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LEGISLATURE OF NEBRASKA
ONE HUNDRED NINTH LEGISLATURE
SECOND SESSION
LEGISLATIVE BILL 732
Introduced by Kauth, 31.
Read first time January 07, 2026
Committee: Health and Human Services
A BILL FOR AN ACT relating to public health and welfare; to amend1
sections 71-7301, 71-7303, 71-7304, 71-7305, and 71-7307, Revised2
Statutes Cumulative Supplement, 2024; to change provisions relating3
to the Let Them Grow Act; to define terms; to prohibit health care4
practitioners from providing cross-sex hormones and puberty blockers5
to individuals younger than nineteen years of age as prescribed; to6
provide powers and duties to the Attorney General; to harmonize7
provisions; and to repeal the original sections.8
Be it enacted by the people of the State of Nebraska,9
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Section 1. Section 71-7301, Revised Statutes Cumulative Supplement,1
2024, is amended to read: 2
71-7301 Sections 71-7301 to 71-7307 and section 6 of this act shall3
be known and may be cited as the Let Them Grow Act.4
Sec. 2. Section 71-7303, Revised Statutes Cumulative Supplement,5
2024, is amended to read: 6
71-7303 For purposes of the Let Them Grow Act:7
(1) Biological sex means the biological indication of male and8
female in the context of reproductive potential or capacity, such as sex9
chromosomes, naturally occurring sex hormones, gonads, and nonambiguous10
internal and external genitalia present at birth, without regard to an11
individual's psychological, chosen, or subjective experience of gender;12
(2) Congenital defect means a physical or chemical abnormality13
present in an individual younger than nineteen years of age that is14
inconsistent with the normal development of a human being of such15
individual's biological sex, including abnormalities caused by a16
medically verifiable disorder of sex development. Congenital defect does17
not include gender dysphoria, gender identity disorder, or any mental18
condition; 19
(3) (2) Cross-sex hormones means testosterone or other androgens20
given to biological females in amounts that are larger or more potent21
than would normally occur naturally in healthy biological sex females and22
estrogen given to biological males in amounts that are larger or more23
potent than would normally occur naturally in healthy biological sex24
males; 25
(4) (3) Gender means the psychological, behavioral, social, and26
cultural aspects of being male or female; 27
(5) (4) Gender-altering surgery means any medical or surgical28
service that seeks to surgically alter or remove healthy physical or29
anatomical characteristics or features that are typical for the30
individual's biological sex in order to instill or create physiological31
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or anatomical characteristics that resemble a sex different from the1
individual's biological sex, including without limitation, genital or2
nongenital gender-altering surgery performed for the purpose of assisting3
an individual with a gender alteration; 4
(6) (5) Gender alteration means the process in which a person goes5
from identifying with and living as a gender that corresponds to his or6
her biological sex to identifying with and living as a gender different7
from his or her biological sex and may involve social, legal, or physical8
changes; 9
(7)(a) (6)(a) Gender-altering procedures includes any medical or10
surgical service, including without limitation physician's services,11
inpatient and outpatient hospital services, or prescribed drugs related12
to gender alteration, that seeks to: 13
(i) Alter or remove physical or anatomical characteristics or14
features that are typical for the individual's biological sex; or15
(ii) Instill or create physiological or anatomical characteristics16
that resemble a sex different from the individual's biological sex,17
including without limitation medical services that provide puberty-18
blocking drugs, cross-sex hormones, or other mechanisms to promote the19
development of feminizing or masculinizing features in the opposite20
biological sex, or genital or nongenital gender-altering surgery21
performed for the purpose of assisting an individual with a gender22
alteration; 23
(b) Gender-altering procedures does not include:24
(i) Services to persons born with a medically verifiable disorder of25
sex development, including a person with external biological sex26
characteristics that are irresolvably ambiguous, such as those born with27
46 XX chromosomes with virilization, 46 XY chromosomes with28
undervirilization, or having both ovarian and testicular tissue;29
(ii) Services provided when a health care practitioner has otherwise30
diagnosed a disorder of sexual development that the health care31
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practitioner has determined, through genetic or biochemical testing, that1
