HB2513

SECTION 1. The legislature finds that minors are not at a fully completed mature state and still undergoing physical, mental, and emotional development. Accordingly, minors are prohibited by law from voting, owning a firearm, getting a tattoo, and being drafted into military service prior to the age of eighteen. Permanent medical alterations to a minor's body are very significant decisions that should be based on the best available evidence. Further, recent studies have demonstrated that gender affirming care for minors may not be best medical practices. Countries such as the United Kingdom, Finland, and Sweden have taken efforts to reverse their previous policies that allowed minors to access gender affirming care, casting doubt on the Dutch Protocol.

The United Kingdom restricted the prescription of puberty blockers to minors in 2024 after the Commission on Human Medicines reported that experts had identified safety risks and the Cass Review noted that uncertainties related to the medical intervention remain. Finland and Sweden imposed similar restrictions on the use of hormone treatments in 2020 and 2022 respectively, noting the ongoing risks and continued need for scientific research.

The legislature further finds that the legal landscape of the United States has recently recognized the legitimacy of laws which prevent youth access to gender affirming care. On June 18, 2025, the Supreme Court of the United States issued a decision upholding a Tennessee law which prohibited minors from receiving puberty blockers or other similar medical interventions. The decision validates twenty-five existing state bans across the nation. The State has an interest in protecting minors from making risky, life-altering permanent decisions that they may come to regret as adults.

Accordingly, the purpose of this Act is to prohibit medical procedures from being administered to or performed on minors when the purpose of the medical procedure is to:

(1) Enable a minor to identify with, or live as, a purported identity inconsistent with the minor's sex; or

(2) Treat purported discomfort or distress from a discordance between the minor's sex and asserted identity.

SECTION 2. Chapter 453, Hawaii Revised Statutes, is amended by adding a new part to be appropriately designated and to read as follows:

"Part . Gender affirming care

§453-A Definitions. As used in this part:

"Congenital defect" means a physical or chemical abnormality present in a minor that is inconsistent with the normal development of a human being of the minor's sex, including abnormalities caused by a medically verifiable disorder of sex development, but does not include gender dysphoria, gender identity disorder, gender incongruence, or any mental condition, disorder, disability, or abnormality.

"Healthcare provider" means a healthcare professional, establishment, or facility licensed, registered, certified, or permitted pursuant to this chapter or chapter 465 and under the regulatory authority of the following:

(1) The department of health;

(2) An agency, board, council, or committee attached to the department of commerce and consumer affairs; or

(3) The office of health care assurance.

"Hormone" means an androgen or estrogen.

"Knowing" and "knowingly" have the same meaning as the term "knowingly" is defined in section 702-206.

"Medical procedure" means:

(1) Surgically removing, modifying, altering, or entering into tissues, cavities, or organs of a human being; or

(2) Prescribing, administering, or dispensing any puberty blocker or hormone to a human being.

"Minor" means an individual under eighteen years of age.

"Parent" means any biological, legal, or adoptive parent or parents of the minor or any legal guardian of the minor.

"Puberty blocker" means a drug or device that suppresses the production of hormones in a minor's body to stop, delay, or suppress pubertal development.

"Sex" means a person's immutable characteristics of the reproductive system that define the individual as male or female, as determined by anatomy and genetics existing at the time of birth.

§453-B Prohibitions. (a) A healthcare provider shall not knowingly perform or offer to perform on a minor, or administer or offer to administer to a minor, a medical procedure if the performance or administration of the procedure is for the purpose of:

(1) Enabling a minor to identify with, or live as, a purported identity inconsistent with the minor's sex; or

(2) Treating purported discomfort or distress from a discordance between the minor's sex and asserted identity.

(b) This section applies to medical procedures that are:

(1) Performed or administered in the state; or

(2) Performed or administered on a minor located in this state, including via telehealth, as defined in section 453-1.3.

(c) It is not a violation of this section if a healthcare provider knowingly performs, or offers to perform, a medical procedure on or administers, or offers to administer, a medical procedure to a minor or if:

(1) The performance or administration of the medical procedure is to treat a minor's congenital defect, precocious puberty, disease, or physical injury; or

(2) The performance or administration of the medical procedure on the minor began prior to the effective date of this Act and concludes on or before January 1, 2027.

(d) For the purposes of subsection (c)(1), "disease" does not include gender dysphoria, gender identity disorder, gender incongruence, or any mental condition, disorder, disability, or abnormality.

(e) For the exception in subsection (c)(2) to apply, the minor's treating physician must certify in writing that, in the physician's good-faith medical judgment, based upon the facts known to the physician at the time, ending the medical procedure would be harmful to the minor. The certification must include the findings supporting the certification and must be made a part of the minor's medical record.

