Protect Children’s Innocence Act
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Would make it a federal crime to perform gender-transition surgeries or administer puberty-blocking or cross-sex hormone medications to minors, punishable by up to 10 years in federal prison. It would also expand the existing federal prohibition on female genital mutilation to cover facilitation or consent by any person, not just a parent or guardian.
The bill would effectively create a national criminal floor — applying regardless of what individual states permit — and would affect a wide range of healthcare providers who currently offer such care to minors.
What this bill would do
What it would do
The bill would amend 18 U.S.C. § 116 — the existing federal female genital mutilation (FGM) statute — to add two new federal offenses. First, it would prohibit performing or attempting to perform gender-transition surgeries on minors, listing specific procedures by name (e.g., mastectomy, orchiectomy, vaginoplasty). Second, it would prohibit "chemical castration" of a minor, defined to include administering puberty-blocking drugs, testosterone to biological females at supraphysiologic doses, or estrogen to biological males at supraphysiologic doses. Both offenses carry up to 10 years in federal prison. It would also broaden the existing FGM prohibition so that any person who facilitates or consents to FGM of a minor is covered, not just a parent, guardian, or caretaker. Minors who undergo any covered procedure could not be arrested or prosecuted.
The bill carves out exceptions for intersex individuals, procedures that a physician certifies are needed to prevent imminent impairment of a major bodily function, treatment of precocious puberty, and care addressing complications from a prior gender-transition procedure. However, the bill explicitly states that mental, behavioral, or emotional distress or disorders do not qualify as medical justification for any exception.
Key provisions
- 1Would criminalize performing or attempting to perform genital or bodily mutilation — including a detailed list of gender-transition surgeries — on a minor, punishable by fine, up to 10 years imprisonment, or both.
- 2Would criminalize chemical castration of a minor, defined as administering puberty-blocking drugs or cross-sex hormones at supraphysiologic doses, punishable by fine, up to 10 years imprisonment, or both.
- 3Would expand the existing FGM prohibition to cover facilitation or consent by any person — not just a parent, guardian, or caretaker — and would bar prosecution of the minor victim.
- 4Would prohibit arresting or prosecuting any minor on whom a covered procedure is performed, shielding victims from criminal liability.
- 5Would exempt intersex individuals, patients with physical disorders certified by a physician as creating imminent danger, minors with precocious puberty, and those treating complications from a prior procedure.
- 6Would explicitly exclude mental, behavioral, or emotional distress or disorders from qualifying as medical justification under the health exception.
Who would be affected
Physicians, surgeons, endocrinologists, pharmacists, and other healthcare providers who perform or prescribe gender-affirming surgeries or hormone therapies for minors; parents, guardians, and any other persons who facilitate or consent to such care or to FGM; minors currently receiving or seeking these treatments; and hospitals or clinics that offer such services.
Why it matters
Healthcare providers who perform or prescribe covered gender-affirming procedures for minors would face federal felony charges regardless of whether their state permits such care, creating a uniform national prohibition. This would effectively shut down access to gender-affirming medical treatment for minors nationwide, since providers could face up to 10 years in federal prison even where state law currently allows the practice.
What would change
Changes to existing law
Amends 18 U.S.C. § 116 (Sec. 2)
Rewrites the section entirely to add federal crimes for gender-transition surgery and chemical castration of minors alongside the existing FGM prohibition, and broadens FGM facilitation to cover any person.
Funding and costs
Congressional Budget Office estimate
CBO estimates enacting H.R. 3492 would decrease the federal deficit by $445 million over the 2026–2035 period, primarily by reducing Medicaid and CHIP spending on gender-affirming care for minors.
CBO estimates that H.R. 3492 would reduce direct spending (mandatory outlays) by $445 million over the 2026–2035 period, with negligible effects on revenues, yielding a net deficit reduction of the same amount. The main savings driver is an expected decline in federal Medicaid and Children's Health Insurance Program (CHIP) spending — the federal government's share of state health program costs — on gender-affirming surgeries and drug treatments for minors, since criminalizing those procedures would lead state agencies and providers to stop billing Medicaid for them. CBO also identified intergovernmental and private-sector mandates on medical professionals and institutions, estimating lost revenue of roughly $105 million per year over 2026–2030, but concluded both mandate costs fall below the thresholds set by the Unfunded Mandates Reform Act ($103 million and $206 million, respectively, in 2025 dollars).
How implementation would work
The bill is a self-executing criminal statute requiring no agency rulemaking. Federal jurisdiction attaches through any interstate commerce nexus — including interstate travel, any electronic communication, payment, or use of an instrument that crossed state or foreign commerce. The Department of Justice would prosecute violations through normal federal criminal channels. No grants, reporting requirements, or administrative machinery are created. The bill's exceptions (intersex conditions, physical medical necessity, precocious puberty) would be assessed case by case in federal prosecutions, with the burden on defendants to demonstrate an exception applies.
Legislative status & sources
Latest action
Received in the Senate and Read twice and referred to the Committee on the Judiciary.
Official CRS summary
Show the CRS summaryHide the CRS summary
This bill establishes federal criminal offenses for providing gender-affirming care to minors. The bill also changes the existing federal criminal offense that prohibits female genital mutilation (FGM) and related conduct.
Specifically, the bill makes it a federal crime to knowingly perform or attempt to perform procedures or provide medications (e.g., hormonal treatments) to a minor for the purpose of changing their body to correspond to a sex that differs from their biological sex. The bill provides exceptions for specified types of surgeries or procedures, including those for treating (1) individuals who have both ovarian and testicular tissue or abnormal sex chromosome structure or hormones, or (2) infections or other harms that result from a previous gender-transition procedure. A violation is punishable by a fine, a prison term of up to 10 years, or both. The bill prohibits the arrest or prosecution of an individual who undergoes gender-affirming procedures or medications.
Additionally, the bill makes changes to the existing federal criminal prohibition on performing FGM on a minor and related conduct. Among the changes, the bill broadens the scope of prohibited conduct to include the facilitation or consent to FGM by any person (currently, prohibited facilitation or consent applies only to a parent, guardian, or caretaker of the minor). The bill also prohibits the arrest or prosecution of an individual who undergoes FGM. The bill does not change the applicable criminal penalty of a fine, a prison term of up to 10 years, or both.
Legislative subjects
Child health; Crime and Law Enforcement; Criminal investigation, prosecution, interrogation; Drug therapy; Sex, gender, sexual orientation discrimination; Surgery and anesthesia
Committee report
H. Rept. 119-311