Federal Bill Criminalizes Gender-Affirming Care for Minors, Threatens Providers with 10 Years in Prison

This bill, titled the “Protect Children’s Innocence Act,” establishes new, severe federal criminal penalties for doctors and others who perform specific medical procedures on anyone under the age of 18. Specifically, it makes “genital or bodily mutilation” and “chemical castration” of a minor a federal crime, punishable by up to 10 years in prison, fines, or both. The kicker here is how broadly the bill defines those terms: it targets what is commonly known as gender-affirming care, including puberty blockers, hormone therapy, and various related surgeries.

The New Federal Crime: What’s Off-Limits?

If you’re a parent, a doctor, or just someone trying to keep up with the policy landscape, the key takeaway is that this bill uses federal law to step directly into medical decisions about gender transition for minors. The bill’s definitions are the crucial part. “Chemical Castration” is defined to include administering medications like puberty-blocking drugs (GnRH analogues) or giving testosterone to biological females and estrogen to biological males for the purpose of changing the body to correspond to a different sex. Likewise, “Genital or Bodily Mutilation” is defined to include surgeries performed to change the body to correspond to a different sex, listing procedures like mastectomies, phalloplasty, and vaginoplasty.

This means that a doctor providing a minor with hormone therapy—a treatment currently legal and regulated in many states—could face federal prosecution if this bill passes. It also criminalizes Female Genital Mutilation (FGM) and explicitly states that religion or custom is not a valid defense, which is an important clarity on that specific issue (Sec. 2).

The Narrow Exit Ramp for Doctors

The bill does include exceptions, but they are extremely narrow and focus almost entirely on physical necessity. Procedures are exempt if they are needed for the physical health of the minor, such as treating a severe injury or a physical disorder that puts the minor in “imminent danger of major bodily function impairment.” The bill also exempts procedures for individuals with both ovarian and testicular tissue, or those with abnormal sex chromosome structure (Sec. 2).

However, the bill explicitly closes the door on the primary reason these treatments are often sought: it states that the “health of a minor” does not include mental, behavioral, or emotional distress or disorders. For a family dealing with a minor diagnosed with severe gender dysphoria, this means that even if a doctor recommends puberty blockers to alleviate profound emotional distress, that treatment would be considered a federal crime, regardless of state medical guidelines.

How Federal Law Gets Involved in Your Doctor’s Office

One of the most striking aspects of this bill is how far it stretches federal jurisdiction. Normally, medical practice is regulated at the state level. This bill applies federal criminal penalties if the act involves almost any connection to interstate commerce. This includes if the doctor or patient traveled across state lines, if the internet or phone was used to communicate about the procedure, if payment was made using interstate commerce (which covers almost all credit card or bank payments), or even if any item used in the procedure “had traveled in interstate commerce” (Sec. 2). Essentially, if the doctor used a syringe made in another state, the federal government could claim jurisdiction.

Real-World Impact: Who Pays the Price?

If this bill becomes law, the immediate impact would be felt by three groups. First, medical practitioners would be forced to immediately stop providing gender-affirming care to minors nationwide, even in states where it is currently protected, facing the risk of a decade in federal prison. Second, transgender minors and their families would lose access to medically recommended care, regardless of the severity of their condition or their doctor’s advice. Third, it could create legal uncertainty for individuals with complex intersex conditions. While the bill tries to exempt some intersex care, the broad definitions and the narrowness of the exceptions could force doctors to hesitate even on physically necessary treatments, fearing they might run afoul of the new federal crime definition.