthetic
surgery that feminizes or masculinizes the
facial or other physiological features of an
individual;
(xxvi) any placement of chest implants to
create feminine breasts;
(xxvii) any placement of fat or artificial
implants in the gluteal region;
(xxviii) augmentation mammoplasty;
(xxix) liposuction;
(xxx) lipofilling;
(xxxi) voice surgery;
(xxxii) hair reconstruction;
(xxxiii) pectoral implants; and
(xxxiv) the removal of any otherwise
healthy or non-diseased body part or tissue.
(B) Exclusions.--The term ``gender transition
procedure'' does not include the following when
furnished to an individual by a health care provider
with the consent of such individual or, if applicable,
such individual's parents or legal guardian:
(i) Services to individuals who have been
diagnosed with a disorder of sex development by
a licensed health care provider operating
within their scope of practice, 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 health care
professional has otherwise diagnosed a disorder
of sexual development in which the health care
professional 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 healthy individual of the
same sex and age.
(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 (but not
mental, behavioral, or emotional distress or a
mental, behavioral, or emotional disorder) that
would, as certified by a health care
professional, place the individual in imminent
danger of death or impairment of major bodily
function, unless the procedure is performed,
which may include the following:
(I) Traumatic bodily injuries (such
as fractures, organ rupture, or
penetrating trauma).
(II) Congenital structural
anomalies of major organs or systems,
including the cardiovascular,
respiratory, renal, hepatic,
neurological, or musculoskeletal
systems.
(III) Acute illnesses with a high
probability of imminent mortality.
(v) Any procedure to restore or reconstruct
the body of the individual in order to
correspond to the individual's sex after one or
more previous gender transition procedures,
which may include the removal of a pseudo
phallus or breast augmentation.
(vi) Puberty suppression or blocking
prescription drugs for the purpose of
normalizing puberty for a minor experiencing
precocious puberty.
(vii) Male circumcision.
(6) 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.
(7) Minor.--The term ``minor'' means an individual under
the age of 18.
(8) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(9) Sex.--The term ``sex'', when referring to a natural
person's sex, means the person's immutable biological
classification as either male or female, as biologically
determined and defined by this section.
SEC. 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 otherwise aid or abet the
performance of any gender transition procedure on a minor.
(2) Circumstances described.--A circumstance referred to in
paragraph (1) is any of the following:
(A) The person, or the minor on whom the gender
transition procedure was performed, attempted to be
performed, or conspired to be performed or on whom the
performance of any gender transition procedure was
aided or abetted, 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, or conspired to be performed or on whom the
performance of any gender transition procedure was
aided or abetted, 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 interstate or foreign commerce.
(D) The person, or the minor on whom the gender
transition procedure was performed, attempted to be
performed, or conspired to be performed or on whom the
performance of any gender transition procedure was
aided or abetted, 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 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 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 of the prohibition
described in paragraph (1); or
(B) a reasonable person acting in the circumstances
and exercising reasonable care would have that
knowledge.
(4) Application to work arrangements.--
(A) In general.--A violation of paragraph (1)--
(i) by an employee acting in the scope of
their employment for an employer shall also be
considered a violation of such paragraph by
such employer; or
(ii) by any other individual who is engaged
by a person for the performance of labor or
services for remuneration and who is acting in
the scope of their performance of such labor or
services for such person shall also be
considered a violation of such paragraph by
such person.
(B) Liability.--
(i) Employee violations.--In the case of a
violation that is described in subparagraph
(A)(i), the employee and the employer described
in such subparagraph shall be jointly and
severally liable for any civil penalty under
subsection (b) and any private right of action
under subsection (c).
(ii) Other worker violations.--In the case
of a violation that is described in
subparagraph (A)(ii), the individual and person
described in such subparagraph shall be jointly
and severally liable for any civil penalty
under subsection (b) and any private right of
action under subsection (c).
(b) Civil Monetary Penalties.--
(1) In general.--The Secretary may impose a civil monetary
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 monetary penalties.--
(A) In general.--The amount of a civil monetary
penalty under paragraph (1) shall be not less than
$100,000 for each violation.
(B) Penalty considerations.--In determining the
amount of a civil monetary penalty under this
subsection, the Secretary shall consider--
(i) the nature, circumstances, extent, and
gravity of the violation; and
(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.
(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 monetary penalty under
this subsection and any accrued interest on the civil
monetary penalty as assessed by the Secretary. In such
a civil action, the amount and appropriateness of the
civil monetary penalty shall not be subject to review.
