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EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
SECOND REGULAR SESSION
SENATE BILL NO. 1200
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR HUDSON.
4146S.01I KRISTINA MARTIN, Secretary
AN ACT
To repeal section 191.1720, RSMo, and to enact in lieu thereof one new section relating to gender
transition procedures.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Section 191.1720, RSMo, is repealed and one 1
new section enacted in lieu thereof, to be known as section 2
191.1720, to read as follows:3
191.1720. 1. This section shall be known and may be 1
cited as the "Missouri Save Adolescents from Experimentation 2
(SAFE) Act". 3
2. For purposes of this section, the following terms 4
mean: 5
(1) "Biological sex", the biological indication of 6
male or female in the context of reproductive potential or 7
capacity, such as sex chromosomes, naturally occurring sex 8
hormones, gonads, and nonambiguous internal and external 9
genitalia present at birth, without regard to an 10
individual's psychological, chosen, or subjective experience 11
of gender; 12
(2) "Cross-sex hormones", testosterone, estrogen, or 13
other androgens given to an individual in amounts that are 14
greater or more potent than would normally occur naturally 15
in a healthy individual of the same age and sex; 16
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(3) "Gender", the psychological, behavioral, social, 17
and cultural aspects of being male or female; 18
(4) "Gender transition", the process in which an 19
individual transitions from identifying with and living as a 20
gender that corresponds to his or her biological sex to 21
identifying with and living as a gender different from his 22
or her biological sex, and may involve social, legal, or 23
physical changes; 24
(5) "Gender transition surgery", a surgical procedure 25
performed for the purpose of assisting an individual with a 26
gender transition, including, but not limited to: 27
(a) Surgical procedures that sterilize, including, but 28
not limited to, castration, vasectomy, hysterectomy, 29
oophorectomy, orchiectomy, or penectomy; 30
(b) Surgical procedures that artificially construct 31
tissue with the appearance of genitalia that differs from 32
the individual's biological sex, including, but not limited 33
to, metoidioplasty, phalloplasty, or vaginoplasty; or 34
(c) Augmentation mammoplasty or subcutaneous 35
mastectomy; 36
(6) "Health care provider", an individual who is 37
licensed, certified, or otherwise authorized by the laws of 38
this state to administer health care in the ordinary course 39
of the practice of his or her profession; 40
(7) "Puberty-blocking drugs", gonadotropin-releasing 41
hormone analogues or other synthetic drugs used to stop 42
luteinizing hormone secretion and follicle stimulating 43
hormone secretion, synthetic antiandrogen drugs to block the 44
androgen receptor, or any other drug used to delay or 45
suppress pubertal development in children for the purpose of 46
assisting an individual with a gender transition. 47
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3. A health care provider shall not knowingly perform 48
a gender transition surgery on any individual under eighteen 49
years of age. 50
4. (1) A health care provider shall not knowingly 51
prescribe or administer cross-sex hormones or puberty- 52
blocking drugs for the purpose of a gender transition for 53
any individual under eighteen years of age. 54
(2) Until March 1, 2027, the provisions of this 55
subsection shall not apply to the prescription or 56
administration of cross-sex hormones or puberty-blocking 57
drugs for any individual under eighteen years of age who was 58
prescribed or administered such hormones or drugs prior to 59
August 28, 2023, for the purpose of assisting the individual 60
with a gender transition. 61
[(3) The provisions of this subsection shall expire on 62
August 28, 2027.] 63
5. The performance of a gender transition surgery or 64
the prescription or administration of cross-sex hormones or 65
puberty-blocking drugs to an individual under eighteen years 66
of age in violation of this section shall be considered 67
unprofessional conduct and any health care provider doing so 68
shall have his or her license to practice revoked by the 69
appropriate licensing entity or disciplinary review board 70
with competent jurisdiction in this state. 71
6. (1) The prescription or administration of cross- 72
sex hormones or puberty-blocking drugs to an individual 73
under eighteen years of age for the purpose of a gender 74
transition shall be considered grounds for a cause of action 75
