; and (B) estrogen given to biological males at doses that are profoundly larger or more potent than would normally occur naturally in healthy biological males. (3) Gender The term gender means the psychological, behavioral, social, and cultural aspects of being male or female. (4) Gender transition The term gender transition means the process in which an individual 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. (5) Gender transition procedure (A) In general The term gender transition procedure means any medical or surgical service that seeks— (i) to alter or remove physical or anatomical characteristics or features that are typical for the individual’s biological sex; or (ii) to instill or create physiological or anatomical characteristics that resemble a sex different from the individual’s birth sex. (B) Inclusions For purposes of subparagraph (A), the term medical or surgical service includes— (i) physician's services; (ii) inpatient and outpatient hospital services; (iii) prescribed drugs relating to gender transition; (iv) a medical service that provides— (I) puberty-blocking drugs; (II) cross-sex hormones; or (III) other mechanisms to promote the development of feminizing or masculinizing features (in the opposite sex); and (v) gender transition surgery. (C) Exclusions The term gender transition procedure does not include— (i) services to individuals born with a medically verifiable disorder of sex development, including an individual with external biological sex characteristics that are irresolvably ambiguous, such as an individual born with 46 XX chromosomes with virilization, an individual born with 46 XY chromosomes with undervirilization, or an individual born having both ovarian and testicular tissue