Senate amendment to the 5th edition makes the following changes. 

Makes Section 2 of this act, which enacts new 90-21.154, concerning civil remedies, effective upon the earlier of July 1, 2023, or when the act becomes law (was, effective July 1, 2023).

Senate committee substitute to the 3rd edition makes the following changes. Deletes the content of the previous edition and replaces it with the following.

Enacts new Article 1N, entitled Gender Procedures on Minors, to GS Chapter 90.  Enacts new GS 90-21-151 that bars a medical professional from performing a surgical gender transition on a minor or from prescribing, dispensing or providing puberty-blocking drugs or cross-sex hormones to a minor.

Sets forth and defines terms sued in the Article, including the following:

• Biological sex is the biological indication of male and female in the context of reproductive potential or capacity, such as sex chromosomes, naturally occurring sex hormones, gonads, and nonambiguous internal and external genitalia present at birth, without regard to an individual's psychological, chosen, or subjective experience of gender.
• Cross-sex hormones are supraphysiologic doses of testosterone or other androgens to members of the female biological sex or supraphysiologic doses of estrogen or synthetic compounds with estrogenic activity to members of the male biological sex when used for the purpose of assisting an individual with a gender transition.
• Gender is the psychological, behavioral, social, and cultural aspects of being male or female.
• Gender reassignment surgery is any surgical service that seeks to surgically alter or remove healthy physical or anatomical characteristics or features that are typical for the individual's biological sex, in order to instill or create physiological or anatomical characteristics that resemble a sex different from the individual's biological sex, including a genital or non-genital gender reassignment surgery as defined in this section.
• Gender transition is the process in which a person goes from identifying with and living as a gender that corresponds to his or her biological sex to identifying with and living as a gender different from his or her biological sex, and may involve social, legal, or physical changes.
• Genital gender reassignment surgery is a gender reassignment surgery performed for the purpose of assisting an individual with a gender transition, including, without limitation, any of the following: (1) surgical procedures such as penectomy, orchiectomy, vaginoplasty, clitoroplasty, or vulvoplasty for biologically male patients or hysterectomy or ovariectomy for biologically female patients; (2) reconstruction of the fixed part of the urethra with or without a metoidioplasty; or (3) phalloplasty, vaginectomy, scrotoplasty, or implantation of erection or testicular prostheses for biologically female patients.
• Medical professional is any individual licensed to practice medicine or licensed to prescribe or dispense drugs.
• Minor is an individual who is younger than 18 years of age.
• Non-genital gender reassignment surgery is a gender reassignment surgery performed for the purpose of assisting an individual with a gender transition, including, without limitation, any of the following: (1) surgical procedures for biologically male patients, such as augmentation mammoplasty, facial feminization surgery, liposuction, lipofilling, voice surgery, thyroid cartilage reduction, gluteal augmentation, or hair reconstruction or (2) surgical procedures for biologically female patients, such as subcutaneous mastectomy, voice surgery, liposuction, lipofilling, or pectoral implants.
• Puberty-blocking drugs are gonadotropin-releasing hormone analogues or other synthetic drugs used in biological males to stop luteinizing hormone secretion and therefore testosterone secretion, or synthetic drugs used in biological females which stop the production of estrogens and progesterone, when used to delay or suppress pubertal development in children for the purpose of assisting an individual with a gender transition.
• Surgical gender transition procedure is any surgical service, including, without limitation, genital gender reassignment surgery and non-genital reassignment surgery, physician's services, and inpatient and outpatient hospital services related to gender transition, that seeks to do any of the following for the purpose of effecting a gender transition: (1) alter or remove physical or anatomical characteristics or features typical for the individual's biological sex or (2) instill or create physiological or anatomical characteristics that resemble a sex different from the individual's biological sex.

