The House of Representatives on Wednesday passed legislation that would make it a federal crime for doctors to provide transgender-related medical procedures to minors, including puberty blockers, hormonal therapies and surgical procedures.

The Protect Children's Innocence Act, sponsored by Rep. Marjorie Taylor Greene of Georgia, cleared the chamber in a 216-211 vote. The bill now advances to the Senate, where it faces significant hurdles due to the 60-vote threshold required to overcome a filibuster.

Three Democrats voted with Republicans in favor of the bill: Reps. Vicente Gonzalez of Texas, Don Davis of North Carolina and Henry Cuellar of Texas. Four Republicans opposed it: Reps. Mike Kennedy of Utah, Brian Fitzpatrick of Pennsylvania, Gabe Evans of Colorado and Mike Lawler of New York.

"Protecting children is not optional, it's our duty," Greene wrote on X before the vote. "Children are not old enough to vote, drive, or get a tattoo and they are certainly not old enough to be chemically castrated or permanently mutilated."

The legislation would subject violators to fines or up to 10 years in prison, or both. It provides exemptions for individuals who medically require treatments for conditions such as precocious puberty.

Provisions of the legislation

Under the bill, health care providers would face felony charges for prescribing puberty blockers or cross-sex hormones to individuals under 18 for the purpose of gender transition. Surgical procedures including mastectomies, phalloplasty and vaginoplasty performed on minors would also be criminalized.

The legislation would additionally punish anyone—including parents—who consents to or transports a minor to receive such treatments.

Children who undergo the procedures cannot be charged under the bill.

Greene said she struck a deal with House leadership to secure a floor vote on her legislation after agreeing to advance the National Defense Authorization Act. She had previously voted against the defense bill but switched her position, allowing it to clear a final procedural hurdle.

The Georgia Republican is set to formally resign from Congress on January 5, 2026.

State laws and Supreme Court ruling

More than half of U.S. states already restrict or ban such medical treatments for minors. Some states, including Mississippi, also prohibit residents from traveling outside state lines to obtain the care.

In June, the Supreme Court ruled that a Tennessee law banning puberty blockers and hormonal treatments for minors with gender dysphoria did not violate the Constitution. The decision gave states broad authority to regulate such medical interventions.

Insurance claims data cited by the Department of Health and Human Services indicate that nearly 14,000 minors received some form of gender transition treatment between 2019 and 2023.

The University of California, Los Angeles estimates that approximately 724,000 individuals between the ages of 13 and 17 identify as transgender in the United States, representing roughly 3 percent of the youth population.

Trump administration regulatory action

The House vote came one day before the Trump administration unveiled a sweeping regulatory campaign against providers who treat minors with transition-related procedures.

The Centers for Medicare and Medicaid Services on Thursday proposed new rules that would bar hospitals from performing such treatments on individuals under 18 as a condition for participation in Medicare and Medicaid programs. The proposed rule would also apply to funding for individuals under 19 through the federal Children's Health Insurance Program.

"Children deserve our protection, not experimental interventions performed on them that carry life-altering risks with no reliable evidence of benefit," CMS Administrator Mehmet Oz said. "This proposal seeks to clarify that hospitals participating in our programs cannot conduct these unproven procedures on children."

Nearly all hospitals in the United States accept Medicare and Medicaid funding. About 75 percent of U.S. hospitals—roughly 3,600 facilities—would need to update their policies and procedures to comply if the proposed rule is enacted, according to CMS.

The proposed rules are subject to a 60-day public comment period before they can be finalized.

Health and Human Services Secretary Robert F. Kennedy Jr. signed a declaration stating that pediatric transition treatments "do not meet professionally recognized standards of health care." The department said medical professionals who provide such treatments on minors "would be deemed out of compliance with those standards."

The Food and Drug Administration also issued warning letters to 12 manufacturers and retailers marketing "breast binders" as medical devices for children undergoing gender transitions. Kennedy said the marketing represented a "significant regulatory violation."

Congressional debate

Democrats largely opposed the bill, with Rep. Mark Takano of California calling it "the most extreme anti-transgender legislation to ever pass through" the House.

"If this bill becomes law, doctors, pharmacists, and—in some circumstances—the parents of young trans people, would face time in prison for choosing to prioritize their child's health," Takano said. "This bill is beyond cruel, and its passage will forever be a stain on the institution of the United States Congress."

Rep. Sarah McBride of Delaware, the first openly transgender person elected to Congress, spoke against the legislation on the House floor.

"I was a kid once. And my biggest regret in life is that I never got a childhood without pain," McBride said. "Politicians should never insert themselves into the personal health care decisions of patients, parents, and their providers."

Rep. Kim Schrier, a Washington Democrat and pediatrician, argued the bill would "instill fear in doctors and patients and rob parents of their freedom to make decisions for and with their own children."

Republicans who supported the measure framed it as a child protection issue.

"In our society, we have all the helping professions—the guidance counselors, the psychologists, the psychiatrists—as well as our pop culture icons from California out there, pushing our poor, young people into the idea that it's cool to be transgender," said Rep. Glenn Grothman of Wisconsin. "And some of these kids, their life is ruined."

Rep. Barry Moore of Alabama said the bill targets "life-altering decisions about their body, involving hormones and surgery and jeopardizing their health."

Rep. Jimmy Patronis of Florida praised the passage, calling it "common-sense legislation" meant to protect future generations.

"As a father of two young boys, I will not stand by while radical woke policies push children into permanent, life-altering medical decisions they can never undo," Patronis said. "Protecting our children isn't a choice—it's our moral duty."