Text of LA HR 158 (2022)

HLS 22RS-2024 ORIGINAL 2022 Regular Session HOUSE RESOLUTION NO. 158 BY REPRESENTATIVE FIRMENT HEALTH/CHILDREN: Requests a study of gender-altering procedures for minors and the risks associated with such procedures 1 A RESOLUTION 2 To urge and request the Louisiana Department of Health to conduct a study focused on the 3 risks associated with gender reassignment procedures on minors, including genital 4 and non-genital surgeries, and chemical treatments such as puberty-blockers and 5 cross-sex hormones and to report its findings to certain legislative committees. 6 WHEREAS, this state has a compelling governmental interest in protecting the health 7 and safety of its citizens, especially minors; and 8 WHEREAS, the Merck Manual once stated that, "gender dysphoria is characterized 9 by a strong, persistent cross-gender identification associated with anxiety, depression, 10 irritability, and often a wish to live as a gender different from the one associated with the sex 11 assigned at birth"; and 12 WHEREAS, gender dysphoria is largely impacting today's minors; and 13 WHEREAS, the Florida Department of Health stated in a press release that eighty 14 percent of those seeking treatment for such gender reassignment procedures will lose their 15 desire to identify with their non-birth sex; and 16 WHEREAS, the Society for Evidence Based Gender Medicine stated that 17 "childhood-onset gender dysphoria has been shown to have a high rate of natural resolution, 18 with sixty-one to ninety-eight percent of children re-identifying with their biological sex 19 during puberty"; and Page 1 of 5 HLS 22RS-2024 ORIGINAL HR NO. 158 1 WHEREAS, scientific studies show that individuals struggling with distress at 2 identifying with their biological sex often have experienced psychopathology; and 3 WHEREAS, suicide rates, psychiatric morbidities, and mortality rates remain 4 markedly elevated above the background population after inpatient gender reassignment 5 procedures have been performed; and 6 WHEREAS, there is no evidence that long-term mental health outcomes are 7 improved or that rates of suicide are reduced by hormonal or surgical intervention; and 8 WHEREAS, some healthcare providers are prescribing puberty-blocking drugs in 9 order to delay the onset or progression of normally-timed puberty in minors who experience 10 distress at identifying with their biological sex; and 11 WHEREAS, the Karolinska Hospital in Sweden has ended the practice of prescribing 12 puberty-blockers for those under the age of eighteen; and 13 WHEREAS, use of such treatments may result in potentially irreversible 14 consequences such as cardiovascular disease, osteoporosis, infertility, increased cancer risk, 15 and thrombosis; and 16 WHEREAS, there are also other healthcare providers that continue to prescribe 17 cross-sex hormones for minors who experience distress identifying with their biological sex, 18 despite the fact that no randomized clinical trials have been conducted to ensure the efficacy 19 or safety of the use of cross-sex hormones in adults or minors for the purpose of treating 20 such distress or gender transition; and 21 WHEREAS, the use of cross-sex hormones comes with the following known risks: 22 (1) For biological females, erythrocytosis, severe liver dysfunction, coronary artery 23 disease, cerebrovascular disease, hypertension, increased risk of breast and uterine cancers, 24 and irreversible infertility; and 25 (2) For biological males, thromboembolic disease, cholelithiasis, macroprolactinoma, 26 coronary artery disease, cerebrovascular disease, hypertriglyceridemia, breast cancer, and 27 irreversible infertility; and 28 WHEREAS, non-genital gender reassignment surgery includes various invasive 29 procedures for males and females, including the following procedures, and also involves the 30 alteration or removal of biologically normal and functional body parts: Page 2 of 5 HLS 22RS-2024 ORIGINAL HR NO. 158 1 (1) For biological males, procedures may include augmentation mammoplasty, facial 2 feminization surgery, liposuction, lipofilling voice surgery, thyroid cartilage reduction, 3 gluteal augmentation, hair reconstruction, and other aesthetic procedures; and 4 (2) For biological females, procedures may include subcutaneous mastectomy, voice 5 surgery, thyroid cartilage reduction, gluteal augmentation, hair reconstruction, and other 6 aesthetic procedures; and 7 WHEREAS, genital gender reassignment surgery includes several irreversible and 8 invasive procedures for males and females and involves the following alterations of 9 biologically normal and functional body parts: 10 (1) For biological males, surgery may involve genital reconstruction including 11 penectomy, orchiectomy, vaginoplasty, clitoroplasty, and vulvoplasty; and 