23 LC 33 9316
H. B. 653
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House Bill 653
By: Representatives Bonner of the 73
rd
, Jasperse of the 11
th
, Jones of the 25
th
, Newton of the
127
th
, Taylor of the 173
rd
, 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 care2
providers from performing specified practices on minors relating to altering a person's3
appearance relating to gender; to prohibit health care providers from aiding or abetting such4
practices for minors; to provide for definitions; to provide for exceptions; to provide for5
enforcement; to amend Part 3 of Article 16 of Chapter 2 of Title 20 of the Official Code of6
Georgia Annotated, relating to student health, so as to prohibit school nurses and other7
employees and officials from engaging in certain conduct relating to a minor's perception of8
his or her gender; to provide for legislative findings; to provide for related matters; to provide9
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 of14
its citizens, especially vulnerable children;15 23 LC 33 9316
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(2) Only a tiny percentage of the American population experiences distress at identifying
16
with their biological sex. According to the American Psychiatric Association, prevalence17
ranges from 0.005 to 0.014 percent for natal adult males and from 0.002 to 0.003 percent18
for natal females;19
(3) Studies consistently demonstrate that the vast majority of children who are gender20
nonconforming or experience distress at identifying with their biological sex come to21
identify with their biological sex in adolescence or adulthood, thereby rendering most22
medical health care interventions unnecessary;23
(4) Scientific studies show that individuals struggling with distress at identifying with their24
biological sex often have already experienced psychopathology, which indicates these25
individuals should be encouraged to seek mental health care services before undertaking26
any hormonal or surgical intervention;27
(5) Suicide rates, psychiatric morbidities, and mortality rates remain markedly elevated28
above the background population after inpatient gender reassignment procedures have been29
performed;30
(6) Some health care providers are prescribing puberty-blocking drugs in order to delay31
the onset or progression of normally timed puberty in children who experience distress at32
identifying with their biological sex. This is being done despite the lack of any long-term33
longitudinal studies evaluating the risks and benefits of using these drugs for the treatment34
of such distress or gender transition;35
(7) Health care providers are also prescribing cross-sex hormones for children who36
experience distress at identifying with their biological sex, despite the fact that no37
randomized clinical trials have been conducted on the efficacy or safety of the use of38
cross-sex hormones in adults or children for the purpose of treating such distress or gender39
transition;40
(8) The use of cross-sex hormones comes with the following serious known risks:41 23 LC 33 9316
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(A) For biological females, erythrocytosis, severe liver dysfunction, coronary artery
42
disease, cerebrovascular disease, hypertension, increased risk of breast and uterine43
cancers, and irreversible infertility; and44
(B) For biological males, thromboembolic disease, cholelithiasis, coronary artery45
disease, macroprolactinoma, cerebrovascular disease, hypertriglyceridemia, breast cancer,46
and irreversible infertility;47
(9) Genital and non-genital reassignment surgeries are generally not recommended for48
children, although evidence indicates referrals for children to have such surgeries are49
becoming more frequent;50
(10) Genital gender reassignment surgery includes several irreversible invasive procedures51
for males and females and involves the following alterations of biologically normal and52
functional body parts:53
(A) For biological males, surgery may involve genital reconstruction including54
penectomy, orchiectomy, vaginoplasty, clitoroplasty, and vulvoplasty; and55
(B) For biological females, surgery may involve a hysterectomy or oophorectomy,56
reconstruction of the urethra, genital reconstruction including metoidioplasty or57
phalloplasty, vaginectomy, scrotoplasty, and implantation of erection or testicular58
prostheses;59
(11) The complications, risks, and long-term care concerns associated with genital gender60
reassignment surgery for both males and females are numerous and complex;61
(12) Non-genital gender reassignment surgery includes various invasive procedures for62
males and females and also involves the alteration or removal of biologically normal and63
functional body parts:64
(A) For biological males, procedures may include augmentation mammoplasty, facial65
feminization surgery, liposuction, lipofilling, voice surgery, thyroid cartilage reduction,66
gluteal augmentation, hair reconstruction, and other aesthetic procedures; and67 23 LC 33 9316
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(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 or70
product is subsidized or paid for, demand for that service or product increases. Just71
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 who73
experience distress at identifying with their biological sex to be subjects of irreversible and74
drastic non-genital gender reassignment surgery and irreversible, permanently sterilizing75
