S. 4426

119 S4426 IS: Safeguarding The Overall Protection of Minors Act
 U.S. Senate
 2026-04-29
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 Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
 II  119th CONGRESS  2d Session  S. 4426  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.
1.
Short title
This Act may be cited as the   Safeguarding The Overall Protection of Minors Act   or the   STOP Act  .
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.
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.
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.