Evidence Opposing Therapy Bans
August 26, 2021
by Andrè Van Mol, MD
Legislation to ban so-called “conversion” therapy or practices for people with undesired same-sex attraction, gender dysphoria and other sexual minority issues is being put forward across the globe. I’ve submitted testimony against these needless bans in numerous countries and several U.S states. The weight of science does not support such ill-conceived and highly misrepresentative legislation. The prohibitionist bills are based on ideology—the problem being that ideology rules the field of engagement.
Here is what I have sent in to two nations in the last few weeks. Add to this my prior blogs on addressing the 2021 American Psychological Association LGBTQ+ State Legislative Advocacy “talking points,” change-allowing counseling being shown in the best study of its kind to reduce suicidality rather than promoting it, the evidence that there exists people of sexual minority status who reject LGBT+ identification and that they can do well and medical rights of conscience when in conflict with sexual minority demands.
Here’s what I sent to the parliamentarians:
Banning counseling choice condemns already at-risk sexual minority youth, in the case of those with gender dysphoria, to experimental and unproven hormonal and surgical gender affirming therapy [GAT], which permanently and prematurely medicalizes children for a condition that overwhelmingly resolves by adulthood. GAT is not proven effective, not proven safe, does not reduce suicides, requires consent ability minors do not have and is not the international standard of care for gender dysphoric minors.
The phrase “conversion therapy/practices” is provocative, pejorative and ill-defined. It is a jamming tactic that combines both anti-religious allusions (“conversion,” implicitly forced) along with intimidation against therapists who allow patient-directed investigation of possible change.
FOR THE GENDER DYSPHORIA/TRANS-IDENTIFIED:
Desistance is the norm for minors with gender dysphoria (GD), resolving on its own for an average of 85 percent by adulthood.[i],[ii],[iii],[iv],[v]
Minors cannot give truly informed consent.[ix] They have developing brains, their minds change often and they don’t grasp long-term consequences.[x],[xi],[xii]
- Thus ruled the UK High Court in Bell vs. Tavistock last year.[xiii]
- Sweden’s Karolinska Hospital ruled the same based on the Bell decision, along with the Swedish Agency for Health Technology Assessment and Assessment of Social Services’ 2019 literature review.[xiv]
PUBERTY BLOCKERS chemically castrate at the level of the brain.[xv]
- They risk infertility by blocking the maturation of sperm and eggs.[xvi] Following them with cross-sex hormones assures sterility.[xvii]
- They compromise bone mineral density and hinder brain development.[xviii]
- Self-harm does not improve on them.[xix],[xx]
- They are not proven fully reversible.[xxi]
AS FOR CROSS-SEX HORMONES [xxii],[xxiii],[xxiv],[xxv],[xxvi],[xxvii],[xxviii]
- Estrogen use in male biology strongly increases the risks of blood clots, heart attacks, strokes, breast cancer, insulin resistance and more.
- Testosterone use in female biology strongly increases the risks of heart attacks, strokes, breast and uterine cancer, hypertension, severe acne and more.
GAT’s SUICIDE REDUCTION CLAIM IS A MYTH, used as emotional blackmail.[xxix],[xxx],[xxxi]
The international standard of care for youth with gender dysphoria is watchful waiting, including psychological evaluation and support for the child and family, exactly what counseling bans prohibit.[xxxii],[xxxiii],[xxxiv]
- Based on the UK High Court Bell vs. Tavistock ruling and the National Institute for Health and Care Excellence (NICE) reviews,[xxxv] as of December 2020 the NHS guidelines now prohibit puberty blockers and cross-sex hormones in those under 16 years of age without application to the court and recommends the same for those under 18.[xxxvi]
- Sweden’s Karolinska Hospital issued a similar policy change effective April 1, 2021.[xxxvii]
- Finland rejected routine “affirmation” pathway for minors with GD in 2020.[xxxviii]
REGARDING CHANGE-ALLOWING THERAPY FOR UNDESIRED SAME-SEX SEXUAL ATTRACTION:
Therapy bans deprive adults and children of the freedom to set their own counseling goals and objectives, and they will likely drive some children and adults to suicide by forbidding therapy for underlying issues.
- The APA Handbook on Sexuality and Psychology specifically warns against a rush affirm same-sex attraction or gender transition because it risks neglecting underlying psychological issues.[xxxix]
- The American Psychological Association’s Handbook on Sexuality and Psychology[xl] and numerous studies acknowledge that childhood sexual abuse can cause unwanted homosexuality in some individuals.[xli],[xlii]
- If this ban passes, children and adults will be unable to heal these wounds, be legislated into a false identity, and can be left suicidal and without hope as a result.
