Researchers claim to have completed the first study to prove that efforts to help people overcome gender dysphoria cause psychological harm. But critics argue the data is fundamentally flawed and the study doesn’t back its claims.
The study, published last month in JAMA Psychiatry by researchers from Harvard University and Massachusetts General Hospital, asked transgender survey participants if a professional psychologist, counselor, or religious adviser had ever tried to “make you identify only with your sex assigned at birth,” or tried to “stop you being trans.” Researchers lumped anyone who answered yes into a single category: “recalled exposure to gender identity conversion efforts.” The study found those people had ongoing severe psychological distress and more than double the odds of attempting suicide than transgender people who answered no.
Eighteen states and the District of Columbia ban any therapy for LGBT minors that could result in them embracing heterosexuality or their biological sex. That number likely will grow by the end of the year. In a rebuttal published by Public Discourse, University of Texas sociologist Mark Regnerus pointed out major methodological problems with the study, which used data from the 2015 United States Transgender Survey of more than 27,000 transgender adults.
Regnerus noted the study lumped together any treatment or therapy that did not involve unqualified affirmation of gender dysphoria into “one imprecise, binary measure.” Patients could interpret simple attempts to obtain ethical informed consent—such as counseling them about the medical, social, and psychological risks of gender-affirming treatment—as trying to discourage their transgender identity, he said.
Regnerus also said the study’s authors did not acknowledge the potential for bias in their data. Their sample came from a nonrandom, opt-in survey of self-identified transgender adults recruited by LGBT organizations, but the researchers presented their conclusions as if the survey was a random sample reflective of the general population.
“Rarely have researchers been so explicit about the political aims of their research,” Regnerus wrote. If the study was the first to show adverse outcomes from transgender identity change efforts, how could LGBT activists have previously justified government bans, and why would researchers support such laws before the study? “Simple,” he concluded. “It was never about science.”
The study’s lead author, Jack Turban of Harvard Medical School, admitted as much in an interview with Newsweek. “We wanted to provide concrete data to support these policy statements,” he said. “We hope that this research will help state legislators understand the magnitude of this problem and the need to pass bans on gender identity conversion efforts.”
Laura Haynes, a retired psychologist in California with more than 40 years of experience, compared the research to surveying divorced individuals to determine whether marriage therapy works. She said the study “omitted people who successfully changed and embraced their body sex through therapy, and who therefore are not found in transgender communities,” making its conclusions “fatally flawed” and “political advocacy science at its worst.”
Haynes is the chairwoman of research and legislative policy for the National Task Force for Therapy Equality, a coalition of licensed therapists that advocates for the rights of individuals to receive therapy for unwanted same-sex attraction or gender identity conflicts.
She said many psychological associations acknowledge that gender identity, like every other complex human trait, develops through a combination of both biological influences and life experiences. The World Professional Association for Transgender Health acknowledges gender dysphoria can have pathological causes and does not recommend gender-affirming treatment that neglects underlying psychiatric disorders. But in states with conversion therapy bans, therapists face a lose-lose situation. If they try to resolve underlying conditions, they risk losing their license, but failure to treat underlying conditions has its risks, including “persisting trauma, mental health problems, and suicide,” Haynes said.
What’s more, gender-affirming treatment often puts minors on a risky path toward experimental hormone blockers, opposite-sex hormones, and surgeries that can lead to a loss of fertility and sexual function, as well as higher rates of heart disease and cancer deaths.
“Who is causing health disparities, again?” asked Haynes.