the person does not have normal sex-chromosome structure, sex-steroid2
production, or sex-steroid hormone action; 3
(iii) The acute and chronic treatment of any infection, injury,4
disease, or disorder that has been caused by or exacerbated by the5
performance of a gender-altering procedure, whether or not the gender-6
altering procedure was performed in accordance with state and federal7
law; or 8
(iv) Any procedure undertaken because the individual suffers from a9
physical disorder, physical injury, or physical illness that would, as10
certified by the health care practitioner, place the individual in11
imminent danger of death or impairment of major bodily function unless12
surgery is performed; 13
(8) (7) Genital gender-altering surgery means a medical procedure14
performed for the purpose of assisting an individual with a gender15
alteration, including without limitation: 16
(a) Surgical procedures such as penectomy, orchiectomy,17
vaginoplasty, clitoroplasty, or vulvoplasty for biologically male18
patients or hysterectomy or ovariectomy for biologically female patients;19
(b) Reconstruction of the fixed part of the urethra with or without20
a metoidioplasty; or 21
(c) Phalloplasty, vaginectomy, scrotoplasty, or implantation of22
erection or testicular prostheses for biologically female patients;23
(9) (8) Health care practitioner means a person licensed or24
certified under the Uniform Credentialing Act; 25
(10) (9) Puberty-blocking drugs means gonadotropin-releasing hormone26
analogues or other synthetic drugs used in biological males to stop27
luteinizing hormone secretion and therefore testosterone secretion, or28
synthetic drugs used in biological females which stop the production of29
estrogens and progesterone, when used to delay or suppress pubertal30
development in children for the purpose of assisting an individual with a31
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gender alteration; and 1
(11) (10) Nongenital gender-altering surgery means medical2
procedures performed for the purpose of assisting an individual with a3
gender alteration, including without limitation: 4
(a) Surgical procedures for biologically male patients, such as5
voice surgery or thyroid cartilage reduction; or 6
(b) Surgical procedures for biologically female patients, such as7
subcutaneous mastectomy or voice surgery; and . 8
(12) Telehealth has the same meaning as in section 38-120.01.9
Sec. 3. Section 71-7304, Revised Statutes Cumulative Supplement,10
2024, is amended to read: 11
71-7304 (1) Except as provided in the Let Them Grow Act and the12
rules and regulations adopted and promulgated pursuant to the act, a13
health care practitioner shall not perform gender-altering procedures in14
this state , including via telehealth to an individual located in this15
state, for an individual younger than nineteen years of age.16
(2) The intentional and knowing performance of gender-altering17
procedures by a health care practitioner for an individual younger than18
nineteen years of age in violation of subsection (1) of this section19
shall be considered unprofessional conduct as defined in section 38-179.20
(3) This section does not apply to the continuation of treatment21
using puberty-blocking drugs, cross-sex hormones, or both when the course22
of treatment began before October 1, 2023 , and concluded on or before23
January 1, 2027. 24
(4) This section does not apply to nonsurgical gender-altering25
procedures when such procedures are provided: 26
(a) Prior to the effective date of this act in compliance with the27
rules and regulations adopted and promulgated pursuant to subsection (1)28
of section 71-7305; or . 29
(b) On and after the effective date of this act in compliance with30
subsection (2) of section 71-7305. 31
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Sec. 4. Section 71-7305, Revised Statutes Cumulative Supplement,1
2024, is amended to read: 2
71-7305 (1) Except as provided in subsection (2) of this section,3
the The chief medical officer as designated in section 81-3115 shall4
adopt and promulgate such rules and regulations as are necessary to5
provide for nonsurgical gender-altering procedures for individuals6
younger than nineteen years of age, such as puberty-blocking drugs,7
cross-sex hormones, or both. Such rules and regulations shall be8
consistent with the Let Them Grow Act and, at a minimum, include the9
following: 10
(a) Specify that a health care practitioner may prescribe approved11
puberty-blocking drugs, cross-sex hormones, or both to an individual12
younger than nineteen years of age if such individual has a long-lasting13
and intense pattern of gender nonconformity or gender dysphoria which14
began or worsened at the start of puberty; 15
(b) Specific criteria, obligations, or conditions regulating the16
