HARMFUL TREATMENT: The Global Reach of So-Called Conversion Therapy

Yet another critical report outlining the motivations and harm of “Conversion/Reparative Therapy”. Yet again we see that these practices do not work and that they proceed from a desire to maintain the status quo or to punish those who do not conform. It is deeply troubling, though not surprising, how widespread these practices are.

Published By: Outright Action International. October 24, 2019. Author: Amie Bishop, MSW, MPH

Executive Summary:

In most countries around the world, discrimination, violence, and oppression based on sexual orientation, gender identity and expression and sex characteristics persist within families, faith communities, and societies at large.

A manifestation of this ongoing rejection is that LGBTIQ people are considered disordered and therefore need “cure,” “repair,” or counselling to regain their presumed heterosexual, cisgender identities. The term “conversion therapy” is most widely used to describe this process of cis-gender, heteronormative indoctrination— that is, attempting to change, suppress, or divert one’s sexual orientation, gender identity or gender expression. The term, however, suggests that treatment is needed for a disorder and that people can be converted to cis­gender heterosexuality through such “treatment.” Neither is true. 

Although the practice of so-called “conversion therapy” has been well-documented over the last five decades in North America and Australia, no study has been undertaken to characterize the nature and extent of these damaging, degrading practices globally. Drawing on data from an extensive literature review, the first-ever global survey on the topic, and in-depth interviews with experts and survivors from various countries, this report seeks to provide a global snapshot of what is known about “conversion therapy” around the world, including who is most vulnerable, what factors lead LGBTIQ people to choose or to be subjected to these harmful practices, what are the main forms of “conversion therapy,” and who are the main perpetrators.

Our findings suggest that efforts to repress, change, or “cure” diverse sexual orientations and gender identities are occurring nearly everywhere in the world. Religion, broadly, is the reason most frequently cited, although there are some regional variations. In Africa, religion, combined with family and cultural pressures, seem to fuel the practice of “conversion therapy.” In Latin America and the Caribbean, family and religious pressure also appear to be the main drivers of “conversion therapy,” with perpetrators largely being either religious personnel or private mental health providers. By contrast, in Asia, the data suggest that family “honor” and culture, more than religion, drive families and LGBTIQ people themselves to seek out “conversion therapy,” primarily through private and public medical and mental health clinics, where it appears that physically abusive methods such as aversion therapy are predominantly used. An additional important finding is that efforts to either curtail these practices through official policies, or ban practices altogether, appear to be minimal, or at least minimally known. This is especially striking given the apparent pervasiveness of “conversion therapy.” As found in our literature review, only four countries actually ban sexual orientation and gender identity change practices. 

Finally, consistent with all scientific literature to date, our data suggest that, regardless of religious, cultur­al, or traditional norms and con­texts, these harmful practices nev­er work; instead, they often cause deep, lasting trauma that affects every realm of life for decades. 

Above all, these data paint a picture of prevailing social, cultural, and religious norms that perpetuate myths about LGBTIQ people; incite and support stigma, violence, and discrimination targeting LGBTIQ people; and fundamentally reinforce messages that being LGBTIQ is pathological or otherwise unacceptable. More worryingly still, providers of “conversion therapy” are hijacking human rights language to promote their services, claiming that those who do not want to be LGBTIQ have the right to choose to undergo “conversion therapy”. 

The demand for “conversion therapy” will only diminish when social, family, and religious condemnation of LGBTIQ lives ceases, and LGBTIQ people are free to access and enjoy their full human rights. Indeed, “conversion therapy” is a manifestation of the scourge of both societal and internalized homophobia and transphobia and is fueled by the messages that being LGBTIQ is pathological, disordered, and unacceptable. Such myths converge in a perfect storm of rejection and condemnation, leading to an ongoing demand for “conversion therapy,” both by LGBTIQ people themselves as well as by their families, faith communities, and broader society. 

