Bill Text: IA SF129 | 2023-2024 | 90th General Assembly | Introduced
Bill Title: A bill for an act relating to actions relative to treatment or intervention regarding the discordance between a minor's sex and gender identity, and providing civil penalties.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced) 2023-01-31 - Subcommittee: Edler, Petersen, and Salmon. S.J. 217. [SF129 Detail]
Download: Iowa-2023-SF129-Introduced.html
Senate
File
129
-
Introduced
SENATE
FILE
129
BY
SALMON
A
BILL
FOR
An
Act
relating
to
actions
relative
to
treatment
or
1
intervention
regarding
the
discordance
between
a
minor’s
sex
2
and
gender
identity,
and
providing
civil
penalties.
3
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
4
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Section
1.
FINDINGS.
The
general
assembly
finds
all
of
the
1
following:
2
1.
“Sex”
is
the
biological
state
of
being
female
or
male,
3
based
on
sex
organs,
chromosomes,
and
endogenous
hormone
4
profiles.
An
individual’s
sex
is
genetically
encoded
into
5
an
individual
at
the
moment
of
conception,
and
it
cannot
be
6
changed.
7
2.
Some
individuals,
including
minors,
may
experience
8
discordance
between
their
sex
and
their
internal
sense
9
of
gender
identity.
Individuals
who
experience
severe
10
psychological
distress
as
a
result
of
this
discordance
may
be
11
diagnosed
with
gender
dysphoria.
12
3.
The
cause
of
the
individual’s
impression
of
discordance
13
between
sex
and
gender
identity
is
unknown.
Diagnosis
is
based
14
exclusively
on
the
individual’s
self-report
of
feelings
and
15
beliefs.
16
4.
This
internal
sense
of
discordance
is
not
permanent
or
17
fixed.
To
the
contrary,
numerous
studies
have
shown
that
a
18
substantial
majority
of
children
who
experience
discordance
19
between
their
sex
and
gender
identity
will
outgrow
the
20
discordance
once
they
go
through
puberty
and
will
eventually
21
have
a
gender
identity
that
aligns
with
their
sex.
22
5.
As
a
result,
taking
a
wait-and-see
approach
to
children
23
who
reveal
signs
of
gender
nonconformity
results
in
a
large
24
majority
of
such
children
resolving
to
a
gender
identity
25
congruent
with
their
sex
by
late
adolescence.
26
6.
Some
in
the
medical
community
are
aggressively
pushing
27
for
interventions
on
children
that
medically
alter
a
child’s
28
hormonal
balance
and
remove
healthy
external
and
internal
sex
29
organs
when
the
child
expresses
a
desire
to
appear
as
a
sex
30
different
from
the
child’s
own.
31
7.
This
course
of
treatment
for
children
commonly
begins
32
with
encouraging
and
assisting
a
child
to
socially
transition
33
to
dressing
and
presenting
as
the
opposite
sex.
In
the
case
34
of
prepubertal
children,
as
puberty
begins,
doctors
then
35
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administer
long-acting
gonadotropin-releasing
hormone
(GnRH)
1
agonists
or
puberty
blockers
that
suppress
the
pubertal
2
development
of
the
child.
This
use
of
puberty
blockers
for
3
gender
nonconforming
children
is
experimental
and
not
approved
4
by
the
United
States
food
and
drug
administration.
5
8.
After
puberty
is
blocked,
the
child
is
administered
6
cross-sex
hormonal
treatments
that
induce
the
development
7
of
secondary
sex
characteristics
of
the
other
sex,
such
as
8
causing
the
development
of
breasts
and
wider
hips
in
male
9
children
taking
estrogen
and
greater
muscle
mass,
bone
density,
10
body
hair,
and
a
deeper
voice
in
female
children
taking
11
testosterone.
Some
children
are
administered
these
hormones
12
independent
of
any
prior
pubertal
blockade.
13
9.
The
final
phase
of
treatment
is
for
the
child
to
undergo
14
cosmetic
and
other
surgical
procedures,
often
to
create
an
15
appearance
similar
to
that
of
the
opposite
sex.
These
surgical
16
procedures
may
include
a
mastectomy
to
remove
a
female
child’s
17
breasts
and
bottom
surgery
that
removes
a
child’s
healthy
18
reproductive
organs
and
creates
an
artificial
form
aiming
to
19
approximate
the
appearance
of
the
genitals
of
the
opposite
sex.
20
10.