administration, prescribing, delivery, sale, or use of puberty-blocking17
drugs, cross-sex hormones, or both involving an individual younger than18
nineteen years of age in accordance with subdivision (1)(a) of this19
section, which shall, at a minimum, set forth the following:20
(i) The minimum number of gender-identity-focused therapeutic hours21
required prior to an individual receiving puberty-blocking drugs, cross-22
sex hormones, or both; 23
(ii) Patient advisory requirements necessary for a health care24
practitioner to obtain informed patient consent; 25
(iii) Patient medical record documentation requirements to ensure26
compliance with the act; and 27
(iv) A minimum waiting period between the time the health care28
practitioner obtains informed patient consent and the administration,29
prescribing, or delivery of puberty-blocking drugs, cross-sex hormones,30
or both to such patient; and 31
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(c) Specify that section 71-7304 does not apply to nonsurgical1
gender-altering procedures when such procedures are provided in2
compliance with the rules and regulations adopted and promulgated3
pursuant to this section. 4
(2)(a) Beginning on and after the effective date of this act, a5
health care practitioner shall not knowingly prescribe for or provide to6
an individual in this state younger than nineteen years of age cross-sex7
hormones or puberty-blocking drugs for the purpose of assisting the8
individual with a gender alteration. 9
(b) A health care practitioner does not violate this subsection if:10
(i) The cross-sex hormones or puberty-blocking drugs were prescribed11
for or provided to an individual in this state younger than nineteen12
years of age to treat the individual's congenital defect, precocious13
puberty, disease, or physical injury; or 14
(ii) The cross-sex hormones or puberty-blocking drugs were15
prescribed for or provided to an individual in this state younger than16
nineteen years of age in compliance with the Let Them Grow Act and the17
rules and regulations adopted and promulgated pursuant to subsection (1)18
of this section and such treatment concluded on or before January 1,19
2027. 20
(c) For purposes of subdivision (2)(b) of this section, disease does21
not include any gender nonconformity, gender dysphoria, gender identity22
disorder, or mental condition. 23
(d) The chief medical officer as designated in section 81-3115 shall24
adopt and promulgate such rules and regulations as necessary to carry out25
this subsection. 26
(3) (2) The Department of Health and Human Services may adopt and27
promulgate rules and regulations not inconsistent with the rules and28
regulations adopted and promulgated by the chief medical officer that are29
necessary to carry out the Let Them Grow Act. 30
Sec. 5. Section 71-7307, Revised Statutes Cumulative Supplement,31
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2024, is amended to read: 1
71-7307 (1) An individual that received a gender-altering procedure2
in violation of section 71-7304 after October 1, 2023, and while such3
individual was younger than nineteen years of age, or the parent or4
guardian of such an individual, may bring a civil action for appropriate5
relief against the health care practitioner who performed the gender-6
altering procedure. Appropriate relief in an action under this section7
includes actual damages and reasonable attorney's fees. An action under8
this section shall be brought within two years after discovery of9
damages. 10
(2) If a court in any civil action brought pursuant to this section11
finds that a health care practitioner knowingly violated section 71-7304,12
the court shall notify the Attorney General and the Department of Health13
and Human Services by mailing a certified copy of the court's order to14
the Attorney General and the department. Notification pursuant to this15
subsection shall be made upon the judgment of the court being made final.16
Sec. 6. (1) The Attorney General may bring an action against a17
health care practitioner that knowingly violates the Let Them Grow Act,18
within twenty years of the violation, to (a) enjoin further violations19
and (b) recover a civil penalty of twenty-five thousand dollars per20
violation. 21
(2) Each time a health care practitioner performs a gender-altering22
procedure, including each instance of prescribing or providing cross-sex23
hormones and puberty-blocking drugs in violation of the Let Them Grow24
Act, constitutes a separate violation. 25
(3) Any civil penalties collected pursuant to this section shall be26
remitted to the State Treasurer for distribution in accordance with27
Article VII, section 5, of the Constitution of Nebraska.28
Sec. 7. Original sections 71-7301, 71-7303, 71-7304, 71-7305, and29
71-7307, Revised Statutes Cumulative Supplement, 2024, are repealed.30
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