Additional in-depth investigation is needed at national and regional levels to more precisely characterize the nature and impact of hetero­sexual, cisgender indoctrination efforts and to formulate advocacy strategies to combat them. It is clear, however, that the issue of “conversion therapy” cannot be tackled in isolation. 

“‘Conversion therapy’ is not a single event - it is a process of continued degradation and assault on the core of who you are. There are often repeated violations in the form of psychological and sometimes physical abuse... It is not one instance–it is a continued sense of rejection. The pressure is enormous.”

- George Barasa gay gender non-conforming Kenyan living in South Africa, survivor of “conversion therapy” 

Executive Summary:

https://outrightinternational.org/sites/default/files/ExecSumm_SinglePagesRandL.pdf 

Full Report:

https://outrightinternational.org/sites/default/files/ConversionFINAL_1.pdf

The AusPATH [Australian Professional Association for Trans Health] Position Statement on "Rapid Onset Gender Dysphoria" (ROGD)

Published September 30, 2019. Shared here in its’ entirety.

“The Australian Professional Association for Trans Health (AusPATH) was established in 2009 and is Australia’s peak body for professionals involved in the health, rights and well-being of trans, including gender diverse and non-binary (TGDNB), people. The AusPATH membership comprises approximately 250 experienced professionals working across Australia.

“The term “Rapid Onset Gender Dysphoria (ROGD)” is not a diagnosis or health condition recognised by any major professional association, nor is it listed as a subtype or classification in the Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD). Therefore, “ROGD” is an acronym describing a proposed phenomenon, with insufficient peer-reviewed scientific evidence to support its implementation and/or use within clinical, community, social and legal settings1.

“AusPATH affirms the rigorous processes by which diagnoses are developed and applied. These academic and clinical processes operate within professional medical organisations, and are developed by expert working groups of  scientists, clinicians, and stakeholders over long periods of time, with high levels of scientific scrutiny of the evidence-based literature. “ROGD” does not meet this standard, and therefore is not recognised by AusPATH.

“Whilst many have a clear picture of their gender from a very early age, for others the journey towards understanding their gender is more prolonged. The timing of when an individual discloses their gender to others is a separate consideration and does not necessarily reflect the development of their experienced gender. Many do not disclose their identity, rather hiding it for fear of negative reactions from others, including family rejection, discrimination, stigmatisation and social exclusion. The term “Rapid Onset Gender Dysphoria” is not, and has never been, a diagnosis or health condition but has been used in a single report describing parental perception of their adolescent’s gender identity without exploration of the gender identity and experiences of the adolescents themselves.

“AusPATH encourages continued scientific exploration within a culture of academic freedom, not censorship. All TGDNB people are deserving of gender-affirmative, evidence-based care that is underpinned by contemporary, adequately endorsed and community engaged standards of care and clinical guidelines.

“AusPATH recognises the harms caused by conversion, reparative and aversion treatments and opposes any such efforts to invalidate an individual’s experienced gender. AusPATH supports affirmative responses to young people whereby self-reported gender is respected, and young people are able to safely explore their gender and expression without judgment, pathologisation or predetermined outcome. AusPATH urges caution in the use of any term that has the potential to invalidate a person’s gender.

  1. WPATH (World Professional Association for Transgender Health) position on “Rapid-Onset Gender Dysphoria (ROGD)”4 September 2018

https://auspath.org/advocacy/?fbclid=IwAR3GN9E6NmvTyZNx-LcCIgW1mg5zpkE8UgpUaFYweTFBawgMS023DFTgtfI

A Viral Fake News Story Linked Trans Health Care to 'Thousands' of Deaths

A Viral Fake News Story Linked Trans Health Care to ‘Thousands’ of Deaths

Hormone blockers used by some transgender people have multiple uses, including treating prostate cancer in terminally ill patients.

