What This Bill Does
This bill creates new rules about who can serve in the military based on gender identity. The bill directs the Secretary of Defense to write regulations within 90 days about military service for people who identify as transgender.
Who It Affects
People who identify as transgender and want to join or serve in the Armed Forces (the military), the Secretary of Defense, and members already serving in the military.
Key Provisions
• People who identify as transgender with a diagnosed condition called gender dysphoria cannot serve in the military unless they meet specific exceptions (Sec. 2(1)).
• New military members with gender dysphoria can join only if they have been stable in their biological sex for 36 consecutive months before joining (Sec. 2(1)(A)).
• Current military members diagnosed with gender dysphoria after joining can stay in the military only if they do not undergo gender transition procedures and remain deployable according to military standards for their biological sex (Sec. 2(1)(B)).
• The Defense Enrollment Eligibility Reporting System (DEERS) must be updated within 90 days so that gender markers match biological sex (Sec. 3).
• People who identify as transgender without a gender dysphoria diagnosis can serve if they are otherwise qualified and meet all physical and mental requirements for their biological sex (Sec. 2(3)).
What Changes
Military rules about transgender service would become more restrictive if this bill becomes law. Gender markers in military records would be required to match biological sex. Current military members with gender dysphoria could continue serving only in their biological sex and could receive treatment for gender dysphoria, but not gender transition procedures.
Important Definitions
The bill defines specific medical terms:
• Gender dysphoria: A significant mismatch between how someone experiences or expresses their gender and their biological sex.
• Gender transition: The process of changing from identifying with the gender that matches biological sex to identifying with a different gender, which may involve social, legal, or physical changes.
• Gender transition procedures: Medical or surgical treatments meant to change physical characteristics typical of someone's biological sex, including hormone treatments and surgeries. This does NOT include treating infections or injuries caused by previous transition procedures, or treating people born with disorders affecting sex development.
• Biological sex (also called birth sex or sex): The biological indication of male or female based on sex chromosomes, naturally occurring hormones, reproductive organs, and genitalia present at birth.
• Cross-sex hormones: Testosterone or similar drugs given to biological females in doses much larger than naturally occur, or estrogen given to biological males in doses much larger than naturally occur.
• Puberty-blocking drugs: Medications used to delay or stop puberty development in children for gender transition purposes.
Effective Date
The Secretary of Defense must write the new regulations within 90 days after this bill becomes law. Not specified in bill text when those regulations would take effect.
II
118TH CONGRESS
1ST SESSION
S. 435
To provide requirements related to the eligibility of individuals who identify
as transgender from serving in the Armed Forces.
IN THE SENATE OF THE UNITED STATES
FEBRUARY 15, 2023
Mr. RUBIO (for himself, Mrs. BLACKBURN, Mr. BUDD, Mr. TUBERVILLE, and
Mr. BRAUN) introduced the following bill; which was read twice and re-
ferred to the Committee on Armed Services
A BILL
To provide requirements related to the eligibility of individ-
uals who identify as transgender from serving in the
Armed Forces.
Be it enacted by the Senate and House of Representa-
1
tives of the United States of America in Congress assembled,
2
SECTION 1. SHORT TITLE.
3
This Act may be cited as the ‘‘Ensuring Military
4
Readiness Act of 2023’’.
5
SEC. 2. LIMITATIONS ON MILITARY SERVICE BY INDIVID-
6
UALS WHO IDENTIFY AS TRANSGENDER.
7
Not later than 90 days after the date of the enact-
8
ment of this Act, the Secretary of Defense shall prescribe
9
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regulations regarding service of individuals who identify
1
as transgender as follows:
2
(1) Persons who identify as transgender with a
3
history of diagnosis of gender dysphoria are disquali-
4
fied from military service except under the following
5
limited circumstances:
6
(A) Individuals may serve in the Armed
7
Forces if they have been stable for 36 consecu-
8
tive months in their biological sex prior to ac-
9
cession.