Exempts the following procedures on minors from the bar set forth above, if the minor’s parents or guardians give informed consent: (1) services to persons born with a medically verifiable disorder of sex development, including a person with external biological sex characteristics that are unresolvedly ambiguous, such as those born with 46 XX chromosomes with virilization, 46 XY chromosomes with under-virilization, or having both ovarian and testicular tissue; (2) services provided when a physician has otherwise diagnosed a disorder of sexual development that the physician has determined through genetic or biochemical testing that the person does not have normal sex chromosome structure, sex steroid hormone production, or sex steroid hormone action; (3) the treatment of any infection, injury, disease, or disorder that has been caused by or exacerbated by the performance of gender transition procedures, whether or not the gender transition procedure was performed in accordance with State and federal law; (4) breast reduction procedures for a female patient causing a physical disorder; (5) any procedure undertaken because the individual suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the individual in imminent danger of death or impairment of major bodily function unless surgery is performed; and (6) any procedure, including those listed in GS 90-21.150(6) (definition of genital gender reassignment surgery) and (9) (definition of non-genital gender reassignment surgery), that a treating physician certifies is medically necessary to treat a physiological condition. Specifies that a medical professional is not prohibited from continuing or completing treatment for a minor that includes a surgical gender transition procedure, or the administration of puberty-blocking drugs or cross-sex hormones if: (1) the treatment commenced before October 1, 2023, and was still active as of that date; (2) it is in the minor’s best interest, in the reasonable medical judgment of the medical professional, for the course of treatment to be continued or completed; or (3) the minor’s parents or guardians consent to the continuation or completion. Specifies that outside of new GS 90-21.15, the Article does not prohibit treatment provided by a licensed mental health professional that is provided within the scope of their practice.

Prohibits a medical professional and entities that they employ or contract with, from being required to perform a surgical gender transition procedure or prescribe, provide, or dispense, puberty-blocking drugs or cross-sex hormones. Prohibits hospitals and healthcare institutions from being required to participate in, or allow the use of their facilities in, performing a surgical gender transition procedure or prescribing, providing, or dispensing puberty-blocking drugs or cross-sex hormones. Provides civil, criminal, and administrative liability to medical professionals, entities, hospitals, and other healthcare institutions for exercising rights under these provisions.

Makes violations of the Article by a medical professional unprofessional conduct that results in revocation of the professional’s license to practice.

Effective October 1, 2023.

Enacts new GS 90-21.154 creating civil liability for any (1) medical professional who performs a surgical gender transition procedure on a minor or who prescribes, provides, or dispenses puberty-blocking drugs or cross-hormones to a minor, and (2) any entity that employs or contracts with a medical professional who does so. Makes those individuals/entities liable to the minor for any physical, psychological, emotional, or physiological harm that the minor suffers to due to the procedure, drugs, or hormones. Allows the minor or the parent or guardian of a minor who suffers injury, to bring a civil action; sets out the required timeframe for bringing the action. Allows seeking declaratory or injunctive relief, compensatory damages (including pain and suffering, loss of reputation, loss of income, and loss of consortium which includes loss of expectation of shared parenthood), punitive damages, attorneys’ fees and court costs, and any other appropriate relief. Excludes any damages that are awarded from the limit on noneconomic damages awarded in any medical malpractice action that is set in GS 90-21.19(a). Prohibits medical professionals and entities that employ or contract with medical professionals from seeking a contractual waiver of this liability and declares null and void any attempted waiver. Effective July 1, 2023.

Effective October 1, 2023, enacts new GS 143C-6-5.6, which prohibits State funds from being used, directly or indirectly, for the performance of or in furtherance of surgical gender transition procedures, to provide puberty-blocking drugs or cross-sex hormones to a minor, or to support the administration of any governmental health plan or government-offered insurance policy offering surgical gender transition procedures, puberty-blocking drugs, or cross-sex hormones to a minor. Exempts the State Health Plan for Teachers and State Employees (Health Plan), and specifies that this exemption expires 30 days after the memorandum and order date June 10, 2022, or the permanent injunction ordered therein in Kadel v. Folwell is vacated, overturned, or no longer in force. Directs the Health Plan to notify the Revisor of Statutes if the order or injunction is vacated, overturned, or no longer in force.

