Landmark Study on "Conversion Therapy" for Transgender People Reveals Its Dangers

In May, Colorado became the 18th state, and the fourth this year, to ban what’s known as gender identity “conversion therapy.” The pseudoscientific practice is defined as any attempt to change a person’s gender identity or expression to their sex assigned at birth.

However, recent research indicates that despite bans, gender conversion therapy, also known as “reparative therapy,” has occurred in every state as recently as the period 2010 to 2015, and they are associated with inducing the risk of transgender people committing suicide.

This frequency finding was presented in a study published this month in the American Journal of Public Health, while the detrimental effects of gender identity conversion therapy were documented in a study published Wednesday in JAMA Psychiatry.

Dr. Jack Turban, lead author and resident physician in psychiatry at The Massachusetts General Hospital and McLean Hospital, tells Inverse that taken together “these are concerning findings that warrant serious public health and legislative action.” Turban, Alex Keuroghlian, MD, and Sari Reisner, ScD, contributed to both of these new studies.

Keuroghlian, a senior author, psychiatrist at Massachusetts General Hospital, and Director of the National LGBT Health Education Center at The Fenway Institute, tells Inverse that the American Journal of Public Health study found that almost 200,000 people in the United States have experienced gender identity conversion efforts by a professional.

What Are Conversion Therapy Treatments?

Currently, talk therapy is the most commonly used technique but some practitioners also use “aversion treatments,” including but not limited to inducing nausea, providing electric shocks, or hypnosis. 

A 2002 paper by Douglas C. Haldeman of the University of Washington, published in the journal Professional Psychology: Research and Practice, describes the tactics of conversion therapy — defined in his paper as “therapies designed to change sexual orientation” — as such:

The most notorious behavioral approaches were aversive treatments, including the application of electric shock to the hands and/or genitals, or nausea-inducing drugs, which would be administered simultaneously with the presentation of homoerotic stimuli. Less cruel methods included masturbatory reconditioning, visualization, and social skills training.

What Are the Mental Health Effects of “Conversion Therapy”?

The JAMA Psychiatry study published this week found that gender conversion efforts are associated with an increased likelihood of adverse mental health outcomes, including suicide attempts. The study is based on the results of a 2015 survey distributed through community outreach to 27,715 adults in all 50 states, the District of Columbia, some U.S. territories including Puerto Rico, and US military bases overseas. This is the largest survey of transgender people to date.

Within this group, 71.3 percent reported having spoken to a secular or religious professional about their gender identity, and 19.6 percent reported exposure to gender identity conversion efforts. That group, compared to those who discussed gender identity but were not exposed to conversion therapy, were much more likely to report severe psychological distress during the month before the survey, as well as state they’ve attempted suicide over the course of their life.

This was especially true for transgender adults who were sent to gender identity conversion therapy before they were 10-years old. Repeated exposure to conversion efforts before the age of 10 was associated with greater lifetime odds of suicide attempts.

The finding that gender identity conversion therapy can result in potentially fatal outcomes is in line with earlier conclusions made by professional organizations like the American Medical Association and the American Psychiatric Association, which describe the practice as both unethical and ineffective.

Conversion therapy has been used in some capacity in the US since the 1890s. It’s only now that the established scientific community agrees that gender diversity is not a pathological finding that requires modification, but simply identity.

Still, the numbers make clear that gender identity conversion therapy is not a thing of the past.

“In our work implementing systems nationally for gender-affirming healthcare, it is unfortunately still very common to encounter practitioners who conduct gender identity conversion efforts,” Keuroghlian explains. “Thus it is critical for practitioners and community members to understand that these efforts are associated with significantly increased risk of suicide attempts.”

While this study was unable to determine causation — why conversion therapy leads to serious mental health problems — first-hand accounts speak of the pain the practice causes. According to the Williams Institute at UCLA School of Law, 69,800 LGBT adults have received conversion therapy, both for sexual orientation and for gender identity and expression. If all states do not completely ban the practice, 20,000 LGBT youth are expected to receive conversion therapy before they reach the age of 18.

Partial Abstract:

Importance: Gender identity conversion efforts (GICE) have been widely debated as potentially damaging treatment approaches for transgender persons. The association of GICE with mental health outcomes, however, remains largely unknown.

Results: Of 27,715 transgender survey respondents (mean [SD] age, 31.2 [13.5] years), 11,857 (42.8%) were assigned male sex at birth. Among the 19,741 (71.3%) who had ever spoken to a professional about their gender identity, 3869 (19.6%; 95% CI, 18.7%-20.5%) reported exposure to GICE in their lifetime. Recalled lifetime exposure was associated with severe psychological distress during the previous month (adjusted odds ratio [aOR], 1.56; 95% CI, 1.09-2.24; P < .001) compared with non-GICE therapy. Associations were found between recalled lifetime exposure and higher odds of lifetime suicide attempts (aOR, 2.27; 95% CI, 1.60-3.24; P < .001) and recalled exposure before the age of 10 years and increased odds of lifetime suicide attempts (aOR, 4.15; 95% CI, 2.44-7.69; P < .001). No significant differences were found when comparing exposure to GICE by secular professionals vs religious advisor.

Conclusions and Relevance: The findings suggest that lifetime and childhood exposure to GICE are associated with adverse mental health outcomes in adulthood. These results support policy statements from several professional organizations that have discouraged this practice.