For
children
who
are
placed
on
puberty
blockers
that
21
inhibit
their
bodies
from
experiencing
the
natural
process
of
22
sexual
development,
the
overwhelming
majority
will
continue
23
down
a
path
toward
cross-sex
hormones
and
cosmetic
surgery.
24
11.
This
unproven,
poorly
studied
series
of
interventions
25
results
in
numerous
harmful
effects
for
children,
as
well
as
26
risks
of
effects
simply
unknown
due
to
the
new
and
experimental
27
nature
of
these
interventions.
28
12.
Among
the
known
harms
from
puberty
blockers
are
29
diminished
bone
density.
The
full
effect
of
puberty
blockers
30
on
brain
development
and
cognition
are
yet
unknown,
though
31
reason
for
concern
is
now
present.
There
is
no
research
on
the
32
long-term
risks
to
children
of
persistent
exposure
to
puberty
33
blockers.
With
the
administration
of
cross-sex
hormones
comes
34
increased
risks
of
cardiovascular
disease,
thromboembolic
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stroke,
asthma,
chronic
obstructive
pulmonary
disease,
and
1
cancer.
2
13.
Puberty
blockers
prevent
gonadal
maturation
and
thus
3
render
children
taking
these
drugs
infertile.
Introducing
4
cross-sex
hormones
to
children
with
immature
gonads
as
a
5
direct
result
of
pubertal
blockade
is
expected
to
cause
6
irreversible
sterility.
Sterilization
is
also
permanent
for
7
those
who
undergo
surgery
to
remove
reproductive
organs,
8
and
such
children
are
likely
to
suffer
through
a
lifetime
9
of
complications
from
the
surgery,
infections,
and
other
10
difficulties
requiring
yet
more
medical
intervention.
11
14.
Several
studies
demonstrate
that
hormonal
and
surgical
12
interventions
often
do
not
resolve
the
underlying
psychological
13
issues
affecting
the
individual.
For
example,
individuals
14
who
undergo
cross-sex
cosmetic
surgical
procedures
have
been
15
found
to
suffer
from
elevated
mortality
rates
from
medical
16
and
psychological
conditions.
Their
suicide
rate
is
nineteen
17
times
higher
than
the
general
population.
They
experience
18
significantly
higher
rates
of
substance
abuse,
depression,
and
19
psychiatric
hospitalizations.
20
15.
Children,
and
often
their
parents,
are
unable
to
21
comprehend
and
fully
appreciate
the
risk
and
life
implications,
22
including
permanent
sterility,
that
result
from
the
use
of
23
puberty
blockers,
cross-sex
hormones,
and
surgical
procedures.
24
16.
For
these
reasons,
the
decision
to
pursue
a
course
of
25
hormonal
and
surgical
interventions
to
address
a
discordance
26
between
an
individual’s
sex
and
sense
of
gender
identity
27
should
not
be
presented
to
or
determined
for
children
who
28
are
incapable
of
comprehending
the
negative
implications
and
29
life-course
difficulties
resulting
from
these
interventions.
30
Sec.
2.
NEW
SECTION
.
147.164
Definitions.
31
As
used
in
this
chapter,
unless
the
context
otherwise
32
requires:
33
1.
“Gender
dysphoria”
means
discomfort
or
distress
over
a
34
marked
incongruence
between
an
individual’s
sex
and
the
gender
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with
which
the
individual
identifies.
1
2.
“Gender
nonconformity”
means
behavior
or
gender
2
expression
by
an
individual
that
does
not
match
gender
norms
3
for
the
individual’s
sex.
4
3.
“Government
agency”
means
a
state
agency
or
an
agent,
5
employee,
volunteer,
or
contractor
of
a
state
agency.
6
4.
“Medical
professional”
means
a
physician
or
surgeon
7
or
osteopathic
physician
and
surgeon
licensed
pursuant
to
8
chapter
148,
a
physician
assistant
licensed
pursuant
to
9
chapter
148C,
a
nurse
or
advanced
registered
nurse
practitioner
10
licensed
pursuant
to
chapter
152,
a
nurse
or
advanced
practice
11
registered
nurse
licensed
pursuant
to
chapter
152E,
or
a
12
psychiatrist
licensed
pursuant
to
chapter
148.
13
5.
“Mental
health
professional”
means
the
same
as
defined
14
in
section
228.1.
15
6.
“Minor”
or
“minor
child”
means
an
unemancipated
16
individual
under
eighteen
years
of
age.
17
7.
“Parent”
means
a
parent,
custodian,
or
guardian
as
18
defined
in
section
232.2.
