[Congressional Record Volume 169, Number 123 (Tuesday, July 18, 2023)]
[Senate]
[Pages S3078-S3079]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

  SA 902. Mr. RUBIO submitted an amendment intended to be proposed by 
him to the bill S. 2226, to authorize appropriations for fiscal year 
2024 for military activities of the Department of Defense, for military 
construction, and for defense activities of the Department of Energy, 
to prescribe military personnel strengths for such fiscal year, and for 
other purposes; which was ordered to lie on the table; as follows:

       At the end of title V, add the following:

          Subtitle J--Ensuring Military Readiness Act of 2023

     SEC. 595. SHORT TITLE.

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

     SEC. 596. 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. 597. 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. 598. DEFINITIONS.

       In this subtitle:
       (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

[[Page S3079]]

     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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