A Literature Review of the Secondary School Experiences of Trans Youth

A Literature Review of the Secondary School Experiences of Trans Youth

 Published by: Journal of LGBT Youth.  2020. Author: Ruari-Santiago McBride.

Find more articles on affirmative care for trans youth at our site: www.gdaworkinggroup.com

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“In this article I review 83 empirical studies that provide insight into the secondary school experiences of trans youth.  The studies show that while some trans youth have affirming experiences, the majority are exposed to institutionalized cisnormativity that makes them vulnerable to macroaggressions, microaggressions and violence within school settings. Trans youth’s exposure to institutionalized cisnormativity was found to intersect with multiple vectors of social power, which subject some trans youth to multiple forms of disadvantage while affording others degrees of privilege.  In conclusion, the findings show that trans youth’s educational experiences reflect broader structural inequalities yet defy essentializing explanations.”

https://www.academia.edu/42009727/A_literature_review_of_the_secondary_school_experiences_of_trans_youth?email_work_card=view-paper

Supporting Gender and Sexual Diversity in High Schools

Supporting Gender and Sexual Diversity in High Schools

Published by: Murdoch University, Young and Well Collective.  June 2016. Author: Jance Pearce, Wendy Cumming-Potvin, Veronica Gardiner.

A comprehensive document outlining  strategies and interventions to build increased awareness and to meet the needs of LGBTQIA+ children and adolescents, which leads directly to improved outcomes.  

“Accounts of teachers’ struggles to create safe classrooms and inclusive practices provide valuable insights for other educators, for whom this resource has been written.  The resource builds on the productive work of many community and government organisations, such as the Safe Schools Coalition, Freedom Centre, Curtin University’s Centre for Human Rights Education and the Equal Opportunity Commission, to raise awareness of and support sexual and gender diversity in schools.  It is hoped this resource will be of interest to every educator who wants to engage in conversations to counter discrimination  and bullying specific to gender and sexuality and protect the human rights of all young people, including those who self-identify as LGBTQI.”

https://www.academia.edu/33920096/supporting_gender_and_sexual_diversity_in_high_schools.pdf?email_work_card=thumbnail

Interrupting institutional heteronormativity: School counsellors' role in advocating for gender and sexually diverse students

An important piece on how school counselors and other school allies can be instrumental in creating a safe space for these vulnerable youth, and can make a dramatic impact towards their wellbeing and safety.

Find more information on affirmative care for trans and gender nonbinary youth at our website: www.gdaworkinggroup.com

And Like/Follow us on Facebook for updates: @gdaffirmative

Published in: Canadian Journal of Counseling and Psychotherapy. 2019. Author: Tanya Surette.

“Abstract:

“Many gender and sexually diverse students continue to view their schools as a hostile and oppressive environment. The focus in research has shifted more recently from individualizing this problem to understanding the complex systemic and institutional contributors to the ongoing marginalization of this population. As an integral part of the school system, school counsellors are uniquely positioned to offer important individual- and group-level supports to these students. Using narrative interviewing, this qualitative study provides an opportunity to visit the lived experiences of 6 current gender and sexually diverse high school students and their encounters with heteronormativity at school. Their stories offer insights into factors contributing to their distress and demonstrate stress-ameliorating factors that could be used to guide school counsellors who advocate for the safety and inclusion of students with diverse sexual orientations and gender identities…”

“Conclusion:

“The findings from this study offer important insights from students who are currently trying to navigate the often hostile and heterosexist school spaces. By listening to their experiences, opportunities are illuminated for school counsellors to work with students, educators, administrators, and policymakers, to create meaningful changes in their schools and promote a welcoming, safe, and inclusive learning environment. 

“Based on the most recent Canadian study exploring school climates about gender and sexual diversity, there remains a high number of gender- and sexually-diverse students who are uncomfortable accessing support, regarding topics of gender and sexuality, from their school counsellor (Taylor et al., 2011). School counsellors are uniquely positioned to provide opportunities for empowerment, advocacy, self-determination, and reflection with individual students and groups. Counsellors can support students in advocating for a more inclusive and democratic educational experience. 

