EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
FIRST REGULAR SESSION
SENATE BILL NO. 26
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR MOON.
1080S.01I KRISTINA MARTIN, Secretary
AN ACT
To repeal section 191.1720, RSMo, and to enact in lieu thereof two new sections relating to gender
transition.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Section 191.1720, RSMo, is repealed and two 1
new sections enacted in lieu thereof, to be known as sections 2
1.208 and 191.1720, to read as follows:3
1.208. As used in the laws and regulations of this 1
state, unless clearly and specifically stated otherwise, the 2
term "reproductive health care" shall not be construed to 3
include gender transition surgeries or the use of cross -sex 4
hormones or puberty-blocking drugs for the pu rpose of gender 5
transition, as such terms are defined in section 191.1720, 6
for minor children or adults. 7
191.1720. 1. This section shall be known and may be 1
cited as the "Missouri Save Adolescents from Experimentation 2
(SAFE) Act". 3
2. For purposes of this section, the following terms 4
mean: 5
(1) "Biological sex", the biological indication of 6
male or female in the context of reproductive potential or 7
capacity, such as sex chromosomes, naturally occurring sex 8
hormones, gonads, and nonambiguous internal and external 9
genitalia present at birth, without regard to an 10 SB 26 2
individual's psychological, chosen, or subjective experience 11
of gender; 12
(2) "Cross-sex hormones", testosterone, estrogen, or 13
other androgens given to an individual in amounts that are 14
greater or more potent than would normally occur naturally 15
in a healthy individual of the same age and sex; 16
(3) "Gender", the psychological, behavioral, social, 17
and cultural aspects of being male or female; 18
(4) "Gender transition", the process in which an 19
individual transitions from identifying with and living as a 20
gender that corresponds to his or her biological sex to 21
identifying with and living as a gender different from his 22
or her biological sex, and ma y involve social, legal, or 23
physical changes; 24
(5) "Gender transition surgery", a surgical procedure 25
performed for the purpose of assisting an individual with a 26
gender transition, including, but not limited to: 27
(a) Surgical procedures that st erilize, including, but 28
not limited to, castration, vasectomy, hysterectomy, 29
oophorectomy, orchiectomy, or penectomy; 30
(b) Surgical procedures that artificially construct 31
tissue with the appearance of genitalia that differs from 32
the individual's biological sex, including, but not limited 33
to, metoidioplasty, phalloplasty, or vaginoplasty; or 34
(c) Augmentation mammoplasty or subcutaneous 35
mastectomy; 36
(6) "Health care provider", an individual who is 37
licensed, certified, or otherwise autho rized by the laws of 38
this state to administer health care in the ordinary course 39
of the practice of his or her profession; 40
(7) "Puberty-blocking drugs", gonadotropin -releasing 41
hormone analogues or other synthetic drugs used to stop 42 SB 26 3
luteinizing hormone secretion and follicle stimulating 43
hormone secretion, synthetic antiandrogen drugs to block the 44
androgen receptor, or any other drug used to delay or 45
suppress pubertal development in children for the purpose of 46
assisting an individual with a gend er transition. 47
3. A health care provider shall not knowingly perform 48
a gender transition surgery on any individual under eighteen 49
years of age. 50
4. (1) A health care provider shall not knowingly 51
prescribe or administer cross -sex hormones or puberty- 52
blocking drugs for the purpose of a gender transition for 53
any individual under eighteen years of age. 54
(2) The provisions of this subsection shall not apply 55
to the prescription or administration of cross -sex hormones 56
or puberty-blocking drugs for any individual under eighteen 57
years of age who was prescribed or administered such 58
hormones or drugs prior to August 28, 2023, for the purpose 59
of assisting the individual with a gender transition. 60
[(3) The provisions of this subsection sha ll expire on 61
August 28, 2027.] 62
5. The performance of a gender transition surgery or 63
the prescription or administration of cross -sex hormones or 64
puberty-blocking drugs to an individual under eighteen years 65
of age in violation of this section shall be considered 66
unprofessional conduct and any health care provider doing so 67
shall have his or her license to practice revoked by the 68
appropriate licensing entity or disciplinary review board 69
with competent jurisdiction in this state. 70
6. (1) The prescription or administration of cross - 71
