SB1095 - 572R

Be it enacted by the Legislature of the State of Arizona:

Section 1. Section 32-3230, Arizona Revised Statutes, is amended to read:

START_STATUTE32-3230. Minors; irreversible gender reassignment surgery; gender transition procedures; referrals; prohibition; right of action; enforcement; definitions

A. A physician or other health professional may not do any of the following:

1. Provide irreversible gender reassignment surgery to any individual who is under eighteen years of age.

2. provide a gender transition procedure to any individual who is under eighteen years of age.

3. refer any individual who is under eighteen years of age to another HEALTH professional for a gender transition procedure.

B. A physician or other health professional may provide any of the following to an individual who is under eighteen years of age:

1. Services to an individual born with a medically verifiable disorder of sex development, including an individual with external biological sex characteristics that are irresolvably ambiguous, such as being born with forty-six XX chromosomes with virilization or forty-six XY chromosomes with undervirilization or having both ovarian and testicular tissue.

2. Services provided when a physician has otherwise diagnosed a disorder of sexual development and 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.

3. 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.

4. Any procedure undertaken because the individual suffers from a physical disorder, physical injury or physical illness that would, as certified by a physician, place the individual in imminent danger of death or impairment of major bodily function unless surgery is performed.

C. Any health professional who makes a referral for or provides a gender transition procedure to any individual who is under eighteen years of age commits unprofessional conduct and is subject to discipline by the appropriate licensing entity or health profession regulatory board.

D. An individual may assert an actual or threatened violation of this section as a claim or defense in a judicial or administrative proceeding and obtain compensatory damages, injunctive relief, declaratory relief or any other appropriate relief. An individual shall bring a claim for a violation of this section not later than two years after the date the cause of action accrues. An individual who is under eighteen years of age may bring an action throughout the individual's minority through a parent or next friend and may bring an action in the individual's own name on attaining eighteen years of age until twenty years after attaining eighteen years of age.

E. Notwithstanding any other law, an action under this section may be commenced and relief may be granted in a judicial proceeding without regard to whether the individual commencing the action has sought or exhausted available administrative remedies. In any action or proceeding to enforce this section, a prevailing party who establishes a violation of this section shall recover reasonable attorney fees.

F. The attorney general may bring an action to enforce compliance with this section. This section does not deny, impair or otherwise affect any right or authority of the attorney general, this state or any agency, officer or employee of this state, acting under any law other than this section, to institute or intervene in any proceeding.

C. G. For the purposes of this section:

1. "Biological sex" means the biological indication of male and female in the context of reproductive potential or capacity, such as sex chromosomes, naturally occurring sex hormones, gonads and nonambiguous internal and external genitalia present at birth, without regard to an individual's psychological, chosen or subjective experience of gender.

2. "Cross-sex hormones" means either of the following:

(a) Testosterone or other androgens given to biological females in amounts that are larger or more potent than would normally occur naturally in healthy biological sex females.

(b) Estrogen given to biological males in amounts that are larger or more potent than would normally occur naturally in healthy biological sex males.

2. 3. "Gender" means the psychological, behavioral, social and cultural aspects of being male or female.

3. 4. "Gender transition" means the process in which a person an individual goes from identifying with and living as a gender that corresponds to the person's individual's biological sex to identifying with and living as a gender different from the person's individual's biological sex and may involve social, legal or physical changes.

5. "Gender transition procedure":

(a) Means any medical or surgical service, including physician services, inpatient and outpatient hospital services or prescribed drugs related to gender transition, that seeks to either:

(i) Alter or remove physical or anatomical characteristics or features that are typical for an individual's biological sex.

(ii) Instill or create physical or anatomical characteristics that resemble a sex different from an individual's biological sex, including medical services that provide puberty-blocking drugs, cross-sex hormones or other mechanisms to promote the development of feminizing or masculinizing features in an individual of the opposite biological sex or genital or nongenital gender reassignment surgery performed for the purpose of assisting an individual with a gender transition.

(b) Does not include any of the following:

(i) Services to individuals born with a medically verifiable disorder of sex development, including an individual with external biological sex characteristics that are irresolvably ambiguous, such as being born with forty-six XX chromosomes with virilization or forty-six XY chromosomes with undervirilization or having both ovarian and testicular tissue.

(ii) Services provided when a physician has otherwise diagnosed a disorder of sexual development and 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.

(iii) The treatment of any infection, injury, disease or disorder that has been caused or exacerbated by the performance of a gender transition procedure, 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 allowable under this section.

(iv) Any procedure undertaken because the individual suffers from a physical disorder, physical injury or physical illness that would, as certified by a physician, place the individual in imminent danger of death or impairment of a major bodily function unless surgery is performed.

4. 6. "Irreversible gender reassignment surgery" means a medical procedure performed for the purpose of assisting an individual with a gender transition, including any of the following:

(a) Penectomy, orchiectomy, vaginoplasty, clitoroplasty or vulvoplasty for biologically male patients or hysterectomy or ovariectomy for biologically female patients.

(b) Metoidioplasty, phalloplasty, vaginectomy, scrotoplasty or implantation of erection or testicular prostheses for biologically female patients.

5. 7. "Physician" means a person who is licensed pursuant to chapter 13 or 17 of this title.

8. "Puberty-blocking drugs" means either of the following when used to delay or suppress pubertal development in children for the purpose of assisting an individual with a gender transition:

(a) Gonadotropin-releasing hormone analogs or other synthetic drugs used in biological sex males to stop luteinizing hormone secretion and testosterone secretion.

(b) Synthetic drugs used in biological sex females to stop the production of estrogens and progesterone. END_STATUTE

Sec. 2. Effective date; purpose

A. This act is effective from and after March 31, 2027.

B. The effective date of this act is delayed so that minors in this state who are currently using puberty-blocking drugs or cross-sex hormones have time for appropriate medication tapering and discontinuation under the care of the minor's physician or other health professional.