Readers who wish to read the full text of the authors’ original letter, including the complete list of sources, are invited to consult the Archives of Sexual Behavior web site.
Turban and his co-authors (whom we will describe simply as “the authors”) set out to examine the effects of what they describe as “gender identity conversion” on the mental health of transgender-identifying individuals. In examining data from the 2015 US Transgender Survey (USTS), they found that survey participants who responded affirmatively to a specific yes/no question—“Did any professional (such as a psychologist, counselor, religious advisor) try to make you identify only with your sex assigned at birth (in other words, try to stop you being trans)?”—reported poorer mental health than those who responded negatively. From this, the authors conclude that what they call “gender identity conversion efforts” (“GICE”) are detrimental to mental health, and so should be avoided in children, adolescents, and adults. These conclusions were widely publicized by mass-media outlets, including as a means to advocate for legislative bans on “GICE,” a policy step that the study authors have explicitly endorsed.
We agree with Turban’s position that therapies using coercive tactics to force a change in gender identity have no place in healthcare. However, we take issue with the authors’ problematic analysis and flawed conclusions, which they use to justify the misguided notion that any practice that deviates from reflexively “affirmative” psychotherapy for gender dysphoria (GD) is harmful and should be banned. Their analysis is compromised by serious methodological flaws, including the use of a biased data sample, reliance on poorly constructed survey questions, and the omission of any control variable that tracks subjects’ baseline mental-health status.
Given the risky and irreversible nature of “gender-affirming” treatments, it is concerning that for many years now, there has been a lack of systematic research into the role that developmentally-informed psychotherapy can play in the amelioration of GD, especially among young people. The need for the continued development and evaluation of non-invasive psychological treatment alternatives for GD has never been more urgent, given the fact that over three percent of young people now report transgender identification or ideation. In the face of this phenomenon, it is time to raise the bar on science—or at least enforce the bar that already exists—and to heed the first and most fundamental tenet of medicine: “First, do no harm.”