12 (2) For biological females, surgery may involve a hysterectomy or oophorectomy, 13 reconstruction of the urethra, genital reconstruction including metoidioplasty or phalloplasty, 14 vaginectomy, scrotoplasty, and implantation of erection or testicular prostheses; and 15 WHEREAS, genital gender reassignment surgery often results in the permanent 16 sterilization of minors through procedures such as castration, vasectomy, hysterectomy, 17 oophorectomy, metoidioplasty, orchiectomy, penectomy, phalloplasty, and vaginoplasty, and 18 chemical treatments such as the use of puberty-blocking drugs and cross-sex hormones to 19 minors often cause transient or permanent infertility; and 20 WHEREAS, procedures such as these allow minors to "consent" to life-altering and 21 irreversible treatment in the midst of reported psychological distress even though minors 22 cannot determine the long-term risks associated with such treatment the way that adults do 23 and minors lack the requisite legal capacity to give such consent; and 24 WHEREAS, though the dramatic increase in these procedures is a relatively recent 25 development, the sterilization of minors and other vulnerable populations without legal 26 consent is not a new phenomenon and has historically been weaponized against minorities 27 and other vulnerable populations; and 28 WHEREAS, it still remains medically impossible to truly change the sex of an 29 individual because this is determined biologically at conception; and Page 3 of 5 HLS 22RS-2024 ORIGINAL HR NO. 158 1 WHEREAS, there has been a number of individuals who regret undergoing 2 irreversible gender reassignment procedures and have attempted to "detransition" to the 3 gender that aligns with their biological sex; and 4 WHEREAS, several European countries have revised their recommendations in 5 regards to a minor's capacity to consent to gender reassignment procedures, including 6 Sweden, Finland, and the United Kingdom; and 7 WHEREAS, states like Texas, Arkansas, Alabama, and Florida have recently passed 8 laws or issued legal opinions recognizing these gender reassignment surgeries and 9 procedures as illegal, harmful, unethical, and consistent with child abuse; and 10 WHEREAS, it is a grave concern to the legislature that the medical community is 11 allowing minors who experience distress identifying with their biological sex to be subjects 12 of irreversible gender reassignment procedures and surgeries. 13 THEREFORE, BE IT RESOLVED that the House of Representatives of the 14 Legislature of Louisiana does hereby urge and request the Louisiana Department of Health 15 to conduct a study focused on the risks associated with gender reassignment surgeries and 16 procedures for minors. The study should not be limited in scope but should include all of 17 the following: 18 (1) The number and types of procedures performed annually. 19 (2) The historic trends in the number of procedures performed and the number of 20 providers performing the procedures. 21 (3) The ages of the minors involved. 22 (4) The number of providers performing the procedures and the number of clinics 23 performing the procedures. 24 (5) An analysis of the psychological and psychiatric outcomes of minors who have 25 undergone gender reassignment procedures. 26 (6) An analysis of the physical and medical outcomes of minors who have 27 undergone gender reassignment procedures. 28 (7) The propensity of minors who have undergone these procedures to "detransition" 29 to the gender aligned with their biological sex. Page 4 of 5 HLS 22RS-2024 ORIGINAL HR NO. 158 1 (8) The amount of Medicaid funds used to cover the cost of gender reassignment 2 procedures in this state. 3 (9) The availability of mental health counseling services for minors experiencing 4 gender dysphoria. 5 (10) A review of a minor's mental and cognitive capacity to consent to gender 6 reassignment procedures. 7 BE IT FURTHER RESOLVED that this study should not include an analysis of 8 services provided to individuals born with a medically verifiable disorder of sex 9 development, including a person with external biological sex characteristics that are 10 irresolvably ambiguous, such as an individual born with forty-six XX chromosomes with 11 virilization, forty-six XY chromosomes with undervirilization, or having both ovarian and 12 testicular tissue. 13 BE IT FURTHER RESOLVED that the Louisiana Department of Health shall submit 14 its findings from the study called for in this Resolution in the form of a written report to the 15 House Committee on Health and Welfare and the David R. Poynter Legislative Research 16 Library no later than sixty days prior to the convening of the 2023 Regular Session of the 17 Legislature. 18 BE IT FURTHER RESOLVED that a copy of this Resolution be transmitted to the 19 secretary of the Louisiana Department of Health. DIGEST The digest printed below was prepared by House Legislative Services. It constitutes no part of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)] HR 158 Original 2022 Regular Session Firment Urges the Louisiana Department of Health to conduct a study focused on the risks associated with gender reassignment surgeries and procedures for minors and to report its findings. Page 5 of 5