“Often, when teachers encounter a student who is having trouble at school, they will reach out to the school counsellor for guidance and support. By listening to the stories contained in this paper, counsellors can better understand the barriers that students who are gender- and sexually-diverse experience when pursuing their right to develop a healthy identity. School counsellors can collaborate with their educational team. They can also collaborate with gender- and sexually-diverse youth to create school spaces that help them thrive, and allow space for diverse gender expressions and non-heteronormative sexual orientations.”

https://www.academia.edu/41076146/Interrupting_institutional_heteronormativity_School_counsellors_role_in_advocating_for_gender_and_sexually_diverse_students?email_work_card=view-paper

The Delaware Journal of Public Health: LGBT Health Equity

This issue of the Delaware Journal of Public Health is devoted to LGBT Health Equity and features several articles relevant to trans and gender nonbinary youth and adults. Several are listed below, and others in the journal are interesting as well.

Most notable are:

Keeping Youth Alive: Considerations for Suicide Prevention of Gender Diverse Youth. Author: Elise Mora, LCSW.

“Objective. This article examines suicidality of gender expansive youth and identifies evidence=based practical interventions for healthcare professionals and other adults who interact with gender expansive youth…

“Results. Gender expansive youth are at significantly heightened risk of suicide compared to their cisgender peers. Nonbinary youth are the most vulnerable of all subgroups.

“Conclusion: Explicit recommendations for enhancing resilience for this population complete the article. More research is critical for this demographic, as current literature is severely limited.”

A Mother’s Story. Author: Sally McBride.

“Sally and David McBride’s youngest child came out as transgender on Christmas Day 2011 as a junior at American University. The news rocked their world. Here is their story as told by Sally.”

Building Resilience, Reducing Risk: Four Pillars to Creating Safer, More Supportive Schools for LGBT Youth. Author: Rev Karla Fleshman, LCSW, M.Div.

“Abstract. In 2017 Delaware, LGBTQ+ Youth reported that almost 1 out of 3 were bullied on school grounds. Additionally, over 50% reported feeling sad/hopeless, and almost as many seriously considered suicide as an option, while 32% planned for suicide with almost 1 in 4 reported having acted on their suicide plan at least once. Of all the students who reported a suicide attempt, 10% required medical treatment as a result of their attempt. The Delaware Department of Education does not have comprehensive statewide protections in place to support some of our most vulnerable youth, yet school districts can make a positive difference in implementing policy/practices to build resilience and reduce risk.

“This article will focus on four key areas where schools and school districts may implement changes toward creating safer, more supportive schools: (1) policy/procedures that protect LGBTQ+ students at the administrative level; (2) comprehensive cultural sensitivity training for serving LGBTQ+ students and their families; (3) incorporating inclusive curriculum on LGBTQ+ history into the classroom; (4) and creating, supporting, and sustaining gender and sexuality alliances in both the middle and high schools.”

https://www.academia.edu/39955943/LGBTQ_Health_Equity

American Psychoanalytic Association Speaks Out Against Harmful Laws Targeting Transgender Youth and Healthcare Providers

American Psychoanalytic Association Speaks Out Against Harmful Laws Targeting Transgender Youth and Healthcare Providers

The Gender Dysphoria Affirmative Working Group respects and fully endorses the position of the American Psychoanalytic Association and wants to express thanks for their position affirming the rights and needs of this vulnerable population.

Find more information on affirmative care for trans and non binary youth at our website: www.gdaworkinggroup.com

And like/follow us on Facebook for more updates: @gdaffirmative

“New York, NY – February 4, 2020– The American Psychoanalytic Association urges South Dakota governor Kristi Noem to reject a recently passed bill in the state legislature known as the Vulnerable Child Protection Act (HB 1057). This harmful legislation would make it a misdemeanor for physicians or any other medical professional to perform gender reassignment surgeries on minors or anyone who provides patients younger than 16-years-old with hormone therapy. If passed, South Dakota would be the first state to impose such a law.”"

““APsaA strongly opposes efforts to legislate appropriate medical treatments for transgender youth based on political ideologies that ignore both scientific research and expert clinical opinion,” said Lee Jaffe, president of the Association. “This law is fundamentally dangerous and if it becomes law would jeopardize the health and mental well-being of transgender youth in South Dakota.””