Professional Psychological Associations state that homosexuality can be changeable.
- The 2014 APA Handbook states that sexual orientation may change over a person’s lifetime especially during adolescence.[xliii]
- The APA’s Dr. Lisa Diamond concluded “…arguments based on the immutability of sexual orientation are unscientific, given what we now know….”[xliv]
- The UK’s Royal College of Psychiatrists declared in 2014: “sexual orientation is determined by a combination of biological and postnatal environmental factors” . . . “[it] is not the case that sexual orientation is immutable or might not vary to some extent in a person’s life….” Numerous studies concur.[xlv],[xlvi],[xlvii],[xlviii]
Therapy bans are needless.
- Complaints of harmful practice and clinician malfeasance are documented and addressed by appointed licensed mental health professionals on state licensing boards. Where are the verified, documented harms from (and the subsequent penalties issued to) specific licensed change-allowing therapists?
- According to a therapy-hostile piece in the American professional literature, “As of this writing, to our knowledge, there have been no formal actions by a regulatory body against a provider for engaging in conversion therapy.”[xlix]
There is no evidence of harm from modern sexual orientation change-allowing therapy provided by licensed professionals.[l],[li],[lii],[liii],[liv],[lv] Decades of supportive studies exist.[lvi],[lvii],[lviii],[lix],[lx]
- Change-allowing counseling is patient-initiated, patient-directed talk therapy led by licensed therapists working with willing and motivated people.
- Most harm claims have not involved trained therapists and generally are unsubstantiated.
- The popularly misquoted American Psychological Association’s Gay and Lesbian Task Force’s 2009 report stated specifically that modern change allowing therapy “since 1978” was “nonaversive,” meaning free of pain or shame infliction (p. 43), and that research meeting scientific standards did not allow attributing harm or help, inefficacy or efficacy to change-allowing therapy (pp. 43,82).[lxi]
- A recent study by Prof. Paul Sullins revealed that, “Experiencing SOCE therapy does not encourage higher suicidality, as they claim; rather, experiencing higher suicidality appears to encourage recourse to SOCE, which in turn strongly reduces suicidality, particularly initial suicide attempts. Restrictions on SOCE deprive sexual minorities of an important resource for reducing suicidality, putting them at substantially increased suicide risk.”[lxii] So therapy bans may in fact promote suicidality among sexual minorities.
As American constitutional law catches up to therapy bans, they are falling. The city of Tampa, Florida lost in court in Vazzo v. Tampa.[lxiii] Another city lost in Otto, et al v. City of Boca Raton, Florida et al, in the 11th Circuit Court of Appeals.[lxiv]
New York City withdrew its therapy ban when challenged, fearing a loss in higher court.[lxv] Other cases are under way.
Bans against counseling choice are one-sided ideology that would place us squarely against the tide of science and evidence-based healthcare. Please oppose such.
Andre Van Mol, MD
Board-certified family physician
Co-chair, Sexual and Gender Identity Task Force, Christian Medical & Dental Assoc.
Co-chair, Committee on Adolescent Sexuality, American College of Pediatricians
As an addendum, our colleagues in the American College of Pediatricians (ACPeds) (disclosure, I’m in both CMDA and ACPeds) are fighting the good fight for children, and their website has a great deal of scientifically sound and practical information for both healthcare providers and parents.[lxvi]
[i] APA Diagnostic and Statistical Manual, 5th edition, “Gender Dysphoria,” p. 455.
[ii] APA Handbook on Sexuality and Psychology (American Psychological Association, 2014), Bockting, W. Chapter 24: Transgender Identity Development, vol. 1, p. 744.
[iii] Cohen-Kettenis PY, et al. “The treatment of adolescent transsexuals: changing insights.” J Sex Med. 2008 Aug;5(8):1892-7.
[iv] “Do Trans- kids stay trans- when they grow up?” Sexologytoday.org, 11 Jan. 2016.
[v] Kaltiala-Heino et al. Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development. Child and Adolescent Psychiatry and Mental Health (2015) 9:9.
[vi] S. Bewley, “Safeguarding adolescents from premature, permanent medicalisation,” BMJ.com, 11 Feb. 2019.