To be clear: Lupron has been widely used in thousands of trans youth, and members of the Gender Dysphoria Affirmative Working Group are NOT AWARE OF ANY DEATHS attributable to Lupron use in trans and gender noxnbinary youth.

As people may have already seen, an ultra conservative Catholic website (Lifesite News) spread misleading news that some 6,300 deaths over 40 years were attributed to leuprolide acetate (Lupron), a medication also used as a puberty blocker in trans youth. Articles and other information released about this issue minimized or did not mention that Lupron is commonly used in palliative care for long-term and terminally ill cancer patients, and instead implied that this medication has been widely killing transgender youth. Multiple conservative outlets further distributed this story (including Breitbart and Daily Wire). We have become aware that parent groups have reported this article (and similar ones reflecting the same misinformation) being sent by "well meaning" relatives to parents of trans youth. We also are concerned that this issue will be used as a ‘talking point’ in other venues like school board meetings and such by those opposed to policies supporting trans youth.

Thus far only one article in mainstream journalism outlet has debunked this misleading press. The "good" article is linked below.

Sadly, we all may be obligated to push back against the further discrimination, hatred, and transphobia only encouraged by these stories. We encourage you to remember that affirmative care - including puberty blockers such as Lupron - have been demonstrated to have vastly improved outcomes for trans youth including dramatic decreases in depression, anxiety, substance use, school dropout, obesity, smoking rates, suicidal ideation and gestures.

“A recent article published by Catholic news outlet LifeSiteNews alleged that the drugs used to treat gender dysphoria in some transgender children are linked to “thousands” of deaths.

“The story went viral on right-wing news websites such as the Christian Postand the Daily Wire. According to CrowdTangle, a social media metric platform, these posts — including shares by Daily Wire founder Ben Shapiroand commentator Matt Walsh— are currently some of the top performing LGBTQ-related content on Facebook and Twitter.

“The problem is: the “thousands” of people who die while taking these drugs are likely the terminally ill cancer patients who receive hormone blockers to fight hormone-sensitive cancers, like prostate cancer, according to experts.”

https://www.nbcnews.com/feature/nbc-out/viral-fake-news-story-linked-trans-healthcare-thousands-deaths-n1059831

OUT Health and Wellness Transgender 'conversion therapy' associated with 'severe psychological distress'

Transgender 'conversion therapy' associated with 'severe psychological distress'

A study in JAMA Psychiatry is one of the first to highlight the psychological impact of efforts to change a trans person’s gender identity.

A new large-scale study linking conversion therapy - an approach founded on disaffirming a person’s self-identified gender or sexual orientation - is directly link to a sharp increase in suicidal ideation and attempts.

Find more about the benefits of affirmative care, and the risks of disaffirming approaches, at our website:

www.gdaworkinggroup.com

And follow us on Facebook for regular updates:

@gdaffirmative

“Exposure to "conversion therapy" — efforts by a secular or religious professional to change a transgender person’s gender identity — is associated with thoughts of and attempts at suicide, according to a study published Wednesday in the journal JAMA Psychiatry…”

“…But this was novel, he said, because of its large sample size — over 27,000 transgender people responded to the survey — and its broad approach to identifying past efforts to change participants’ gender identity...”

“…Turban said that previous reports showing the negative effects of conversion therapy, also known as “ex-gay therapy” or “reparative therapy,” have focused on efforts to change a person’s sexual orientation…”

“But this was novel, he said, because of its large sample size — over 27,000 transgender people responded to the survey — and its broad approach to identifying past efforts to change participants’ gender identity...”

“"The term 'conversion therapy' is a misnomer,” Keuroghlian noted. “It suggests that conversion efforts are a legitimate therapeutic practice, even though we are finding that this practice is associated with significantly increased risk of harm, including serious psychological distress and potentially fatal suicide attempts.””

https://www.nbcnews.com/feature/nbc-out/transgender-conversion-therapy-associated-severe-psychological-distress-n1052416

Counterpoint: Pediatric gender care is safe and necessary

While not research, this is a well written piece, concisely outlining the issues and why evidence-based, affirmative care for trans and gender nonbinary youth is safe and effective, and the current standard of care.

