In an exciting tie-breaker vote, the Senate Health and Welfare Committe tabled a bill which would have prohibited surgical and hormonal sex change procedures for miners. The committee chair, Senator Fred Mills, broke the tie and voted with the opposition to defer the bill.

Authored by Representative Michael Firment, the measure had passed the House, 71 to 24, after being heavily amended and substituted in committee. The Senate Committee vote was a tie at 4 to 4, splitting down party lines. The chair, a Republican, Senator Mills acknowledged his vote would break the tie.

He said, “It comes down to me. I’m going to make a statement then. I guess I’ve always in my heart of hearts, I believe that a decision should be made by a patient and a physician. I believe in the physicians in Louisiana. I believe the people that are licensed by the Board of Medical Examiners are well regulated. I believe in the scope of practice. I believe in the standard of care.” […] “So because of that, I do believe in opposition, and I believe in the right of a family to choose what’s best for them. I vote yes.”

During the hearing, Clinical psychologist, Dr. Clifton Mixson, was among those who testified in opposition to HB 648.

“I work in a gender clinic that prescribes hormone therapies to youth,” he said. “At the heart of this debate is mistrust in our medical and mental health providers to provide ethical, individualized care without prejudice and based on best practices and established research,” Mixon said. “I’m here to address these concerns in opposition to a mean-spirited bill that defies science and humanity.

“The evidence is clear––gender affirming medical interventions are safe and effective treatment for gender dysphoria and resulting mental health problems for many trans youth. Unfortunately, you’ve been exposed to false information that misrepresents the established research and practice guidelines on gender health care medicine. I am here with actual studies that can help you understand the actual facts. I have a doctoral degree with training in how to conduct and interpret research,” he said.

“These medical interventions reduce risk for suicide and improve overall mental health functioning and quality of life. We are not providing access to youth for whom it is not appropriate.”

He noted the success rate is high; high rates of treatment satisfaction and low rates of regret less than 1%. And he pointed out 20 position statements for major medical and mental health organizations across the country.

He explained that when he and his team suggest hormone therapy to these children, it is because they have exhausted all other options and when this happens they get better, he said.

“I’m here to tell you we know what we are doing. We are following established research, Best practice guidelines and our ethical codes and we are doing so with an awareness of our role and supporting safe exploration and decision-making. We are doing so with the best interest of every child and family member.”

Psychologist, Dr. Jesse Lambert, also testified in opposition, representing the Louisiana Psychological Association.

“A lot of research has been discussed today scientifically sound research that indicates that this is a true phenomena and that individuals who are trans have suffered greatly.

“Citing from the American Psychological Association, we have data that indicates that individuals who are trans experience more victimization, be that bullying, be that acts of violence occurring in school. They feel more ostracized, more isolated and this generalizes into relationships including close family relationships.

“I echo the data that indicates the greater likelihood of psychological morbidity including self-mutilation, suicide and also note research again endorsed by the American Psychological Association that shows greater degrees of satisfaction and resolution of these issues and that this isn’t immediately about going to a biological treatment modality.”

He explained that a model of triage issues with different intensities and that practitioners don’t automatically jump to biological modalities.

“If this bill should pass, psychologist would not be able to take part in a team-based approach, involving endocrinologists, psychiatrists, pediatricians and contribute to an individual’s care from a holistic standpoint.”

Speaking in favor of his measure, Rep. Firment said, “Perhaps the most compelling scientific evidence to consider today is the fact that several progressive European nations who pioneered chemical and surgical sex change procedures like England, Sweden, and Finland have completely reversed course on this issue and they are now recommending counseling and watchful waiting as opposed to the use of dangerous and experimental drugs and invasive and irreversible surgeries,” he said.

“We know that for 85% of the kids experiencing gender dysphoria, the confusion will resolve itself with time in counseling. We also know that despite claims to the contrary rates of suicides are not decreased and health outcomes are not improved with so-called gender affirming care. Where children are self diagnosing, decisions can lead to permanent damage including sterilization and loss of sexual function.”

Dr, Quenton Vanmeter, a pediatric endocrinologist from Atlanta, Georgia, cited evidence from European countries that suggests that there is no benefit in transgender surgery or hormonal treatment and that the suicide rate is not impacted.

Dr. Evelyn Griffin from Baton Rouge testified as a certified OB/GYN that puberty blockers are not approved for adolescents and are dangerous.

The clashing world views of the individuals supporting and those opposing the bill included both sides claiming that they had the more valid research and that the other side’s research was flawed. Sen. Mills asked why so many differences in the evidence.

Dr. Stephen Félix, a pediatrician, said, “The problem with the studies that the AEP reports and others, they do not have significant randomized control trials. They have small sample sizes, they have poor follow up, they have a lot of people lost to follow up, they have individuals who they have a very short period of time that they follow them. That’s why,” he said.

“The studies that are coming out of Sweden, Finland or long-term studies where they looked extensively and they said, ‘wait, this is all wrong.’ The quality of evidence that supports this transition therapy is poor. The level of evidence that we’re presenting is strong.”

Sen. Mills said that he just needed them to understand that there are a lot of organizations that have the other side.

Dr. Griffin said, “Policies are created by organizations, a small group of individuals in organizations. That is then broadcast out and physicians like ourselves, in the trenches, […] It does become increasingly difficult to practice medicine when you’re told by your employer that these are the benchmarks that you have to check off. So that’s actually the reality of what’s happening nowadays and that’s why you see a contradiction and what is perhaps shown in mainstream media or by organizations and why you see front line doctors like ourselves saying something different.”

During the two-hour hearing, some degenerated into mudslinging. Dr. Mixson remarked that Dr. Vanmeter’s views had been compared to a hollow chocolate Easter Bunny, and Rep. Firment returned that Dr. Mixson was a “radical activist who works for Ochsner’s Hospital.”

The hearing is available on the Senate archives.