sex hormones or puberty -blocking drugs to an individual 72
under eighteen years of age for the purpose of a gender 73
transition shall be considered grounds for a cause of action 74 SB 26 4
against the health care provider. The provisions of chapter 75
538 shall not apply to any action brought under this 76
subsection. 77
(2) An action brought pursuant to this subsection 78
shall be brought within fifteen years of the individual 79
injured attaining the age of twenty -one or of the date the 80
treatment of the injury at issue in the action by the 81
defendant has ceased, whichever is later. 82
(3) An individual bringing an action under this 83
subsection shall be entitled to a rebuttable presumption 84
that the individual was harmed if the i ndividual is 85
infertile following the prescription or administration of 86
cross-sex hormones or puberty -blocking drugs and that the 87
harm was a direct result of the hormones or drugs prescribed 88
or administered by the health care provider. Such 89
presumption may be rebutted only by clear and convincing 90
evidence. 91
(4) In any action brought pursuant to this subsection, 92
a plaintiff may recover economic and noneconomic damages and 93
punitive damages, without limitation to the amount and no 94
less than five hundred thousand dollars in the aggregate. 95
The judgment against a defendant in an action brought 96
pursuant to this subsection shall be in an amount of three 97
times the amount of any economic and noneconomic damages or 98
punitive damages assessed. Any award of damages in an 99
action brought pursuant to this subsection to a prevailing 100
plaintiff shall include attorney's fees and court costs. 101
(5) An action brought pursuant to this subsection may 102
be brought in any circuit court of this state. 103
(6) No health care provider shall require a waiver of 104
the right to bring an action pursuant to this subsection as 105
a condition of services. The right to bring an action by or 106 SB 26 5
through an individual under the age of eighteen shall not be 107
waived by a parent o r legal guardian. 108
(7) A plaintiff to an action brought under this 109
subsection may enter into a voluntary agreement of 110
settlement or compromise of the action, but no agreement 111
shall be valid until approved by the court. No agreement 112
allowed by the court shall include a provision regarding the 113
nondisclosure or confidentiality of the terms of such 114
agreement unless such provision was specifically requested 115
and agreed to by the plaintiff. 116
(8) If requested by the plaintiff, any pleadings, 117
attachments, or exhibits filed with the court in any action 118
brought pursuant to this subsection, as well as any 119
judgments issued by the court in such actions, shall not 120
include the personal identifying information of the 121
plaintiff. Such information shall be provided in a 122
confidential information filing sheet contemporaneously 123
filed with the court or entered by the court, which shall 124
not be subject to public inspection or availability. 125
7. The provisions of this section shall not apply to 126
any speech protected by the First Amendment of the United 127
States Constitution. 128
8. The provisions of this section shall not apply to 129
the following: 130
(1) Services to individuals born with a medically - 131
verifiable disorder of sex development, including, bu t not 132
limited to, an individual with external biological sex 133
characteristics that are irresolvably ambiguous, such as 134
those born with 46,XX chromosomes with virilization, 46,XY 135
chromosomes with undervirilization, or having both ovarian 136
and testicular tissue; 137 SB 26 6
(2) Services provided when a physician has otherwise 138
diagnosed an individual with a disorder of sex development 139
and determined through genetic or biochemical testing that 140
the individual does not have normal sex chromosome 141
structure, sex steroid hormone production, or sex steroid 142
hormone action; 143
(3) The treatment of any infection, injury, disease, 144
or disorder that has been caused by or exacerbated by the 145
performance of gender transition surgery or the prescription 146
or administration of cross-sex hormones or puberty -blocking 147
drugs regardless of whether the surgery was performed or the 148
hormones or drugs were prescribed or administered in 149
accordance with state and federal law; or 150
(4) Any procedure undertaken because the indivi dual 151
suffers from a physical disorder, physical injury, or 152
physical illness that would, as certified by a physician, 153
place the individual in imminent danger of death or 154
impairment of a major bodily function unless surgery is 155
performed. 156