Published in: Star Tribune. June 25, 2019. Authors: KATHLEEN MILLER , MARLA EISENBERG , AMY GOWER AND G. NIC RIDER.

"Transgender and nonbinary youths experience persistent and significant distress when forced to conform to the gender they were assigned at birth. They face substantial health disparities, with higher rates of depression, suicide attempts, substance use, bullying and unprotected sexual encounters than their cisgender (i.e., not transgender) peers. However, research shows that these health outcomes are related to stigma, rather than the simple fact of being transgender or nonbinary. This is a subtle, but critical, distinction: Negative health outcomes are not intrinsic to being trans and nonbinary. Rather, daily experiences of discrimination and harassment lead to poor health outcomes..."

"The medical and research community supports gender affirming medical care as a powerful tool to improve the lives of children and adolescents who are transgender or nonbinary. There is ample and growing evidence that children and adolescents have better health outcomes when they are supported in their gender, which includes access to medical interventions when appropriate. As clinicians and pediatric researchers, we firmly support expanding access to gender affirming care for youth."

http://m.startribune.com/counterpoint-pediatric-gender-care-is-safe-and-necessary/511804792/?fbclid=IwAR0KqZCmu9H8RiUQyTQVVjBDKzlqb5_UjPutRB1CflsVs3AmNhisXrMKG2g

Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents 

The 2018 Australian SOC for Trans and Gender Diverse Children and Adults... a very strongly affirming document based on the latest research making clear that affirmative treatment approaches - in which the youth's identity is respected and supported, where the youth are provided the freedom and safety to explore their gender without judgment - yield much happier and better adjusted youth and young adults. It also makes clear that disaffirming approaches are unethical and may cause harm.

Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents 

Authors: M.M. Telfer, M.A. Tollit, C.C. Pace, & K.C. Pang.   2018.  

“Being trans or gender diverse is now largely viewed as part of the natural spectrum of human diversity. It is, however, frequently accompanied by significant gender dysphoria (GD), which is characterised by the distress that arises from incongruence between a person’s gender identity and their sex assigned at birth. It is well recognised that trans and gender diverse individuals are at increased risk of harm because of discrimination, social exclusion, bullying, physical assault and even homicide. Serious psychiatric morbidity is seen in children and adolescents. A study of the mental health of trans young people living in Australia found very high rates of ever being diagnosed with depression (74.6%), anxiety (72.2%), post-traumatic stress disorder (25.1%), a personality disorder (20.1%), psychosis (16.2%) or an eating disorder (22.7%). Furthermore 79.7% reported ever self-harming and 48.1% ever attempting suicide.”

 

“Increasing evidence demonstrates that with supportive, gender affirming care during childhood and adolescence, harms can be ameliorated and mental health and wellbeing outcomes can be significantly improved.”

 

“Understanding and using a person’s preferred name and pronouns is vital to the provision of affirming and respectful care of trans children and adolescents.  Providing an environment that demonstrates inclusiveness and respect for diversity is essential... Some children or adolescents may request use of a preferred name or pronoun only in certain circumstances, such as when their parents are, or are not, present in the room. This is important to respect and enact to enable optimal patient-clinician engagement, and ensure confidentiality and patient safety.”

 

“Avoiding harm is an important ethical consideration for health professionals when considering different options for medical and surgical intervention. Withholding of gender affirming treatment is not considered a neutral option, and may exacerbate distress in a number of ways including increasing depression, anxiety and suicidality, social withdrawal, as well as possibly increasing chances of young people illegally accessing medications.” 

 

“In the past, psychological practices attempting to change a person’s gender identity to be more aligned with their sex assigned at birth were used.  Such practices, typically known as conversion or reparative therapies, lack efficacy, are considered unethical and may cause lasting damage to a child or adolescent’s social and emotional health and wellbeing.”

