Text of GA HB 653 (2023)

23 LC 33 9316 H. B. 653 - 1 - House Bill 653 By: Representatives Bonner of the 73rd, Jasperse of the 11th, Jones of the 25th, Newton of the 127th, Taylor of the 173rd, and others A BILL TO BE ENTITLED AN ACT To amend Chapter 1 of Title 43 of the Official Code of Georgia Annotated, relating to 1 general provisions relative to professions and businesses, so as to prohibit health care 2 providers from performing specified practices on minors relating to altering a person's 3 appearance relating to gender; to prohibit health care providers from aiding or abetting such 4 practices for minors; to provide for definitions; to provide for exceptions; to provide for 5 enforcement; to amend Part 3 of Article 16 of Chapter 2 of Title 20 of the Official Code of 6 Georgia Annotated, relating to student health, so as to prohibit school nurses and other 7 employees and officials from engaging in certain conduct relating to a minor's perception of 8 his or her gender; to provide for legislative findings; to provide for related matters; to provide 9 for an effective date; to repeal conflicting laws; and for other purposes. 10 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA: 11 SECTION 1. 12 The General Assembly finds and declares that: 13 (1) This state has a compelling government interest in protecting the health and safety of 14 its citizens, especially vulnerable children; 15 23 LC 33 9316 H. B. 653 - 2 - (2) Only a tiny percentage of the American population experiences distress at identifying 16 with their biological sex. According to the American Psychiatric Association, prevalence 17 ranges from 0.005 to 0.014 percent for natal adult males and from 0.002 to 0.003 percent 18 for natal females; 19 (3) Studies consistently demonstrate that the vast majority of children who are gender 20 nonconforming or experience distress at identifying with their biological sex come to 21 identify with their biological sex in adolescence or adulthood, thereby rendering most 22 medical health care interventions unnecessary; 23 (4) Scientific studies show that individuals struggling with distress at identifying with their 24 biological sex often have already experienced psychopathology, which indicates these 25 individuals should be encouraged to seek mental health care services before undertaking 26 any hormonal or surgical intervention; 27 (5) Suicide rates, psychiatric morbidities, and mortality rates remain markedly elevated 28 above the background population after inpatient gender reassignment procedures have been 29 performed; 30 (6) Some health care providers are prescribing puberty-blocking drugs in order to delay 31 the onset or progression of normally timed puberty in children who experience distress at 32 identifying with their biological sex. This is being done despite the lack of any long-term 33 longitudinal studies evaluating the risks and benefits of using these drugs for the treatment 34 of such distress or gender transition; 35 (7) Health care providers are also prescribing cross-sex hormones for children who 36 experience distress at identifying with their biological sex, despite the fact that no 37 randomized clinical trials have been conducted on the efficacy or safety of the use of 38 cross-sex hormones in adults or children for the purpose of treating such distress or gender 39 transition; 40 (8) The use of cross-sex hormones comes with the following serious known risks: 41 23 LC 33 9316 H. B. 653 - 3 - (A) For biological females, erythrocytosis, severe liver dysfunction, coronary artery 42 disease, cerebrovascular disease, hypertension, increased risk of breast and uterine 43 cancers, and irreversible infertility; and 44 (B) For biological males, thromboembolic disease, cholelithiasis, coronary artery 45 disease, macroprolactinoma, cerebrovascular disease, hypertriglyceridemia, breast cancer, 46 and irreversible infertility; 47 (9) Genital and non-genital reassignment surgeries are generally not recommended for 48 children, although evidence indicates referrals for children to have such surgeries are 49 becoming more frequent; 50 (10) Genital gender reassignment surgery includes several irreversible invasive procedures 51 for males and females and involves the following alterations of biologically normal and 52 functional body parts: 53 (A) For biological males, surgery may involve genital reconstruction including 54 penectomy, orchiectomy, vaginoplasty, clitoroplasty, and vulvoplasty; and 55 (B) For biological females, surgery may involve a hysterectomy or oophorectomy, 