The bill adds a new section to chapter 18.130 RCW that creates a regulatory prohibition on health care providers licensed under that title: they may not knowingly engage in or cause specified practices to be performed on an unemancipated person under 18 years of age when those practices are performed for the purpose of attempting to alter the minor’s appearance of, or affirm the minor’s perception of, a gender or sex that is inconsistent with the minor’s sex. This is a new substantive prohibition (a new section of law), not framed in the excerpt as an amendment to an existing penalty scheme. The prohibited practices named in the text include prescribing or administering gonadotropin-releasing hormone analogues or other synthetic drugs to suppress luteinizing hormone and follicle-stimulating hormone secretion, synthetic antiandrogens to block androgen receptors, or any drug to suppress or delay normal puberty; prescribing or administering testosterone, estrogen, or progesterone to a minor in amounts greater than endogenous production for that age and sex; performing sterilizing surgeries (examples listed: castration, vasectomy, hysterectomy, oophorectomy, orchiectomy, penectomy); performing surgeries that construct tissue with the appearance of genitalia that differs from the individual’s sex (examples listed: metoidioplasty, phalloplasty, vaginoplasty); and removing any healthy or nondiseased body part or tissue. The section also enumerates five exceptions that are not prohibited: care for minors born with medically verifiable disorders of sex development, physician‑diagnosed disorders of sexual development confirmed by genetic or biochemical testing, tapering a minor off puberty blockers or hormones, treatment of conditions caused or worsened by prior gender transition procedures, and emergency or medically necessary surgeries certified by a physician to prevent imminent death or major bodily function impairment. The text defines key terms: “gender” as the psychological, behavioral, social, and cultural aspects of being male or female; “sex” as the biological indication of male and female based on chromosomes, naturally occurring sex hormones, gonads, and nonambiguous genitalia present at birth; and “minor” as an unemancipated person under 18 years of age. Affected parties identified include health care providers licensed under the cited title, physicians, and minors (including those with disorders of sex development). Important implementation details are not included in the extracted text: there is no effective date, enforcement mechanism, penalties, licensing board responsibilities, or administrative deadlines specified here; the precise scope of “this title” and how the prohibited “purpose” would be determined or proven are also not provided. The bill was prefiled 12/11/24, read first time 01/13/25, and referred to the House Committee on Health Care & Wellness.

If enacted, licensed health care providers covered by chapter 18.130 RCW would no longer be allowed to provide or cause to be provided a range of gender‑affirming medical treatments to anyone under 18 when those treatments are done to change or affirm a minor’s gender that differs from their biological sex. That means puberty blockers, cross‑sex hormones above natural levels for age and sex, sterilizing operations, genital construction surgeries, and removal of healthy tissue would be off the table for minors except in narrow cases for medically verifiable disorders of sex development, tapering off prior hormones, treating complications from earlier transition care, or emergency surgeries certified to prevent imminent death or major bodily impairment. The people most affected are pediatric and adolescent health providers, surgeons, and other clinicians who currently treat transgender minors and the minors and families seeking those treatments; those providers would have fewer treatment options to offer and would need to rely on the narrow exceptions and physician certifications described in the bill. The measure does not address funding, penalties, how intent to “alter or affirm” gender would be proven, or the exact scope of which licensed professionals are covered, so how it would be enforced and what professional risks or administrative costs would follow remains unclear.