19
8.
“Political
subdivision”
means
a
city,
county,
township,
20
school
district,
municipal
corporation,
special
purpose
21
district,
board,
department,
commission,
or
any
other
division
22
of
local
government,
or
an
agent,
employee,
volunteer,
or
23
contractor
of
such
entity.
24
9.
“Sex”
means
the
biological
state
of
being
female
or
25
male,
based
on
sex
organs,
chromosomes,
and
endogenous
hormone
26
profiles.
27
10.
“State
agency”
means
the
same
as
defined
in
section
28
8.11.
29
Sec.
3.
NEW
SECTION
.
147.165
Prohibited
practices.
30
1.
Notwithstanding
any
other
provision
of
law
to
the
31
contrary,
it
shall
be
unlawful
for
a
medical
professional
to
32
engage
in
any
of
the
following
practices
upon
a
minor,
or
to
33
cause
such
practice
to
be
performed
to
facilitate
a
minor’s
34
desire
to
present
or
appear
in
a
manner
that
is
inconsistent
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with
the
minor’s
sex:
1
a.
Performing
a
surgery
that
sterilizes,
including
2
castration,
vasectomy,
hysterectomy,
oophorectomy,
3
metoidioplasty,
orchiectomy,
penectomy,
phalloplasty,
and
4
vaginoplasty.
5
b.
Performing
a
mastectomy.
6
c.
Administering
or
supplying
the
following
medications
that
7
induce
transient
or
permanent
infertility:
8
(1)
Puberty-blocking
medication
to
stop
or
delay
normal
9
puberty.
10
(2)
Supraphysiologic
doses
of
testosterone
or
other
11
androgens
to
members
of
the
female
sex.
12
(3)
Supraphysiologic
doses
of
estrogen
or
synthetic
13
compounds
with
estrogenic
activity
to
members
of
the
male
sex.
14
d.
Removing
any
otherwise
healthy
or
nondiseased
body
part
15
or
tissue.
16
2.
A
medical
professional
who
engages
in
any
of
the
17
practices
prohibited
under
this
section
or
who
causes
such
18
practices
to
be
performed
shall
be
subject
to
revocation
of
19
licensure
and
other
appropriate
discipline
by
the
medical
20
professional’s
licensing
board.
A
medical
professional
who
21
violates
this
section
shall
also
be
subject
to
a
civil
penalty
22
of
up
to
one
thousand
dollars
per
occurrence
of
a
violation.
23
3.
This
section
shall
not
apply
to
the
good
faith
medical
24
decision
of
a
parent
of
a
minor
born
with
a
medically
25
verifiable
genetic
disorder
of
sexual
development,
including
26
any
of
the
following:
27
a.
A
minor
with
external
biological
sex
characteristics
that
28
are
irresolvably
ambiguous,
such
as
a
minor
born
with
forty-six
29
XX
chromosomes
with
virilization,
forty-six
XY
chromosomes
with
30
undervirilization,
or
with
both
ovarian
and
testicular
tissue.
31
b.
When
a
medical
professional
has
otherwise
diagnosed
32
a
disorder
of
sexual
development
in
which
the
medical
33
professional
has
determined
through
genetic
testing
that
the
34
minor
does
not
have
the
normal
sex
chromosome
structure
for
a
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male
or
female.
1
Sec.
4.
NEW
SECTION
.
147.166
Counseling.
2
A
government
agency,
political
subdivision,
or
any
3
organization
with
authority
to
license
or
discipline
the
4
members
of
a
profession
shall
not
prohibit,
impose
any
5
penalty,
or
take
any
adverse
action
against
any
member
of
such
6
profession
who
gives
or
receives
counsel,
advice,
guidance,
7
or
any
other
communication
however
described,
and
whether
or
8
not
in
exchange
for
a
fee,
in
accordance
with
this
chapter
and
9
consistent
with
the
professional’s
conscience
or
religious
10
belief.
11
Sec.
5.
NEW
SECTION
.
147.167
Protection
of
parental
rights.
12
1.
A
parent,
in
exercising
the
fundamental
right
to
care
13
for
the
parent’s
minor
child,
may
withhold
consent
for
any
14
treatment,
activity,
or
mental
health
service
that
is
designed
15
and
intended
to
form
the
minor
child’s
conception
of
sex
and
16
gender
or
to
treat
gender
dysphoria
or
gender
nonconformity.
A
17
government
agency
or
political
subdivision
shall
not
infringe
18
upon
or
impede
the
exercise
of
this
right.