56 reconstruction of the urethra, genital reconstruction including metoidioplasty or 57 phalloplasty, vaginectomy, scrotoplasty, and implantation of erection or testicular 58 prostheses; 59 (11) The complications, risks, and long-term care concerns associated with genital gender 60 reassignment surgery for both males and females are numerous and complex; 61 (12) Non-genital gender reassignment surgery includes various invasive procedures for 62 males and females and also involves the alteration or removal of biologically normal and 63 functional body parts: 64 (A) For biological males, procedures may include augmentation mammoplasty, facial 65 feminization surgery, liposuction, lipofilling, voice surgery, thyroid cartilage reduction, 66 gluteal augmentation, hair reconstruction, and other aesthetic procedures; and 67 23 LC 33 9316 H. B. 653 - 4 - (B) For biological females, procedures may include subcutaneous mastectomy, voice 68 surgery, liposuction, lipofilling, pectoral implants, and other aesthetic procedures; 69 (13) It is an accepted principle of economics and public policy that when a service or 70 product is subsidized or paid for, demand for that service or product increases. Just 71 between 2015 and 2016, gender reassignment surgeries increased by 20 percent; 72 (14) It is of grave concern that the medical community is allowing individuals who 73 experience distress at identifying with their biological sex to be subjects of irreversible and 74 drastic non-genital gender reassignment surgery and irreversible, permanently sterilizing 75 genital gender reassignment surgery, despite the lack of studies showing that the benefits 76 of such extreme interventions outweigh the risks; and 77 (15) The risks of gender transition procedures far outweigh any benefit at this stage of 78 clinical study on these procedures. 79 SECTION 2. 80 Chapter 1 of Title 43 of the Official Code of Georgia Annotated, relating to general 81 provisions relative to professions and businesses, is amending by adding a new Code section 82 to read as follows: 83 "43-1-36. 84 (a) As used in this Code section, the term: 85 (1) 'Health care provider' means any person licensed under Chapter 9, 10A, 11, 11A, 26, 86 28, 30, 33, 34, 35, 39, or 44 of Title 43 or any hospital, nursing home, home health 87 agency, institution, or medical facility licensed or defined under Chapter 7 of Title 31. 88 Such term shall also include any corporation, professional corporation, partnership, 89 limited liability company, limited liability partnership, authority, or other entity 90 composed of such health care providers. 91 (2) 'Sex' means the biological indication of male and female, including sex 92 chromosomes, naturally occurring sex hormones, gonads, and nonambiguous internal and 93 23 LC 33 9316 H. B. 653 - 5 - external genitalia present at birth, without regard to an individual's psychological, chosen, 94 or subjective experience of gender. 95 (b) Except as otherwise provided in subsection (d) of this Code section, no health care 96 provider in this state shall knowingly engage in or cause any of the following practices to 97 be performed upon any minor if the practice is performed for the purpose of attempting to 98 alter the appearance of or affirm the minor's perception of his or her gender or sex, if that 99 appearance or perception is inconsistent with the minor's sex: 100 (1) Prescribing or administering gonadotropin-releasing hormone analogues or other 101 synthetic drugs used to stop luteinizing hormone and follicle-stimulating hormone 102 secretion, synthetic antiandrogen drugs used to block the androgen receptor, or any drug 103 to suppress or delay normal puberty; 104 (2) Prescribing or administering testosterone, estrogen, or progesterone to a minor in an 105 amount greater than would normally be produced endogenously in a healthy individual 106 of that individual's age and sex; 107 (3) Performing surgeries that sterilize, including castration, vasectomy, hysterectomy, 108 oophorectomy, orchiectomy, and penectomy; 109 (4) Performing surgeries that artificially construct tissue with the appearance of genitalia 110 that differs from the individual's sex, including metoidioplasty, phalloplasty, and 111 vaginoplasty; or 112 (5) Removing any healthy or nondiseased body part or tissue. 113 (c) No health care provider shall knowingly engage in conduct that aids or abets the 114 practices described in subsection (b) of this Code section on any minor. 