[vii] MK Laidlaw, Q Van Meter, PW Hruz, A Van Mol, W Malone, “Letter to the Editor: ‘Endocrine Treatment of Gender-
Dysphoric/Gender-Incongruent Persons: An Endocrine Society* Clinical
Practice Guideline,’” The Journal of Clinical Endocrinology & Metabolism, First Online: Nov. 23, 2018. DOI: 10.1210/jc.2018-01925.
[viii] Brief of Amici Curiae, 11th Circuit Court of Appeals, Case: 18-13592, Drs. Miriam Grossman, Michael Laidlaw, Quentin Van Meter, and Andre Van Mol in Support of Defendant-Appellant School Board of ST. Johns County, Florida.
[ix] Stephen B. Levine (2018): Informed Consent for Transgendered Patients,
Journal of Sex & Marital Therapy, 22 Dec 2018. DOI:10.1080/0092623X.2018.1518885
[x] National Institute of Mental Health (2001). Teenage Brain: A work in progress. http://www2.isu.edu/irh/projects/better_todays/B2T2VirtualPacket/BrainFunction/NIMH-Teenage%20Brain%20-%20A%20Work%20in%20Progress.pdf.
[xi] Pustilnik AC, and Henry LM. Adolescent Medical Decision Making and the Law of the Horse. Journal of Health Care Law and Policy 2012; 15:1-14. (U of Maryland Legal Studies Research Paper 2013-14).
[xii] Stringer, H. (Oct. 2017) Justice for teens, APA Monitor on Psychology, pp. 44-49. http://www.apamonitor-digital.org/apamonitor/201710/MobilePagedArticle.action?articleId=1169604&app=false#articleId1169604
[xv] Lupron Depot-Ped Injection Label (August 2012) at 12.1 “Mechanism of Action” https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/020263s036lbl.pdf.
[xvi] Michael K. Laidlaw, Quentin L. Van Meter, Paul W. Hruz, Andre Van Mol,
and William J. Malone, Letter to the Editor: Endocrine Treatment of Gender-Dsyphoria/Gender-Incongruent Persons: An Endocrine Society* Clinical Practice Guideline, JCEM, Online, November 23, 2018.
[xvii] Howard E. Kulin, et al., “The Onset of Sperm Production in Pubertal Boys. Relationship to Gonadotropin Excretion,” American Journal of Diseases in Children 143, no. 2 (March, 1989): 190-193, https://www.ncbi.nlm.nih.gov/pubmed/2492750.
[xviii] Polly Carmichael, Gary Butler, et al.. Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK. medRxiv 2020.12.01.20241653; doi:https://doi.org/10.1101/2020.12.01.20241653
[xix] Michael Biggs, The Tavistock’s Experiment with Puberty Blockers, 29 July 2019, http://users.ox.ac.uk/~sfos0060/Biggs_ExperimentPubertyBlockers.pdf
[xx] Polly Carmichael, Gary Butler, et al.. Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK. medRxiv 2020.12.01.20241653; doi:https://doi.org/10.1101/2020.12.01.20241653
[xxi] Gallagher, Jenny Sadler et al. Long-Term Effects of Gonadotropin-Releasing Hormone Agonist and Add-Back in Adolescent Endometriosis. Journal of Pediatric and Adolescent Gynecology, Volume 31, Issue 2, 190. (2018)
[xxii] Alzahrani, Talal, et al. “Cardiovascular Disease Risk Factors and Myocardial Infarction in the Transgender Population.” Circulation: Cardiovascular Quality and Outcomes, vol. 12, no. 4, 2019, doi:10.1161/circoutcomes.119.005597.
[xxiii] Getahun D, Nash R, Flanders WD, Baird TC, Becerra-Culqui TA, Cromwell L, et al. Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort Study. Ann Intern Med. [Epub ahead of print 10 July 2018]169:205–213.doi: 10.7326/M17-2785.
[xxiv] Irwig MS. Cardiovascular Health in Transgender People. Rev Endocr Metab Disord. 2018 Aug 3 epub.
[xxv] Nota NM, et al. Occurrence of Acute Cardiovascular Events in Transgender Individuals Receiving Hormone Therapy. Circulation, 139(11), 2019, pp. 1461-1462.
[xxvi] Getahun D, Nash R, Flanders WD, et al. Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort Study. Ann Intern Med 2018; 169(4): 205-13. doi: 10.7326/M17-2785.
