2021 - 2022 LEGISLATURE
February 1, 2022 - Introduced by Senators Jacque,
Stroebel and Bernier,
cosponsored by Representatives
Allen, Knodl, Wichgers, Gundrum,
Skowronski, Penterman, Steffen, Murphy, Brandtjen, Behnke, Dittrich
and Schraa. Referred to Committee on Human Services, Children and
1An Act to amend
448.02 (3) (a); and
146.36 and 632.8983 of the 2
statutes; relating to: gender transition procedures.
Analysis by the Legislative Reference Bureau
This bill prohibits physician and health care providers from providing any
gender transition procedure to an individual under 18 years of age. The bill also
prohibits a physician or health care provider from referring an individual under 18
years of age to any other health care provider for any gender transition procedure.
“Gender transition procedure” is defined in the bill as a medical or surgical service
provided or performed for the purpose of assisting an individual with a physical
Under the bill, no one may use public moneys for any entity, organization, or
individual that provides any gender transition procedure to an individual under 18
years of age. Facilities owned by and health care providers employed by the state
may not include gender transition procedures for individuals under 18 years of age
in their provided health care services. Under the bill, amounts paid by an entity,
organization, or individual for a gender transition procedure or for premiums for
health care coverage that includes gender transition procedures is not tax
The bill prohibits the Department of Health Services from reimbursing or
providing as a benefit under the Medical Assistance program any gender transition
procedure for an individual under 18 years of age. The bill also prohibits a health
insurance policy or self-insured governmental health plan from providing coverage
of any gender transition procedure for an individual under 18 years of age. Health
insurance policies are referred to in the bill as disability insurance policies.
The bill specifies that a violation of the prohibitions on providing to an
individual under 18 years of age, or referring an individual under 18 years of age for,
a gender transition procedure is presumed to be reckless conduct for purposes of civil
liability. The bill explicitly allows an individual injured by such a violation or a
parent, guardian, or legal representative of an injured individual to bring a claim for
any of the damages specified in the bill. The action must be commenced before 30
years after the date the injured individual reached the age of 18. A legal disability
of the injured individual when the individual attains the age of 18 tolls the time to
bring the action until the disability is resolved. Any time during which the injured
individual is subject to threats, intimidation, manipulation, fraudulent
concealment, or fraud by the physician or health care provider involved in the gender
transition procedure or a person acting in that physician's or health care provider's
interest also tolls the time to bring the action. Under the bill, an allegation that a
physician violated either of the prohibitions on providing to an individual under 18
years of age, or referring an individual under 18 years of age for, a gender transition
procedure is considered an allegation of unprofessional conduct, and the Medical
Examining Board is required to investigate allegations of unprofessional conduct.
The attorney general and any district attorney is also authorized to bring an action
to enforce the bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
146.36 of the statutes is created to read:
2146.36 Gender transition procedures. (1) Definitions.
In this section:
(a) “Biological sex” means the biological indication of male or female in the 4
context of reproductive potential or capacity, such as by sex chromosomes, naturally 5
occurring sex hormones, gonads, and unambiguous internal and external genitalia 6
present at birth, without regard to psychological, chosen, or subjective experience of 7
(b) “Cross-sex hormones” means any of the following:
1. Testosterone or other androgens given to biological females in amounts that 10
are larger or more potent than would normally occur naturally in healthy biological 11
2. Estrogen given to biological males in amounts that are larger or more potent 2
than would normally occur naturally in healthy biological males.
(c) “Gender reassignment surgery” means any medical or surgical service that 4
seeks to surgically alter or remove healthy physical or anatomical characteristics or 5
features that are typical for an individual's biological sex in order to instill or create 6
physiological or anatomical characteristics that resemble a sex different from the 7
individual's biological sex, including genital gender reassignment surgery or 8
nongenital gender reassignment surgery performed for the purpose of assisting an 9
individual with a gender transition.
(d) “Gender transition” means a process, which may involve social, legal, or 11
physical changes, in which an individual goes from identifying with and living as a 12
gender that corresponds with the individual's biological sex to identifying with and 13
living as a gender different from the individual's biological sex.
(e) 1. “Gender transition procedure” means any medical or surgical service 15
provided or performed for the purpose of assisting an individual with a physical 16
2. “Gender transition procedure” includes any physician's service, inpatient 18
and outpatient hospital service, puberty-blocking drug, cross-sex hormone, genital 19
gender reassignment surgery, or nongenital gender reassignment surgery.