ENROLLED 2022 Regular Session HOUSE RESOLUTION NO. 158 BY REPRESENTATIVES FIRMENT AND GAROFALO A RESOLUTION To urge and request the Louisiana Department of Health to conduct a study focused on the risks associated with gender reassignment procedures on minors, including genital and non-genital surgeries, and chemical treatments such as puberty-blockers and cross-sex hormones and to report its findings to certain legislative committees. WHEREAS, this state has a compelling governmental interest in protecting the health and safety of its citizens, especially minors; and WHEREAS, the Merck Manual once stated that, "gender dysphoria is characterized by a strong, persistent cross-gender identification associated with anxiety, depression, irritability, and often a wish to live as a gender different from the one associated with the sex assigned at birth"; and WHEREAS, gender dysphoria is largely impacting today's minors; and WHEREAS, the Florida Department of Health stated in a press release that eighty percent of those seeking treatment for such gender reassignment procedures will lose their desire to identify with their non-birth sex; and WHEREAS, the Society for Evidence Based Gender Medicine stated that "childhood-onset gender dysphoria has been shown to have a high rate of natural resolution, with sixty-one to ninety-eight percent of children re-identifying with their biological sex during puberty"; and WHEREAS, scientific studies show that individuals struggling with distress at identifying with their biological sex often have experienced psychopathology; and WHEREAS, there is no evidence that long-term mental health outcomes are improved or that rates of suicide are reduced by hormonal or surgical intervention; and Page 1 of 5 HR NO. 158 ENROLLED WHEREAS, instead, research shows that suicide rates, psychiatric morbidities, and mortality rates are higher after inpatient gender reassignment procedures have been performed; and WHEREAS, some healthcare providers are prescribing puberty-blocking drugs in order to delay the onset or progression of normally-timed puberty in minors who experience distress at identifying with their biological sex; and WHEREAS, the Karolinska Hospital in Sweden, a pioneer in the procedure, has ended the practice of prescribing puberty-blockers for those under the age of eighteen; and WHEREAS, use of such treatments may result in potentially irreversible consequences such as cardiovascular disease, osteoporosis, infertility, increased cancer risk, and thrombosis; and WHEREAS, there are also other healthcare providers that continue to prescribe cross-sex hormones for minors who experience distress identifying with their biological sex, despite the fact that no randomized clinical trials have been conducted to ensure the efficacy or safety of the use of cross-sex hormones in adults or minors for the purpose of treating such distress or gender transition; and WHEREAS, the use of cross-sex hormones comes with the following known risks: (1) For biological females, erythrocytosis, severe liver dysfunction, coronary artery disease, cerebrovascular disease, hypertension, increased risk of breast and uterine cancers, and irreversible infertility; and (2) For biological males, thromboembolic disease, cholelithiasis, macroprolactinoma, coronary artery disease, cerebrovascular disease, hypertriglyceridemia, breast cancer, and irreversible infertility; and WHEREAS, non-genital gender reassignment surgery includes various invasive procedures for males and females, including the following procedures, and also involves the alteration or removal of biologically normal and functional body parts: (1) For biological males, procedures may include augmentation mammoplasty, facial feminization surgery, liposuction, lipofilling voice surgery, thyroid cartilage reduction, gluteal augmentation, hair reconstruction, and other aesthetic procedures; and Page 2 of 5 HR NO. 158 ENROLLED (2) For biological females, procedures may include subcutaneous mastectomy, voice surgery, thyroid cartilage reduction, gluteal augmentation, hair reconstruction, and other aesthetic procedures; and WHEREAS, genital gender reassignment surgery includes several irreversible and invasive procedures for males and females and involves the following alterations of biologically normal and functional body parts: (1) For biological males, surgery