[xxvii] Journal of Clinical & Translational Endocrinology 21 (2020) 100230
[xxviii] Diabetes Care 2020 Feb; 43(2): 411-417; World J Diabetes. 2020 Mar 15; 11(3): 66–77.
[xxix] Sadjadi, Sahar. “The Endocrinologist’s Office—Puberty Suppression: Saving Children from a Natural Disaster?” Journal of Medical Humanities, vol. 34, no. 2, 2013, pp. 255–260., doi:10.1007/s10912-013-9228-6.
[xxx] Limentani A. The significance of transsexualism in relation to some basic psychoanalytic concepts. International Review of Psycho-Analysis 1979; 6: 139-53.
[xxxi] J. Michael Bailey and Ray Blanchard, “Suicide or transition: The only options for gender dysphoric kids?” 4thwavenow.com, Sept. 8, 2017. https://4thwavenow.com/2017/09/08/suicide-or-transition-the-only-options-for-gender-dysphoric-kids/
[xxxii] James M. Cantor (2019): Transgender and Gender Diverse Children
and Adolescents: Fact-Checking of AAP Policy, Journal of Sex & Marital Therapy, DOI:10.1080/0092623X.2019.1698481
[xxxiii] de Vries, A. L., and P. T. Cohen-Kettenis. 2012. Clinical management of gender dysphoria in children and adolescents: The Dutch approach. Journal of Homosexuality 59(3): 301–320.
[xxxiv] Michael Laidlaw, Michelle Cretella & Kevin Donovan (2019) The Right to Best Care for Children Does Not Include the Right to Medical Transition, The American Journal of Bioethics, 19:2, 75-77, DOI: 10.1080/15265161.2018.1557288
[xxxvii] Karolinska Policyförändring K2021-3343 March 2021 (Swedish).pdf;
Karolinska Policy Change K2021-3343 March 2021 (English, unofficial translation).pdf
[xxxix] APA Handbook on Sexuality and Psychology (American Psychological Association, 2014). V.1, Bockting, W. Chapter 24: Transgender Identity Development, p. 750.
[xl] APA Handbook on Sexuality and Psychology (American Psychological Association, 2014). V.1, Mustanski, Kuper, & Greene, pp. 609-610.
[xli] Tomeo, M.E., Templer, D. I., Anderson, S., & Kotler, D. (2001). Comparative Data of Childhood and Adolescence Molestation in Heterosexual and Homosexual Persons. Archives of Sexual Behavior, 30(5), 535-541.
[xlii] Walker, M. D., Hernandez, A. M., & Davey, M. (2012). Childhood Sexual Abuse and
Adult Sexual Identity Formation: Intersection of Gender, Race, and Sexual Orientation. Family Therapy, 40(5), 385-398.
[xliii] APA Handbook on Sexuality and Psychology (American Psychological
Association, 2014) V.1, p.636.
[xliv] Diamond, LM; Rosky, CJ; “Scrutinizing Immutability: Research on Sexual Orientation and U.S. Legal Advocacy for Sexual Minorities.” Annals of Sex Research. 00(00), 1-29, 2016.
[xlv] Savin-Williams RC, Ream GL. June 2007. Prevalence and stability of sexual orientation components during adolescence and young adulthood. Archives of Sexual Behaviour 36:385-394.
[xlvi] Savin-Williams, R., Joyner, K., & Rieger, G. (2012), Prevalence and stability of self-reported sexual orientation identity during young adulthood, Archives of Sexual Behavior, 41:103-110.
[xlvii] Ott, MQ, et al., “Stability and Change in Self-Reported Sexual Orientation Identity in Young People: Application of Mobility Metrics.” Archives of Sexual Behavior. June 2011; Vol. 40, Iss. 3: 519-312.
[xlviii] Christine E. Kaestle (2019) Sexual Orientation Trajectories Based on Sexual Attractions, Partners, and Identity: A Longitudinal Investigation From Adolescence Through Young Adulthood Using a U.S. Representative Sample, The Journal of Sex Research, 56:7, 811-826, DOI: 10.1080/00224499.2019.1577351
[xlix] Drescher, J., Schwarz, A., Casoy, F., McIntosh, C., Hurley, B., Ashley, K., Barber, M., Goldenberg, D., Herbert, S., Lothwell, L., Mattson, M., McAfee, S., Pula, J., Roario, V., Tompkins, A. (2016), The growing regulation of conversion therapy: What state medical boards need to know, Journal of Medical Regulation, 102, p. 10, http://jmr.fsmb.org/archives/archive-2010s/
[l] Sexual Orientation Change Efforts Do Not Lead to Increased Suicide Attempts (Summary of excerpt from Whitehead, N.) (2010). Homosexuality and Co-Morbidities: Research and Therapeutic Implications. Journal of Human Sexuality, 2, 125-176).