(B) Compromise.--The Secretary may compromise the
amount of a civil monetary 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 monetary penalty on
a person on whom procedures are performed.--No person on whom a
gender transition procedure is performed, attempted to be
performed, or conspired to be performed or on whom the
performance of any gender transition procedure was aided or
abetted in violation of subsection (a)(1), and no parent,
guardian, or caretaker of such a person, may be held liable for
a civil monetary 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 ``Victims of Gender Transition
Procedures Compensation 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 2026
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.--
(1) In general.--An individual on whom a gender transition
procedure is performed in violation of subsection (a)(1), or
the parent, guardian, or caretaker of such an individual if
such individual is a minor, may bring a civil action in an
appropriate district court of the United States against any
person in violation of subsection (a)(1) for damages, including
damages described in paragraph (3).
(2) Availability.--A cause of action described in paragraph
(1) shall be available regardless of whether the alleged
violation occurred before, on, or after the date of enactment
of this Act.
(3) Damages.--Damages referred to in paragraph (1)
include--
(A) compensatory damages, including all economic
damages associated with undoing, correcting, or
ameliorating the effects or results of any gender
transition procedure;
(B) non-economic damages for emotional distress and
pain and suffering; and
(C) punitive damages, if the claimant proves by
clear and convincing evidence that the defendant
against whom punitive damages are sought acted
maliciously, intentionally, fraudulently, or
recklessly.
(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) Rules of Construction.--
(1) In general.--In any proceeding described in subsection
(b) or (c) any ambiguities shall be resolved against any person
found to be in violation of subsection (a)(1).
(2) Health care professionals.--In any proceeding described
in subsection (b) or (c) against a health care professional, if
a gender transition procedure of a minor is shown to have
occurred before the date of enactment of this Act, limited
deference shall be given to prevailing standards of care in
effect at such time, to the extent that such standards of care
contradict the intent of this Act and it is shown that such
health care professional knew or should have known that such
standards of care were in serious, scientific, and medical
dispute at the time of the gender transition procedure.
(3) No liability for minors.--Nothing in this Act shall be
construed to impose any liability whatsoever on a minor who is
the individual on whom a gender transition procedure is
performed, attempted to be performed, or conspired to be
performed or on whom the performance of any gender transition
procedure was aided or abetted.
(f) Effect.--Nothing in this Act--
(1) establishes a private right of action based on
counseling, referrals to mental health professionals, or
discussions of treatment options (including counseling,
referrals, or options available upon reaching adulthood)
provided by health care professionals or mental health
professionals or against health care professionals or mental
health professionals based on circumstances not described in
subsection (a)(2), on the condition that such actions do not
constitute participation in a gender transition procedure;
(2) prohibits a health care professional or mental health
professional from providing information about all available
treatment options, discussing risks and benefits, or expressing
professional medical opinions, so long as such actions do not
constitute participation in a gender transition procedure; or
(3) waives liability for a health care professional.
(g) Statute of Limitations.--An action under subsection (c) may be
brought within 25 years from the date of the eighteenth birthday of an
individual on whom a gender transition procedure is performed as a
minor or within 4 years from the time the cost of a detransition
treatment is incurred, whichever date is later.
(h) 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.
SEC. 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--
(A) shall be a private nonprofit entity;
(B) shall submit to the Secretary an application at
such time, in such manner, and containing such
information and assurances as the Secretary may
require, including an assurance that such entity will--
(i) submit to the Secretary such reports of
deidentified data, information, and metrics as
the Secretary may require to assess the
entity's performance in carrying out activities
under the grant and ensure the entity is in
compliance with the terms and conditions of
such grant;
(ii) not charge individuals for services
provided through the grant; and
(iii) provide each individual counseled
through the grant with accurate information on
the appropriate medical procedures to reverse
gender transition procedures; and
(C) shall agree to 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;
(B) performs, induces, refers for, or counsels in
favor of an abortion, except--
(i) if the pregnancy is the result of an
act of rape or incest; or
(ii) in the case where a woman suffers from
a physical disorder, physical injury, or
physical illness, including a life-endangering
physical condition caused by or arising from
the pregnancy itself, that would, as certified
by a physician, place the woman in danger of
death unless an abortion is performed; or
(C) provides financial support to any other entity
that conducts any activity described in subparagraph
(A) or (B).
(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, 1 or more of the following services:
(A) Medical advice and care to reverse a gender
transition procedure.
(B) Education and employment assistance, including
services that support the continuation and completion
of high school.
(C) Voluntary mental health and substance use
disorder services.
(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--
(1) gender transition procedures;
(2) payment for an abortion, except--
(A) if the pregnancy is the result of an act of
rape or incest; or
(B) in the case where a woman suffers from a
physical disorder, physical injury, or physical
illness, including a life-endangering physical
condition caused by or arising from the pregnancy
itself, that would, as certified by a physician, place
the woman in danger of death unless an abortion is
performed; or
(3) requiring any person to perform, or facilitate in any
way the performance of, any abortion.
(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.
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