19
2.
Notwithstanding
any
provision
to
the
contrary,
a
20
government
agency
or
political
subdivision
shall
not
encourage
21
or
coerce
a
minor
to
withhold
information
from
the
minor’s
22
parent,
and
shall
not
withhold
information
from
a
minor’s
23
parent
that
is
relevant
to
the
physical
or
mental
health
of
24
the
minor
exhibiting
symptoms
of
gender
dysphoria,
gender
25
nonconformity,
or
otherwise
demonstrating
a
desire
to
be
26
treated
in
a
manner
incongruent
with
the
minor’s
sex.
27
3.
Notwithstanding
any
provision
to
the
contrary,
if
a
28
government
agency
or
political
subdivision
has
knowledge
that
29
a
minor
under
the
care
or
supervision
of
a
government
agency
30
or
political
subdivision
has
exhibited
symptoms
of
gender
31
dysphoria,
gender
nonconformity,
or
has
otherwise
demonstrated
32
a
desire
to
be
treated
in
a
manner
incongruent
with
the
minor’s
33
sex,
the
government
agency
or
political
subdivision
shall
34
immediately
notify,
in
writing,
any
parent
of
the
minor.
The
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notice
shall
describe
all
of
the
relevant
circumstances
with
1
reasonable
specificity.
2
Sec.
6.
NEW
SECTION
.
147.168
Whistleblower
protection.
3
1.
An
individual
shall
not
be
discriminated
against
in
any
4
manner
because
the
individual
does
any
of
the
following:
5
a.
Provides
or
causes
to
be
provided
to
the
individual’s
6
employer,
the
office
of
the
attorney
general,
the
civil
rights
7
commission,
or
any
applicable
federal
agency,
information
8
relating
to
any
violation
of
this
chapter.
9
b.
Testifies
in
a
proceeding
concerning
a
violation
of
this
10
chapter.
11
c.
Assists
or
participates
in
a
proceeding
concerning
12
violation
of
this
chapter.
13
2.
Unless
the
disclosure
is
otherwise
specifically
14
prohibited
by
law,
an
individual
shall
not
be
discriminated
15
against
in
any
manner
because
the
individual
disclosed
16
information
under
this
chapter
that
the
individual
believes
17
evinces
any
of
the
following:
18
a.
A
violation
of
any
law,
rule,
or
regulation.
19
b.
A
violation
of
any
standard
of
care
or
other
ethical
20
guidelines
for
the
provision
of
any
health
care
service.
21
c.
Gross
mismanagement,
a
gross
waste
of
funds,
an
abuse
22
of
authority,
or
a
substantial
and
specific
danger
to
public
23
health
or
safety.
24
Sec.
7.
NEW
SECTION
.
147.169
Judicial
relief.
25
1.
A
person
harmed
by
a
violation
of
section
147.165
may
26
bring
an
action
for
injunctive
relief,
compensatory
and
special
27
damages,
and
any
other
relief
available
under
law
against
any
28
person
responsible
for
the
violation.
29
2.
A
person
harmed
by
a
violation
of
section
147.166,
30
147.167,
or
147.168
may
bring
an
action
for
injunctive
relief,
31
compensatory
and
special
damages,
and
any
other
relief
32
available
under
law
against
a
government
agency,
political
33
subdivision,
or
any
other
person
who
is
responsible
for
the
34
violation.
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3.
a.
Unless
paragraph
“b”
applies,
an
action
under
this
1
chapter
is
barred
unless
the
action
is
commenced
within
two
2
years
after
the
cause
of
action
accrues.
3
b.
Notwithstanding
any
provision
to
the
contrary,
including
4
sections
614.8
and
614.8A,
a
minor
injured
by
practices
5
prohibited
under
section
147.165
may
bring
an
action
during
the
6
minor’s
minority
through
a
parent
or
guardian,
and
may
bring
an
7
action
in
the
minor’s
own
name
upon
reaching
majority
and
for
8
twenty
years
after
reaching
majority.
9
4.
A
person
shall
have
standing
to
assert
a
claim
or
defense
10
under
this
section
if
the
person
is
adversely
affected
by
an
11
alleged
violation
or
the
alleged
failure
to
perform
a
duty
or
12
act
under
this
chapter.
13
5.
A
person
who
prevails
on
a
claim
brought
pursuant
to
14
this
section
shall
be
entitled
to
monetary
damages,
including
15
for
all
psychological,
emotional,
and
physical
harm
suffered,
16
reasonable
attorney
fees
and
costs,
and
any
other
appropriate
17
relief.