may involve genital reconstruction including penectomy, orchiectomy, vaginoplasty, clitoroplasty, and vulvoplasty; and (2) For biological females, surgery may involve a hysterectomy or oophorectomy, reconstruction of the urethra, genital reconstruction including metoidioplasty or phalloplasty, vaginectomy, scrotoplasty, and implantation of erection or testicular prostheses; and WHEREAS, genital gender reassignment surgery often results in the permanent sterilization of minors through procedures such as castration, vasectomy, hysterectomy, oophorectomy, metoidioplasty, orchiectomy, penectomy, phalloplasty, and vaginoplasty, and chemical treatments such as the use of puberty-blocking drugs and cross-sex hormones to minors often cause transient or permanent infertility; and WHEREAS, procedures such as these allow minors to "consent" to life-altering and irreversible treatment in the midst of reported psychological distress even though minors cannot determine the long-term risks associated with such treatment the way that adults do and minors lack the requisite legal capacity to give such consent; and WHEREAS, though the dramatic increase in these procedures is a relatively recent development, the sterilization of minors and other vulnerable populations without legal consent is not a new phenomenon and has historically been weaponized against minorities and other vulnerable populations; and WHEREAS, it still remains medically impossible to truly change the sex of an individual because this is determined biologically at conception; and WHEREAS, there has been a number of individuals who regret undergoing irreversible gender reassignment procedures and have attempted to "detransition" to the gender that aligns with their biological sex; and Page 3 of 5 HR NO. 158 ENROLLED WHEREAS, several European countries have revised their recommendations in regards to a minor's capacity to consent to gender reassignment procedures, including Sweden, Finland, and the United Kingdom; and WHEREAS, states like Texas, Arkansas, Alabama, and Florida have recently passed laws or issued legal opinions recognizing these gender reassignment surgeries and procedures as illegal, harmful, unethical, and consistent with child abuse; and WHEREAS, it is a grave concern to the legislature that the medical community is allowing minors who experience distress identifying with their biological sex to be subjects of irreversible gender reassignment procedures and surgeries. THEREFORE, BE IT RESOLVED that the House of Representatives of the Legislature of Louisiana does hereby urge and request the Louisiana Department of Health to conduct a study focused on the risks associated with gender reassignment surgeries and procedures for minors. The study should not be limited in scope but should include all of the following: (1) The number and types of procedures performed annually. (2) The historic trends in the number of procedures performed and the number of providers performing the procedures. (3) The ages of the minors involved. (4) The number of providers performing the procedures and the number of clinics performing the procedures. (5) An analysis of the psychological and psychiatric outcomes of minors who have undergone gender reassignment procedures. (6) An analysis of the physical and medical outcomes of minors who have undergone gender reassignment procedures. (7) The propensity of minors who have undergone these procedures to "detransition" to the gender aligned with their biological sex. (8) The amount of Medicaid funds used to cover the cost of gender reassignment procedures in this state. (9) The availability of mental health counseling services for minors experiencing gender dysphoria. Page 4 of 5 HR NO. 158 ENROLLED (10) A review of a minor's mental and cognitive capacity to consent to gender reassignment procedures. BE IT FURTHER RESOLVED that this study should not include an analysis of services provided to individuals born with a medically verifiable disorder of sex development, including a person with external biological sex characteristics that are irresolvably ambiguous, such as an individual born with forty-six XX chromosomes with virilization, forty-six XY chromosomes with undervirilization, or having both ovarian and testicular tissue. BE IT FURTHER RESOLVED that the Louisiana Department of Health shall submit its findings from the study called for in this Resolution in the form of a written report to the House Committee on Health and Welfare and the David R. Poynter Legislative Research Library no later than sixty days prior to the convening of the 2023 Regular Session of the Legislature. BE IT FURTHER RESOLVED that a copy of this Resolution be transmitted to the secretary of the Louisiana Department of Health. SPEAKER OF THE HOUSE OF REPRESENTATIVES Page 5 of 5