115 (d) Subsections (b) and (c) of this Code section shall not apply to: 116 (1) Services provided to individuals born with a medically verifiable disorder of sex 117 development, including a person with external biological sex characteristics that are 118 irresolvably ambiguous, such as an individual born with 46 XX chromosomes with 119 23 LC 33 9316 H. B. 653 - 6 - virilization, 46 XY chromosomes with undervirilization, or having both ovarian and 120 testicular tissue; 121 (2) Services provided to an individual when a physician has otherwise diagnosed a 122 disorder of sexual development, in which the physician has determined through genetic 123 or biochemical testing that the individual does not have normal sex chromosome 124 structure, sex steroid hormone production, or sex steroid hormone action for a biological 125 male or biological female; 126 (3) The treatment of any infection, injury, disease, or disorder that has been caused or 127 exacerbated by the performance of a procedure described in subsection (b) of this Code 128 section, whether or not the procedures were performed in accordance with state and 129 federal law; or 130 (4) Any procedure undertaken because an individual suffers from a physical disorder, 131 physical injury, or physical illness that is certified by a physician and that would place 132 the individual in imminent danger of death or impairment of major bodily function unless 133 surgery is performed. 134 (e)(1) The provision of services to or engaging in conduct regarding any minor described 135 in subsections (b) and (c) of this Code section shall be considered unprofessional conduct 136 and shall be subject to discipline by the licensing entity with jurisdiction over the health 137 care provider. 138 (2) A person may assert an actual or threatened violation of this Code section as a claim 139 or defense in a judicial or administrative proceeding and obtain compensatory damages, 140 injunctive relief, declaratory relief, or any other appropriate relief. 141 (3) A person shall be required to bring a claim for a violation of this Code section not 142 later than two years after the day the cause of action accrues. A minor may bring an 143 action before reaching 18 years of age through a parent or guardian, and may bring an 144 action in the minor's own name upon reaching 18 years of age at any time from that point 145 until he or she reaches 38 years of age. 146 23 LC 33 9316 H. B. 653 - 7 - (4) An action under this Code section may be commenced, and relief may be granted, in 147 a judicial proceeding without regard to whether the person commencing the action has 148 sought or exhausted available administrative remedies. 149 (5) In any action or proceeding to enforce a provision of this Code section, a prevailing 150 party who establishes a violation of this Code section shall be entitled to recover 151 reasonable attorney's fees. 152 (6) The Attorney General may bring an action to enforce compliance with this Code 153 section. Nothing in this Code section shall be construed to deny, impair, or otherwise 154 affect any right or authority of the Attorney General, the state, or any agency, officer, or 155 employee of the state to institute or intervene in any proceeding. 156 (f) Nothing in this Code section shall be construed to impose liability on any speech or 157 conduct protected by federal or state law." 158 SECTION 3. 159 Part 3 of Article 16 of Chapter 2 of Title 20 of the Official Code of Georgia Annotated, 160 relating to student health, is amended by adding a new Code section to read as follows: 161 "20-2-779.3. 162 (a) As used in this Code section, the term 'sex' means the biological indication of male and 163 female, including sex chromosomes, naturally occurring sex hormones, gonads, and 164 nonambiguous internal and external genitalia present at birth, without regard to an 165 individual's psychological, chosen, or subjective experience of gender. 166 (b) No school nurse, counselor, teacher, principal, or other official or staff at a public or 167 private school shall knowingly: 168 (1) Encourage or coerce a minor to withhold from the minor's parent or legal guardian 169 the fact that the minor's perception of his or her gender is inconsistent with his or her sex; 170 or 171 23 LC 33 9316 H. B. 653 - 8 - (2) Withhold from a minor's parent or legal guardian information related to the minor's 172 perception that his or her gender is inconsistent with his or her sex." 173 SECTION 4. 174 This Act shall become effective on January 1, 2024. 175 SECTION 5. 176 All laws and parts of laws in conflict with this Act are repealed. 177