10
(B) Members of the Armed Forces diag-
11
nosed with gender dysphoria after entering into
12
service may be retained if they do not undergo
13
gender
transition
procedures
and
remain
14
deployable within applicable retention standards
15
for their biological sex.
16
(C) Members of the Armed Forces serving
17
as of the date of the enactment of this Act who
18
have been diagnosed with gender dysphoria may
19
continue to serve only in their biological sex, ir-
20
respective of any changes previously made to
21
their gender marker in the Defense Enrollment
22
Eligibility Reporting System (DEERS), and re-
23
ceive medically necessary treatment for gender
24
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•S 435 IS
dysphoria. Such treatment may not include gen-
1
der transition procedures.
2
(2) Persons who identify as transgender who
3
seek or have undergone gender transition are dis-
4
qualified from military service.
5
(3) Persons who identify as transgender with-
6
out a history or diagnosis of gender dysphoria, who
7
are otherwise qualified for service and meet all phys-
8
ical and mental requirements, may serve in the
9
Armed Forces in their biological sex.
10
SEC. 3. REVISED REGULATIONS REGARDING GENDER
11
MARKINGS.
12
Not later than 90 days after the date of the enact-
13
ment of this Act, the Secretary of Defense shall prescribe
14
regulations updating the Defense Enrollment Eligibility
15
Reporting System (DEERS) to require the gender mark-
16
ers for members of the Armed Forces to match their bio-
17
logical sex, irrespective of any previous changes allowed.
18
SEC. 4. DEFINITIONS.
19
In this Act:
20
(1) CROSS-SEX HORMONES.—The term ‘‘cross-
21
sex
hormones’’
means
testosterone
or
other
22
androgens given to biological females at doses that
23
are profoundly larger or more potent than would
24
normally occur naturally in healthy biological fe-
25
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males, or estrogen given to biological males at doses
1
that are profoundly larger or more potent than
2
would normally occur naturally in healthy biological
3
males.
4
(2) GENDER.—The term ‘‘gender’’ means the
5
psychological, behavioral, social, and cultural aspects
6
of being male or female.
7
(3) GENDER DYSPHORIA.—The term ‘‘gender
8
dysphoria’’ means a marked incongruence between
9
one’s experienced or expressed gender and biological
10
sex.
11
(4) GENDER TRANSITION.—The term ‘‘gender
12
transition’’ means the process by which a person
13
goes from identifying with and living as a gender
14
that corresponds to his or her biological sex to iden-
15
tifying with and living as a gender different from his
16
or her biological sex, and may involve social, legal,
17
or physical changes.
18
(5) GENDER
TRANSITION
PROCEDURES.—The
19
term ‘‘gender transition procedures’’—
20
(A) means—
21
(i) any medical or surgical interven-
22
tion, including physician’s services, inpa-
23
tient and outpatient hospital services, or
24
prescribed drugs related to gender transi-
25
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tion, that seeks to alter or remove physical
1
or anatomical characteristics or features
2
that are typical for the individual’s biologi-
3
cal sex or to instill or create physiological
4
or anatomical characteristics that resemble
5
a sex different from the individual’s birth
6
sex, including medical services that provide
7
puberty-blocking
drugs,
cross-sex
hor-
8
mones, or other mechanisms to promote
9
the
development
of
feminizing
or
10
masculinizing features (in the opposite
11
sex); and
12
(ii) genital or non-genital gender tran-
13
sition surgery performed for the purpose of
14
assisting an individual with a gender tran-
15
sition; and
16
(B) does not include—
17
(i) services to those born with a medi-
18
cally verifiable disorder of sex development,
19
including a person with external biological
20
sex characteristics that are irresolvably
21
ambiguous, such as those born with 46 XX
22
chromosomes with virilization, 46 XY chro-
23
mosomes with undervirilization, or having
24
both ovarian and testicular tissue;
25
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(ii) services provided when a physician
1
has otherwise diagnosed a disorder of sex-
2
ual development, in which the physician
3
has determined through genetic or bio-
4
chemical testing that the person does not
5
have normal sex chromosome structure, sex
6
steroid hormone production, or sex steroid
7
hormone action for a biological male or bi-
8
ological female; or
9
(iii) the treatment of any infection, in-
10
jury, disease, or disorder that has been
11
caused by or exacerbated by the perform-
12
ance of gender transition procedures,
13
whether or not the gender transition proce-
14
dure was performed in accordance with
15
State and Federal law or whether or not
16
funding for the gender transition proce-
17
dure is permissible.