 

https://www.rch.org.au/uploadedFiles/Main/Content/adolescent-medicine/australian-standards-of-care-and-treatment-guidelines-for-trans-and-gender-diverse-children-and-adolescents.pdf

 

Chosen Name Use Is Linked to Reduced Depressive Symptoms, Suicidal Ideation, and Suicidal Behavior Among Transgender Youth

Even something as “simple” as using a trans youth’s chosen/preferred/self-identified name can be a very powerful intervention with clear positive outcomes. And don’t we want our youth to have less depression, anxiety, and suicidal ideation?

Published in: Journal of Adolescent Health. October, 2018. Authors: Stephen T. Russell, Amanda M. Pollitt, Gu Li, Arnold H. Grossman.

“Transgender youth whose gender expression and names do not appear to match may be vulnerable to unintended disclosure or “outing,” and to discrimination or victimization, factors that could lead to mental health problems [1]. The purpose of the current study was to examine the relation between chosen name use, as a proxy for youths' gender affirmation in various contexts, and mental health among transgender youth.”

“We asked transgender youth whether they had a preferred name different from the name they were given at birth, and, if yes, asked, ‘are you able to go by your preferred name’ at home (n = 54), at school (n = 57), at work (n = 50), or with friends (n=69).”

“…chosen name use in more contexts predicted fewer depressive symptoms and less suicidal ideation and suicidal behavior. An increase by one context in which a chosen name could be used predicted a 5.37-unit decrease in depressive symptoms, a 29% decrease in suicidal ideation, and a 56% decrease in suicidal behavior. We observed similar results when we individually tested specific contexts for chosen name use (except that chosen name use with friends did not significantly predict mental health after adjusting for demographics and close friend support). Depressive symptoms, suicidal ideation, and suicidal behavior were at the lowest levels when chosen names could be used in all four contexts.”

https://www.jahonline.org/article/S1054-139X(18)30085-5/fulltext



Suicide risk in the UK Trans population and the role of gender transition in decreasing suicidal ideation and suicide attempt

Published in: Mental Health Review Journal. · December 2014.  Authors: Louis Bailey, Jay McNeil, Sonja J. Ellis.

“The findings reported here indicate that there are extremely high rates of suicidal ideation and suicide attempt within this non-random sample of the UK trans population. However, gender transition – for those that wanted it – was shown to drastically reduce instances of suicidal ideation and suicide attempt, highlighting the important role played by social transition and gender reassignment in improving quality of life and overall well-being amongst respondents…”

“A key finding to emerge from the study was the importance of timely access to gender reassignment treatment for those who required it. Transition was shown to have a positive impact on trans people’s mental health and well-being; the processes of gender reassignment and social transition serving to significantly reduce rates of suicidal ideation and suicide attempt. The majority of participants cited the significant benefits of gender reassignment in terms of aligning their physical body with their internal sense of self, and the knock-on effects of being recognised as the gender that they felt themselves to be…”

“Despite the clear advantages of gender reassignment, some respondents reported significant issues whilst trying to obtain treatment. As has been reported elsewhere, funding delays or refusals were common within this sample and respondents alluded to having gender reassignment treatment stopped or postponed altogether. These issues may, in some cases, contribute to suicide risk within this population…”

“It is crucial that those experiencing gender dysphoria have access to gender reassignment treatment with minimal delays or disruption and that they receive relevant information and support both from medical professionals as well as more informal sources – such as family, friends and support organisations – in order to build resilience and bolster health and well-being during this particularly difficult time.”

https://www.researchgate.net/publication/281441727

The role of gender affirmation in psychological well-being among transgender women

No surprise that validating someone’s sense of self decreases depression and improves self esteem.

