The Scientific Case for Counseling Choice for LGBTQ Identified Youth
By Andre Van Mol, MD
Legislative bodies throughout the world have attempted to limit counseling choices for LGBTQ-identifying youth, promoting potentially harmful affirmative care instead.
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 no have, and is not the international standard of care for gender dysphoric minors.
The phrase “Conversion therapy” 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% by adulthood. (1,2,3,4,5)
Why medicalizing children for life for it? (6,7,8)
MINORS CANNOT GIVE TRULY INFORMED CONSENT.(9) They have developing brain, their minds change often, and they don’t grasp long-term consequences. (10,11,12)
Thus ruled the UK High Court in Bell vs. Tavistock last year. (13)
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. (14)
PUBERTY BLOCKERS chemically castrate at the level of the brain. (15)
They risk infertility by blocking the maturation of sperm and eggs.(16) Following them with cross-sex hormones assures sterility.(17)
They compromise bone mineral density and hinder brain development.(18)
Self-harm does not improve on them.(19,20)
They are not proven fully reversible.(21)
AS FOR CROSS-SEX HORMONES (22,23, 24, 25, 26, 27, 28)
Estrogen use in male biology strongly increases the risks blood clots, heart attacks, strokes, breast cancer, insulin resistance and more.
Testosterone use in female biology strongly increases the risks heart attacks, strokes, breast and uterine cancer, hypertension, severe acne and more.
GAT’s SUICIDE REDUCTION CLAIM IS A MYTH, used as emotional blackmail.(29, 30, 31)
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.(32,33, 34)
Based on the UK High Court Bell vs. Tavistock ruling and the National Institute for Health and Care Excellence (NICE) reviews, (35) as of Decmeber 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. (36)
Sweden’s Karolinska Hospital issued a similar policy change effective April 1, 2021.(37)
Finland rejected routine “affirmation” pathway for minors with GD in 2020.(38)
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 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.(39)
The American Psychological Association's Handbook on Sexuality and Psychology (40) and numerous studies acknowledge that childhood sexual abuse can cause unwanted homosexuality in some individuals.(41,42)
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.(43)
The APA’s Dr. Lisa Diamond concluded “…arguments based on the immutability of sexual orientation are unscientific, given what we now know…”(44)
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.(45,46,47,48)
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.”(49)
There is no evidence of harm from modern sexual orientation change-allowing therapy provided by licensed professionals. (50,51,52,53,54,55) Decades of supportive studies exist.(56,57,58,59,60)
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). (61)
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.”(62) So the proposed Scottish therapy ban may in fact promote suicidality among sexual minorities.
As American constitutional law catches up to therapy bans, they are falling.
The city of Tamp, Florida lost in court in Vazzo v Tampa.(63) Another city lost in Otto, et al v. City of Boca Raton, Florida et al, in the 11th Circuit Court of Appeals.(64)
New York City withdrew its therapy ban when challenged, fearing a loss in higher court.(65) Other cases are under way.
Why should struggling youth be denied any opportunity to find healing? Why should they be medicalized and used as scientific guinea pigs for what remain unproven treatments that have life-altering side effects? The scientific truth stands that counseling is an effective method of care for willing youth battling gender dysphoria and other sexuality issues. Therapy bans against counseling choice represent one-sided ideology that would place us squarely against the tide of science and evidence-based health care.
Andre Van Mol, MD
Board-certified family physician
Co-chair, Committee on Adolescent Sexuality, American College of Pediatricians
Co-chair, Sexual and Gender Identity Task Force, Christian Medical & Dental Assoc.
Psychotherapeutic and Behavioral Approaches to Treating Gender Dysphoria
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