against the health care provider. The provisions of chapter 76
538 shall not apply to any action brought under this 77
subsection. 78
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(2) An action brought pursuant to this subsection 79
shall be brought within fifteen years of the individual 80
injured attaining the age of twenty-one or of the date the 81
treatment of the injury at issue in the action by the 82
defendant has ceased, whichever is later. 83
(3) An individual bringing an action under this 84
subsection shall be entitled to a rebuttable presumption 85
that the individual was harmed if the individual is 86
infertile following the prescription or administration of 87
cross-sex hormones or puberty-blocking drugs and that the 88
harm was a direct result of the hormones or drugs prescribed 89
or administered by the health care provider. Such 90
presumption may be rebutted only by clear and convincing 91
evidence. 92
(4) In any action brought pursuant to this subsection, 93
a plaintiff may recover economic and noneconomic damages and 94
punitive damages, without limitation to the amount and no 95
less than five hundred thousand dollars in the aggregate. 96
The judgment against a defendant in an action brought 97
pursuant to this subsection shall be in an amount of three 98
times the amount of any economic and noneconomic damages or 99
punitive damages assessed. Any award of damages in an 100
action brought pursuant to this subsection to a prevailing 101
plaintiff shall include attorney's fees and court costs. 102
(5) An action brought pursuant to this subsection may 103
be brought in any circuit court of this state. 104
(6) No health care provider shall require a waiver of 105
the right to bring an action pursuant to this subsection as 106
a condition of services. The right to bring an action by or 107
through an individual under the age of eighteen shall not be 108
waived by a parent or legal guardian. 109
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(7) A plaintiff to an action brought under this 110
subsection may enter into a voluntary agreement of 111
settlement or compromise of the action, but no agreement 112
shall be valid until approved by the court. No agreement 113
allowed by the court shall include a provision regarding the 114
nondisclosure or confidentiality of the terms of such 115
agreement unless such provision was specifically requested 116
and agreed to by the plaintiff. 117
(8) If requested by the plaintiff, any pleadings, 118
attachments, or exhibits filed with the court in any action 119
brought pursuant to this subsection, as well as any 120
judgments issued by the court in such actions, shall not 121
include the personal identifying information of the 122
plaintiff. Such information shall be provided in a 123
confidential information filing sheet contemporaneously 124
filed with the court or entered by the court, which shall 125
not be subject to public inspection or availability. 126
7. The provisions of this section shall not apply to 127
any speech protected by the First Amendment of the United 128
States Constitution. 129
8. The provisions of this section shall not apply to 130
the following: 131
(1) Services to individuals born with a medically- 132
verifiable disorder of sex development, including, but not 133
limited to, an individual with external biological sex 134
characteristics that are irresolvably ambiguous, such as 135
those born with 46,XX chromosomes with virilization, 46,XY 136
chromosomes with undervirilization, or having both ovarian 137
and testicular tissue; 138
(2) Services provided when a physician has otherwise 139
diagnosed an individual with a disorder of sex development 140
and determined through genetic or biochemical testing that 141
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the individual does not have normal sex chromosome 142
structure, sex steroid hormone production, or sex steroid 143
hormone action; 144
(3) The treatment of any infection, injury, disease, 145
or disorder that has been caused by or exacerbated by the 146
performance of gender transition surgery or the prescription 147
or administration of cross-sex hormones or puberty-blocking 148
drugs regardless of whether the surgery was performed or the 149
hormones or drugs were prescribed or administered in 150
accordance with state and federal law; or 151
(4) Any procedure undertaken because the individual 152
suffers from a physical disorder, physical injury, or 153
physical illness that would, as certified by a physician, 154
place the individual in imminent danger of death or 155
impairment of a major bodily function unless surgery is 156
performed. 157
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