Published in: Psychology of Sexual Orientation and Gender Diversity. September 2016. Authors Tiffany R. Glynn, Kristi E. Gamarel, Christopher W. Kahler, Mariko Iwamoto, Don Operario, Tooru Nemoto.

“… we found that social, psychological, and medical gender affirmation were significant predictors of lower depression and higher self-esteem... Findings support the need for accessible and affordable transitioning resources for transgender women in order to promote better quality of life among an already vulnerable population.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5061456/

Suicide risk in the UK trans population and the role of gender transition in decreasing suicidal ideation and suicide attempt

It is well known that trans and gender nonbinary people have high rates of suicidality… studies consistently show that affirming treatments decrease risk.

Published in: Mental Health Review Journal.  December 2014.  Authors: Louis Bailey, Sonja J. Ellis, Jay McNeil.

“A supportive environment for social transition and timely access to gender reassignment, for those who required it, emerged as key protective factors… The paper highlights the devastating impact that delaying or denying gender reassignment treatment can have and urges commissioners and practitioners to prioritisetimely intervention and support.”

“The findings reported here indicate that there are extremely high rates of suicidal ideation and suicide attempt within this non-random sample of the UK trans population. However, gender transition – for those that wanted it – was shown to drastically reduce instances of suicidal ideation and suicide attempt, highlighting the important role played by social transition and gender reassignment in improving quality of life and overall well-being amongst respondents…”

“A key finding to emerge from the study was the importance of timely access to gender reassignment treatment for those who required it. Transition was shown to have a positive impact on trans people’s mental health and well-being; the processes of gender reassignment and social transition serving to significantly reduce rates of suicidal ideation and suicide attempt. The majority of participants cited the significant benefits of gender reassignment in terms of aligning their physical body with their internal sense of self, and the knock-on effects of being recognised as the gender that they felt themselves to be…”

“Despite the clear advantages of gender reassignment, some respondents reported significant issues whilst trying to obtain treatment. As has been reported elsewhere, funding delays or refusals were common within this sample and respondents alluded to having gender reassignment treatment stopped or postponed altogether. These issues may, in some cases, contribute to suicide risk within this population…”

“It is crucial that those experiencing gender dysphoria have access to gender reassignment treatment with minimal delays or disruption and that they receive relevant information and support both from medical professionals as well as more informal sources – such as family, friends and support organisations – in order to build resilience and bolster health and well-being during this particularly difficult time.”

https://www.researchgate.net/publication/281441727_Suicide_risk_in_the_UK_Trans_population_and_the_role_of_gender_transition_in_decreasing_suicidal_ideation_and_suicide_attempt

Family Rejection as a Predictor of Suicide Attempts and Substance Misuse Among Transgender and Gender Nonconforming Adults

Published in: LGBT Health. May 25, 2016. Authors: Augustus Klein and Sarit Golub.

"42.3% of [transgender adults] reported a suicide attempt and 26.3% reported misusing drugs or alcohol to cope with transgender-related discrimination… family rejection was associated with increased odds of both behaviors. Odds increased significantly with increasing levels of family rejection."

https://www.liebertpub.com/doi/abs/10.1089/lgbt.2015.0111?journalCode=lgbt

Analysis finds strong consensus on effectiveness of gender transition treatment

Published in: Cornell Chronicle. April 9, 2018

"Of 56 peer-reviewed studies, 52 (93 percent) found that gender transition improves the overall well-being of transgender people. The other 7 percent reported mixed or null findings. None of the reviewed studies showed that gender transition harms well-being."

"The positive outcomes of gender transition and related medical treatments include improved quality of life, greater relationship satisfaction, higher self-esteem and confidence, and reductions in anxiety, depression, suicidal tendencies and substance use."

"The positive impact of gender transition has grown considerably in recent years, as surgical techniques and social support have improved."

"Regrets following gender transition are extremely rare and have become increasingly rarer."

http://news.cornell.edu/stories/2018/04/analysis-finds-strong-consensus-effectiveness-gender-transition-treatment