(f) The exception in subsection (c)(2) does not allow a healthcare provider to perform or administer a medical procedure that is different from the medical procedure performed prior to the effective date of this Act when the sole purpose of the subsequent medical procedure is to:

(1) Enable the minor to identify with, or live as, a purported identity inconsistent with the minor's sex; or

(2) Treat purported discomfort or distress from a discordance between the minor's sex and asserted identity.

(g) It is not a defense to any legal liability incurred as the result of a violation of this section that the minor, or a parent of the minor, consented to the conduct that constituted the violation.

(h) This section supersedes any common law rule regarding a minor's ability to consent to a medical procedure that is performed or administered for the purpose of:

(1) Enabling the minor to identify with, or live as, a purported identity inconsistent with the minor's sex; or

(2) Treating purported discomfort or distress from a discordance between the minor's sex and asserted identity.

§453-C Distribution of hormones or puberty blockers to minors. A person shall not knowingly provide a hormone or puberty blocker by any means to a minor if the provision of the hormone or puberty blocker is not in compliance with this chapter.

§453-D Private right of action. (a) Except as otherwise provided in subsection (b), a minor, or the parent of a minor, injured as a result of a violation of this part, may bring a civil cause of action to recover compensatory damages, punitive damages, and reasonable attorney's fees, court costs, and expenses against the healthcare provider or any person alleged to have violated this part.

(b) The parent of a minor injured as a result of a violation of this part shall not bring a civil cause of action against a healthcare provider or another person if the parent consented to the conduct that constituted the violation on behalf of the minor.

(c) The parent or next of kin of a minor may bring a wrongful death action, pursuant to section 663-3, against a healthcare provider alleged to have violated section 453-B, if the injured minor is deceased and:

(1) The minor's death is the result of the physical or emotional harm inflicted upon on the minor by the violation; and

(2) The parent of the minor did not consent to the conduct that constituted the violation on behalf of the minor.

(d) If a court in any civil action brought pursuant to this section finds that the healthcare provider knowingly violated section 453-B, then the court shall notify the appropriate regulatory authority and the attorney general by mailing a certified copy of the court's order to the regulatory authority and the attorney general. Notification pursuant to this section shall be made upon the judgment of the court being made final.

(e) For purposes of this section, compensatory damages may include:

(1) Reasonable economic losses caused by the emotional, mental or physical effects of the violation, including but not limited to:

(A) The cost of counseling, hospitalization, and any other medical expenses connected with treating the harm caused by the violation;

(B) Any out-of-pocket costs of the minor paid to the healthcare provider for the prohibited medical procedure; and

(2) Noneconomic damages caused by the violation, including but not limited to, psychological and emotional anguish.

(f) Notwithstanding any law to the contrary, an action commenced under this section must be brought:

(1) Within thirty years from the date the minor reaches eighteen years of age; or

(2) Within ten years of the minor's death if the minor dies.

(g) This section is declared to be remedial in nature, and this section must be liberally construed to effectuate its purpose.

§453-E State right of action. (a) The attorney general shall establish a process by which violations of this part may be reported.

(b) The attorney general may bring an action against a healthcare provider or any person that knowingly violates this chapter, within twenty years of the violation, to enjoin further violations, to disgorge any profits received due to the medical procedure, and to recover a civil penalty of twenty-five thousand dollars per violation. Each time a healthcare provider performs or administers a medical procedure in violation of section 453-B constitutes a separate violation.

(d) The attorney general is entitled to reasonable attorney's fees, court costs, and expenses if the attorney general prevails in an action brought pursuant to this section.

(e) Jurisdiction for an action brought pursuant to this section is in the circuit court in the county where the violation occurred.

§453-F Healthcare provider licensing sanctions. A violation of section 453-B constitutes a potential threat to public health, safety, and welfare and requires emergency action by an alleged violator's appropriate regulatory authority. Upon receiving notification pursuant to section 453-D, or upon otherwise becoming aware of an alleged violation of section 453-B, the appropriate regulatory authority shall proceed pursuant this chapter or chapter 465, as applicable.

§453-G Minor immunity. A minor upon whom a medical procedure is performed or administered must not be held liable for violating this chapter.

§453-H Application. This part does not prohibit or restrict psychological practice regulated pursuant to chapter 465; the practice of professional counseling regulated pursuant to chapter 453D; or the practice of social work regulated pursuant to chapter 467E.

SECTION 3. If any provision of this Act, or the application thereof to any person or circumstance, is held invalid, the invalidity does not affect other provisions or applications of the Act that can be given effect without the invalid provision or application, and to this end the provisions of this Act are severable.

SECTION 4. In codifying the new sections added by section 2 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in designating the new sections in this Act.

SECTION 5. This Act shall take effect upon its approval.

INTRODUCED BY:	_____________________________

HOUSE OF REPRESENTATIVES	H.B. NO.	2513
THIRTY-THIRD LEGISLATURE, 2026
STATE OF HAWAII