Includes a severability clause.

Changes the act’s titles.

House committee substitute to the 1st edition makes the following changes.  

Deletes whereas clauses.

Changes the title of new Article 1M, to Surgical Gender Transition Procedures on Minors (was, Youth Health Protection Act), of GS Chapter 90. Deletes Article 1M’s prohibition for an individual to engage in any of the following practices upon a minor, or cause them to be performed for the purpose of attempting to alter the appearance of or affirm the minor's perception of his or her gender or sex, if that is inconsistent with the minor's sex: (1) performing surgeries that sterilize, including castration, vasectomy, hysterectomy, oophorectomy, orchiectomy, or penectomy; (2) performing surgeries that artificially construct tissue with the appearance of genitalia that differs from the individual's sex, including metoidioplasty, phalloplasty, and vaginoplasty; (3) performing a mastectomy; (4) prescribing, administering, or supplying gonadotropin releasing hormone analogues or other synthetic drugs used to stop luteinizing hormone and follicle stimulating hormone secretion, synthetic antiandrogen drugs used to block the androgen receptor, or any drug to suppress or delay normal puberty; (5) prescribing, administering, or supplying testosterone, estrogen, or  progesterone to a minor in an amount greater than would normally be produced endogenously in a healthy individual of that individual's age and sex; (6) removing any otherwise healthy or nondiseased body part or tissue.  Now provides that it is unlawful for any physician or other health care provider to provide surgical gender transition procedures to any individual under 18 years of age, except as provided in Article 1M. Specifies that a physician or other health care provider may not refer any individual under 18 years of age to any health care provider for surgical gender transition procedures. Deletes old defined terms and enacts ten newly defined terms, including gender reassignment surgery, genital gender reassignment surgery, and non-genital gender reassignment surgery.  Deletes exemptions to prohibition except for exemption authorizing treatment of any infection, disease, or disorder that has been caused or exacerbated by the performance of a procedure described in the act, whether or not the procedures were performed in accordance with State or federal law and exemption authorizing procedure if death or substantial bodily injury is imminent. Now provides that a physician or other health care provider is not prohibited from providing any of the following additional procedures to a minor: (1) services to persons born with a medically verifiable disorder of sex  development, including a person with external biological sex characteristics  that are unresolvedly ambiguous, such as those born with 46 XX chromosomes with virilization, 46 XY chromosomes with under-virilization, or having both ovarian and testicular tissue; (2) services provided when a physician has otherwise diagnosed a disorder of sexual development that the physician has determined through genetic or biochemical testing that the person does not have normal sex chromosome structure, sex steroid hormone production, or sex steroid hormone action; (3) breast reduction procedures for a female patient causing a physical disorder; (4) any procedure, including defined term non-genital gender reassignment surgery, which a treating physician is medically necessary to treat a physiological condition. Specifies that Article 1M does not require any person to perform surgical gender transition procedures. Amends GS 143C-6-5.6 to only require that state funds not be used for surgical gender transition procedures for individuals under 18 years of age (was, all gender transition procedures for any person, regardless of age). 

Deletes provisions pertaining to aiding/abetting liability for medical professionals, parental consent and required disclosure, professional misconduct provisions, civil remedies, preemption, and whistleblower provisions (all of GS 90-21.142-GS 90-146). Deletes proposed amendments to GS 90-21.5 (pertaining to consent of a minor for certain medical health services) which would have deleted all provisions of the article that allow minors to consent to certain medical services, including certain mental health services as well as the provision requiring a health care provider to obtain parental consent before administering a vaccine that has been granted emergency use authorization. Section would’ve only been limited to emancipated minors.

Amends the act's titles.