18
(6) GENDER TRANSITION SURGERY.—The term
19
‘‘gender transition surgery’’ means any medical or
20
surgical service that seeks to surgically alter or re-
21
move healthy physical or anatomical characteristics
22
or features that are typical for the individual’s bio-
23
logical sex in order to instill or create physiological
24
or anatomical characteristics that resemble a sex dif-
25
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ferent from the individual’s birth sex, including gen-
1
ital or non-genital gender reassignment surgery per-
2
formed for the purpose of assisting an individual
3
with a gender transition.
4
(7) GENITAL GENDER TRANSITION SURGERY.—
5
The term ‘‘genital gender transition surgery’’ in-
6
cludes surgical procedures such as penectomy,
7
orchiectomy,
vaginoplasty,
clitoroplasty,
or
8
vulvoplasty
for
biologically
male
patients
or
9
hysterectomy, ovariectomy, reconstruction of the
10
fixed part of the urethra with or without a
11
metoidioplasty
or
a
phalloplasty,
vaginectomy,
12
scrotoplasty, or implantation of erection or testicular
13
prostheses for biologically female patients, when per-
14
formed for the purpose of assisting an individual
15
with a gender transition.
16
(8) NON-GENITAL
GENDER
TRANSITION
SUR-
17
GERY.—The term ‘‘non-genital gender transition
18
surgery’’—
19
(A) includes, when performed for the pur-
20
pose of assisting an individual with a gender
21
transition—
22
(i) surgical procedures such as aug-
23
mentation mammoplasty, facial feminiza-
24
tion surgery, liposuction, lipofilling, voice
25
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surgery, thyroid cartilage reduction, gluteal
1
augmentation (implants or lipofilling), hair
2
reconstruction, or various aesthetic proce-
3
dures for biologically male patients; or
4
(ii) subcutaneous mastectomy, voice
5
surgery, liposuction, lipofilling, pectoral
6
implants or various aesthetic procedures
7
for biologically female patients; and
8
(B) does not include any procedure under-
9
taken because the individual suffers from a
10
physical disorder, physical injury, or physical
11
illness that would, as certified by a physician,
12
place the individual in imminent danger of
13
death or impairment of major bodily function
14
unless surgery is performed, unless the proce-
15
dure is for the purpose of a gender transition.
16
(9) PUBERTY-BLOCKING
DRUGS.—The term
17
‘‘puberty-blocking drugs’’ means, when used to delay
18
or suppress pubertal development in children for the
19
purpose of assisting an individual with a gender
20
transition—
21
(A)
Gonadotropin-releasing
hormone
22
(GnRH) analogues or other synthetic drugs
23
used in biological males to stop luteinizing hor-
24
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mone secretion and therefore testosterone secre-
1
tion; and
2
(B) synthetic drugs used in biological fe-
3
males that stop the production of estrogen and
4
progesterone.
5
(10) SEX; BIRTH SEX; BIOLOGICAL SEX.—The
6
terms ‘‘sex’’, ‘‘birth sex,’’ and ‘‘biological sex’’ refer
7
to the biological indication of male and female in the
8
context of reproductive potential or capacity, such as
9
sex chromosomes, naturally occurring sex hormones,
10
gonads, and non-ambiguous internal and external
11
genitalia present at birth, without regard to an indi-
12
vidual’s psychological, chosen, or subjective experi-
13
ence of gender.
14
Æ
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