3. “Gender transition procedure” does not include any of the following:
a. A service provided to individuals who are born with a medically verifiable 22
disorder of sex development, including individuals with external biological sex 23
characteristics that are irresolvably ambiguous, such as those born with 46,XX 24
karyotype with virilization, born with 46,XY karyotype with under virilization, or 25
having both ovarian and testicular tissue.
b. A service provided when a physician has diagnosed a disorder of sexual 2
development by determining, through genetic or biochemical testing, that the 3
individual does not have normal sex chromosome structure, sex steroid hormone 4
production, or sex steroid hormone action.
c. The acute or chronic treatment of any infection, injury, disease, or disorder 6
that has been caused by or exacerbated by the performance of a gender transition 7
procedure, whether or not the gender transition procedure was performed in 8
accordance with state and federal law and whether or not funding for the gender 9
transition procedure is permissible under this section.
d. Any procedure undertaken because the individual suffers from a physical 11
disorder, physical injury, or physical illness that would, as certified by a physician, 12
place the individual in imminent danger of death or impairment of a major bodily 13
function unless surgery is performed.
(f) “Genital gender reassignment surgery” means a medical procedure, 15
including any of the following surgical procedures, that is performed for the purpose 16
of assisting an individual with a physical gender transition:
1. For individuals of male biological sex, a penectomy, an orchiectomy, a 18
vaginoplasty, a clitoroplasty, or a vulvoplasty.
2. For individuals of female biological sex, a hysterectomy, an oophorectomy, 20
a reconstruction of the urethra, a metoidioplasty or phalloplasty, a vaginectomy, a 21
scrotoplasty, or an implantation of erectile or testicular prostheses.
(g) “Health care provider” has the meaning given in s. 146.81 (1) (a) to (hp).
(h) “Nongenital gender reassignment surgery” means a medical procedure, 24
including any of the following surgical procedures, that is performed for the purpose 25
of assisting an individual with a physical gender transition:
1. For individuals of male biological sex, augmentation mammoplasty, facial 2
feminization surgery, liposuction, lipofilling, voice feminization surgery, thyroid 3
cartilage reduction, gluteal augmentation, hair reconstruction, or any of various 4
2. For individuals of female biological sex, subcutaneous mastectomy, voice 6
masculinization surgery, liposuction, lipofilling, pectoral implants, or various 7
(i) “Puberty-blocking drug” means any of the following when used to delay or 9
suppress pubertal development in children for the purpose of assisting an individual 10
with a gender transition:
1. A gonadotropin-releasing hormone analogue or other synthetic drug used 12
in biological males to stop luteinizing hormone secretion and, therefore, testosterone 13
2. A synthetic drug used in biological females to stop the production of estrogen 15
(j) “Public funds” means any moneys of the state, a county or local government, 17
or any department, agency, or instrumentality authorized or appropriated under 18
state law or derived from any fund in which moneys are deposited.
19(2) Prohibiting gender transition on minors.
(a) No physician or health care 20
provider may provide any gender transition procedure to any individual under 18 21
years of age.
(b) No physician or health care provider may refer any individual who is under 23
18 years of age to any other physician or health care provider for any gender 24
1(3) Prohibiting use of public funds for gender transition of minors.
(a) No 2
person may use public funds directly or indirectly for or grant, pay, or distribute 3
public funds to any entity, organization, or individual that provides any gender 4
transition procedure to an individual under 18 years of age.
(b) None of the following may include any gender transition procedure provided 6
to an individual under 18 years of age in the health care services it provides:
1. A facility owned by the state or a county or local government.
2. A physician or health care provider who is employed by the state or a county 9
or local government.
(c) The department may not reimburse or include as a benefit under the 11
Medical Assistance program under subch. IV of ch. 49 any gender transition 12
procedure for an individual under 18 years of age.
13(4) Tax deduction prohibited.
Any amount paid during a taxable year by an 14
entity, organization, or individual to provide a gender transition procedure or as 15
premiums for health care coverage that includes coverage for a gender transition 16
procedure is not tax deductible.
17(5) Civil liability.
(a) Any violation of sub. (2) is presumed to be reckless 18
conduct for purposes of civil liability. The party injured by a violation of sub. (2) or 19
a parent, guardian, or legal representative of the injured party may bring a claim for 20
any of the following damages:
1. Any compensatory damages, including damages for pain and suffering, loss 22
of reputation, loss of income, and loss of consortium, including loss of expectation of 23
2. Injunctive relief.