S. 4426

[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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