18
Sec.
8.
NEW
SECTION
.
147.170
Preemption
——
immunity.
19
1.
A
political
subdivision
is
preempted
from
enacting,
20
adopting,
maintaining,
or
enforcing
any
order,
ordinance,
rule,
21
regulation,
policy,
or
other
similar
measure
that
prohibits,
22
restricts,
limits,
controls,
directs,
or
otherwise
interferes
23
with
the
professional
conduct
and
judgment
of
a
mental
health
24
professional,
including
speech,
undertaken
under
this
chapter
25
within
the
course
of
treatment
and
communication
with
clients,
26
patients,
other
persons,
or
the
public,
including
but
not
27
limited
to
therapies,
counseling,
referrals,
and
education.
28
2.
The
attorney
general
or
a
mental
health
professional
29
adversely
affected
may
bring
an
action
for
injunctive
relief
30
to
prevent
or
restrain
a
violation
of
this
section.
A
mental
31
health
professional
may
recover
reasonable
costs
and
attorney’s
32
fees
incurred
in
obtaining
injunctive
relief
under
this
33
section.
34
3.
Sovereign
and
governmental
immunity
from
a
civil
action
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or
from
liability
do
not
apply
to
violations
of
this
chapter.
1
Sec.
9.
CODE
EDITOR
DIRECTIVE.
The
Code
editor
may
create
2
a
new
subchapter
in
chapter
147,
codifying
sections
147.164
3
through
147.170,
as
enacted
in
this
Act,
entitled
“Gender
and
4
Sexual
Discordance
——
Minors”.
5
EXPLANATION
6
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
7
the
explanation’s
substance
by
the
members
of
the
general
assembly.
8
This
bill
includes
provisions
relating
to
practices
9
undertaken
to
cause
a
minor
to
physically
appear
more
like
10
a
person
of
the
opposite
sex
and
less
like
the
minor’s
own
11
sex,
or
to
conform
to
a
gender
identity
incongruent
with
the
12
minor’s
sex.
The
bill
contains
findings
regarding
the
harms
13
and
ineffectiveness
of
such
practices
and
contains
definitions
14
used
in
the
bill.
15
The
bill
makes
it
unlawful
for
a
medical
professional
to
16
perform
interventions
or
surgical
procedures
specified
in
17
the
bill
on
a
minor,
and
subjects
a
medical
professional
to
18
disciplinary
action
and
civil
penalties
for
providing
the
19
prohibited
treatments
to
or
performing
surgical
procedures
on
20
a
minor,
unless
the
treatment
occurs
based
on
the
good
faith
21
medical
decision
of
a
parent
of
a
minor
born
with
a
medically
22
verifiable
genetic
disorder
of
sexual
development.
23
The
bill
protects
the
freedom
of
members
of
a
profession
to
24
provide
counseling,
in
accordance
with
the
bill
and
consistent
25
with
the
individual’s
conscience
or
religious
belief.
26
The
bill
includes
protections
for
parents
to
decline
27
treatment,
activity,
or
mental
health
care
services
intended
28
to
form
their
minor
child’s
conception
of
sex
and
gender
or
29
to
treat
gender
dysphoria
or
gender
nonconformity.
The
bill
30
also
requires
government
agencies
and
political
subdivisions
31
to
inform
parents
of
any
information
relevant
to
the
physical
32
or
mental
health
of
a
minor
exhibiting
symptoms
of
gender
33
dysphoria,
gender
nonconformity,
or
otherwise
demonstrating
a
34
desire
to
be
treated
in
a
manner
incongruent
with
the
minor’s
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sex.
1
The
bill
includes
protections
for
individuals
who
provide
2
information
relating
to
violations
of
the
bill.
3
The
bill
provides
a
private
right
of
action
against
any
4
person
who
violates
the
bill,
and
creates
a
statute
of
5
limitations
for
minors
to
bring
certain
claims
within
20
years
6
of
reaching
majority.
7
The
bill
preempts
political
subdivisions
from
having
8
measures
in
place
that
interfere
with
the
professional
conduct
9
and
judgment
of
a
mental
health
professional
undertaken
10
under
the
bill
within
a
course
of
treatment
or
communication;
11
provides
for
injunctive
relief
for
a
violation
of
this
12
provision;
and
provides
that
sovereign
and
governmental
13
immunity
from
a
civil
action
or
from
liability
do
not
apply
to
14
violations
of
the
bill.
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