[li] A.D. Byrd, Joseph Nicolosi, and R.W. Potts (February 2008), “Clients’ Perceptions of How Reorientation Therapy and Self-Help Can Promote Changes in Sexual Orientation,” Psychological Reports 102, pp. 3-28.
[lii] Nicolosi, Joseph, Byrd, D., Potts, R.W. (June, 2002). “A Meta-Analytic Review of Treatment of Homosexuality,” Psychological Reports 90: 1139-1152.
[liii] Nicolosi, J., Byrd, A. Dean, Potts, R.W. (June 2000), “Retrospective Self-Reports of Changes in Homosexual Orientation, A Consumer Survey of Conversion Therapy Clients,” Psychological Reports, 86: 1071-1088.
[liv] Essential Psychopathology and Its Treatment, Third Ed, Maxmen, War, and Kilgus (W.W. Norton & Co.).
[lv] Christopher H. Rosik (2019): RE: Ryan, Toomey, Diaz, and Russell (2018),
Journal of Homosexuality, DOI: 10.1080/00918369.2019.1656506.
[lvi] Karten, E. Y., & Wade, J. C. (2010). Sexual orientation change efforts in men: A client perspective. The Journal of Men’s Studies, 18, 84-102.
[lvii] Spitzer RL. “Can some gay men and lesbians change their sexual orientation? 200 participants reporting a change from homosexual to heterosexual orientation. Arch of Sexual Behavior, Vol. 32, No. 5, Oct. 2003, pp. 403-417.
[lviii] Spitzer, R. L. (2012). Spitzer reassesses his 2003 study of reparative therapy of homosexuality [Letter to the Editor]. Arch Sex Behav. 2012 Aug;41(4):757. doi: 10.1007/s10508-012-9966-y.
[lix] Homosexuality and the Politics of Truth, Jeffrey Satinover (Baker Books, 1996) pp. 179-195.
[lx] Successful Outcomes of Sexual Orientation Change Efforts, James E. Phelan (Phelan Consultants LLC, 2014).
[lxi] American Psychological Association, Task Force on Appropriate Therapeutic Responses to Sexual Orientation. (2009). Report of the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation. Retrieved from http://www. apa.org/pi/lgbc/publications/therapeutic-resp.html
[lxii] Paul Sullins, SEXUAL ORIENTATION CHANGE EFFORTS (SOCE) REDUCE SUICIDE: CORRECTING A FALSE RESEARCH NARRATIVE, Pre-print researchgate.net, March 2021,https://www.researchgate.net/publication/350124048_SEXUAL_ORIENTATION_CHANGE_EFFORTS_SOCE_REDUCE_SUICIDE_CORRECTING_A_FALSE_RESEARCH_NARRATIVE?enrichId=rgreq-610bacc159836fbb103f4eefce465664-XXX&enrichSource=Y292ZXJQYWdlOzM1MDEyNDA0ODtBUzoxMDAyNDI4NDcyMjMzOTg2QDE2MTYwMDg5ODA0NDc%3D&el=1_x_2&_esc=publicationCoverPdf
[lxv] Marisa Lati, “Why the N.Y. City Council made the ‘painful’ decision to repeal its ban on conversion therapy,” washingtonpost.com, Sep. 13. 2019.
Outstanding work and documentation, Dr. Van Mol! May documented truth triumph over hearsay falsehood!
Thank you for your work on this, Dr Van Mol. A truly important issue that I have been thinking a lot about recently. I completely agree that use of cross sex hormones, puberty blockers, etc in adolescents is very problematic and pushbacks from medical and psychological providers is important. I do wonder though about the blanket statement that “therapy bans are needless”. There have been many reports (both anecdotal and in writing) of adolescents feeling coerced, shamed, and the the like from so called “conversion therapy” in the past decades. Certainly open ended discussion about sexual orientation is important but that is not what has historically always happened (and we also can’t ignore the history of using hormones to “convert” homosexual men). Perhaps a clear definition of what conversion therapy actually is (or should be) would also be a helpful addition to your piece. Thanks again for your work and leadership.