genital gender reassignment surgery, despite the lack of studies showing that the benefits76
of such extreme interventions outweigh the risks; and77
(15) The risks of gender transition procedures far outweigh any benefit at this stage of78
clinical study on these procedures.79
SECTION 2.80
Chapter 1 of Title 43 of the Official Code of Georgia Annotated, relating to general81
provisions relative to professions and businesses, is amending by adding a new Code section82
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 health87
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 entity90
composed of such health care providers.91
(2) 'Sex' means the biological indication of male and female, including sex92
chromosomes, naturally occurring sex hormones, gonads, and nonambiguous internal and93 23 LC 33 9316
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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 care96
provider in this state shall knowingly engage in or cause any of the following practices to97
be performed upon any minor if the practice is performed for the purpose of attempting to98
alter the appearance of or affirm the minor's perception of his or her gender or sex, if that99
appearance or perception is inconsistent with the minor's sex:100
(1) Prescribing or administering gonadotropin-releasing hormone analogues or other101
synthetic drugs used to stop luteinizing hormone and follicle-stimulating hormone102
secretion, synthetic antiandrogen drugs used to block the androgen receptor, or any drug103
to suppress or delay normal puberty;104
(2) Prescribing or administering testosterone, estrogen, or progesterone to a minor in an105
amount greater than would normally be produced endogenously in a healthy individual106
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 genitalia110
that differs from the individual's sex, including metoidioplasty, phalloplasty, and111
vaginoplasty; or112
(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 the114
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 sex117
development, including a person with external biological sex characteristics that are118
irresolvably ambiguous, such as an individual born with 46 XX chromosomes with119 23 LC 33 9316
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virilization, 46 XY chromosomes with undervirilization, or having both ovarian and120
testicular tissue;121
(2) Services provided to an individual when a physician has otherwise diagnosed a122
disorder of sexual development, in which the physician has determined through genetic123
or biochemical testing that the individual does not have normal sex chromosome124
structure, sex steroid hormone production, or sex steroid hormone action for a biological125
male or biological female;126
(3) The treatment of any infection, injury, disease, or disorder that has been caused or127
exacerbated by the performance of a procedure described in subsection (b) of this Code128
section, whether or not the procedures were performed in accordance with state and129
federal law; or130
(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 place132
the individual in imminent danger of death or impairment of major bodily function unless133
surgery is performed.134
(e)(1) The provision of services to or engaging in conduct regarding any minor described135
in subsections (b) and (c) of this Code section shall be considered unprofessional conduct136
and shall be subject to discipline by the licensing entity with jurisdiction over the health137
care provider.138
(2) A person may assert an actual or threatened violation of this Code section as a claim139
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 not142
later than two years after the day the cause of action accrues. A minor may bring an143
action before reaching 18 years of age through a parent or guardian, and may bring an144
action in the minor's own name upon reaching 18 years of age at any time from that point145
until he or she reaches 38 years of age.146 23 LC 33 9316
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(4) An action under this Code section may be commenced, and relief may be granted, in147
a judicial proceeding without regard to whether the person commencing the action has148
sought or exhausted available administrative remedies.149
(5) In any action or proceeding to enforce a provision of this Code section, a prevailing150
party who establishes a violation of this Code section shall be entitled to recover151
reasonable attorney's fees.152
(6) The Attorney General may bring an action to enforce compliance with this Code153
section. Nothing in this Code section shall be construed to deny, impair, or otherwise154
affect any right or authority of the Attorney General, the state, or any agency, officer, or155
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 or157
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 and163
female, including sex chromosomes, naturally occurring sex hormones, gonads, and164
nonambiguous internal and external genitalia present at birth, without regard to an165
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 or167
private school shall knowingly:168
(1) Encourage or coerce a minor to withhold from the minor's parent or legal guardian169
the fact that the minor's perception of his or her gender is inconsistent with his or her sex;170
or171 23 LC 33 9316
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(2) Withhold from a minor's parent or legal guardian information related to the minor's172
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