Transgender

It’s Time to Outlaw Transgender Conversion Efforts in the US

Research shows trans conversion therapy is widespread and potentially deadly.

Posted Nov 10, 2019

As mental health providers, we recently asked a group of transgender youth what they wanted their doctors to know, and they had a powerful message: “If I am depressed or anxious, it’s likely not because I have issues with my gender identity, but because everyone else does.”

As psychiatrists, we’ve entered a new era of understanding for transgender people. Being transgender is not a mental illness. Peoples’ gender diversity isn’t what’s dangerous; our attempts to change them are. And we urgently need legislation to protect them. We need to outlaw conversion efforts for transgender people nationwide.

Despite evidence that attempts to make transgender people cisgender are dangerous, these attempts are still common. In a recent study, published in September by our group at Harvard Medical School and The Fenway Institute, we found that transgender people in every U.S. state have been exposed to conversion efforts. We estimate that nearly 200,000 transgender Americans have been subjected to this dangerous practice. In a second study of over 27,000 transgender people in the U.S. published in JAMA Psychiatry, we found that exposure to these conversion efforts was associated with double the odds of a suicide attempt.

People usually think of “conversion therapy” as referring to attempts to force gay, lesbian or bisexual people to be heterosexual. There is, however, a separate type of “therapy” out there that focuses on making transgender people cisgender.

Some psychologists still argue that this should be done on young gender-diverse children. They claim that there are compelling data showing that most transgender children will grow up to be cisgender. Not only is this untrue, but it also presumes that being transgender is an undesirable outcome that needs to be avoided. It’s also dangerous. Our study in JAMA Psychiatry found that exposing a transgender child to conversion therapy was associated with a four-fold increased odds of that person attempting suicide.

Our research has shown that it makes no difference whether these conversion efforts come from a secular professional (a psychologist, therapist, or psychiatrist) or a religious advisor. Either way, attempts to make transgender people cisgender are associated with suicide attempts. It’s well established that rejection based on gender identity from family or peers leads to worse mental health. It is not surprising that codifying this into a formal practice, be it religious or secular, is devastating to a person’s mental health.

There has been a shift in psychiatry over the past few decades away from pathologizing gender diversity and toward embracing it. In the past, psychiatrists referred to being transgender as a delusion.  We no longer consider gender diversity to be an illness. The American Psychiatric Association and The American Academy of Child and Adolescent Psychiatry have labeled conversion therapy for transgender people unethical. It’s time for our legislators to catch up with psychiatry.

We need to outlaw conversion efforts for transgender people nationwide. There have been two arguments against this in the past. State legislators have argued that this legislation is unnecessary because conversion efforts don’t happen in their state. We have shown that to be false across the United States. The second argument is that there is no evidence that these practices are harmful. We have shown this to also be false, with these practices being strongly associated with suicide attempts.

So far, 18 states, Puerto Rico, and Washington, D.C., have outlawed this practice. It’s time for conversion efforts to be illegal in every state—before more people die.

Jack Turban, M.D., MHS, is a resident physician in psychiatry at The Massachusetts General Hospital and McLean Hospital.

Alex S. Keuroghlian, M.D., MPH, is the director of the National LGBT Health Education Center at The Fenway Institute and Director of the Massachusetts General Hospital Psychiatry Gender Identity Program.

Correction 12/22/2020: The original version of this article included the line "As recently as 2013, the Diagnostic and Statistical Manual of Mental Disorders [DSM] referred to being transgender as a 'gender identity disorder.'" Some interpreted this line to indicate that transgender identity alone is sufficient to meet criteria for the DSM-IV diagnosis, which it is not. For that reason and because the sentence was not essential to the arguments of the piece, the line was removed. A full discussion of how the DSM gender-related diagnoses have evolved can be found here

References

Turban, J. L., Beckwith, N., Reisner, S. L., & Keuroghlian, A. S. (2019). Association Between Recalled Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults. JAMA Psychiatry, 1-9.

Turban, J. L., King, D., Reisner, S. L., & Keuroghlian, A. S. (2019). Psychological Attempts to Change a Person’s Gender Identity From Transgender to Cisgender: Estimated Prevalence Across US States, 2015. American Journal of Public Health, 109(10), 1452-1454.

Turban, J. L., & Ehrensaft, D. (2018). Research review: gender identity in youth: treatment paradigms and controversies. Journal of Child Psychology and Psychiatry, 59(12), 1228-1243.

Turban, J., Ferraiolo, T., Martin, A., & Olezeski, C. (2017). Ten things transgender and gender nonconforming youth want their doctors to know. Journal of the American Academy of Child & Adolescent Psychiatry, 56(4), 275-277.