“Since the start of the 2020 legislative session, at least six states have proposed measures to restrict transgender minors' access to gender reassignment treatments, including surgery and hormone therapy. Some of the bills would make it illegal for physicians to administer the treatments, while others would classify the act as child abuse. If HB 1057 becomes law, it would make South Dakota the first state to make it illegal for physicians to assist minors in their gender reassignment process.”

““As psychoanalysts, we know from research and clinical expertise that discriminatory laws such as this law in South Dakota and elsewhere will have long-term mental health consequences for transgender youth, contributing to increased risk of depression, anxiety, substance abuse, and suicidal behavior. We call on leaders to reject these misguided and dangerous laws.”'“

‘Since 1991, APsaA has issued numerous position statements supporting LGBTQ people regarding discrimination in military service, marriage equality, parenting, efforts to change sexual orientation and gender identity, and bullying and harassment. For a link to our position statements, please visit www.apsa.org/position-statements.”

“The American Psychoanalytic Association is the oldest and largest professional organization for psychoanalysts in North America, representing 3,000 members, 32 approved training institutes, and 38 affiliate societies throughout the United States. Visit apsa.org for more information.”

https://apsa.org/content/apsaa-speaks-out-against-harmful-laws-targeting-transgender-youth-and-healthcare-providers

Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation

Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation

Published in Pediatrics. February, 2020.: Authors: Jack L. Turban, Dana King, Jeremi M. Carswelland Alex S. Keuroghlian.

The full article is behind a paywall and not everyone will have access, but the overview itself will be helpful for many.

Find more research on affirmative care for trans and non binary youth at our website: www.gdaworkinggroup.com

Like/Follow us on Facebook for more updates: @gdaffirmative

“BACKGROUND AND OBJECTIVES:Gonadotropin-releasing hormone analogues are commonly prescribed to suppress endogenous puberty for transgender adolescents. There are limited data regarding the mental health benefits of this treatment. Our objective for this study was to examine associations between access to pubertal suppression during adolescence and adult mental health outcomes.”

“METHODS:Using a cross-sectional survey of 20 619 transgender adults aged 18 to 36 years, we examined self-reported history of pubertal suppression during adolescence. Using multivariable logistic regression, we examined associations between access to pubertal suppression and adult mental health outcomes, including multiple measures of suicidality.”

“RESULTS:Of the sample, 16.9% reported that they ever wanted pubertal suppression as part of their gender-related care. Their mean age was 23.4 years, and 45.2% were assigned male sex at birth. Of them, 2.5% received pubertal suppression. After adjustment for demographic variables and level of family support for gender identity, those who received treatment with pubertal suppression, when compared with those who wanted pubertal suppression but did not receive it, had lower odds of lifetime suicidal ideation (adjusted odds ratio = 0.3; 95% confidence interval = 0.2–0.6).”

“CONCLUSIONS:This is the first study in which associations between access to pubertal suppression and suicidality are examined. There is a significant inverse association between treatment with pubertal suppression during adolescence and lifetime suicidal ideation among transgender adults who ever wanted this treatment. These results align with past literature, suggesting that pubertal suppression for transgender adolescents who want this treatment is associated with favorable mental health outcomes.”

https://pediatrics.aappublications.org/content/145/2/e20191725?

WPATH and USPATH Joint Statement in Response to Proposed Legislation Denying Evidence-Based Care for Transgender People Under 18 Years of Age

WPATH and USPATH Joint Statement in Response to Proposed Legislation Denying Evidence-Based Care for Transgender People Under 18 Years of Age

Published: January 28, 2020.

Yesterday, WPATH and USPATH released a joint statement about a recent and troubling trend across various states in the US. The Gender Dysphoria Affirmative Working Group fully endorses what is written here.

A web link to the statement can be found here: https://listloop.com/wpath/mail.cgi/archive/adhoc/20200128125839/

Statement in Response to Proposed Legislation Denying Evidence-Based Care for Transgender People Under 18 Years of Age and to Penalize Professionals who Provide that Medical Care

The World Professional Association for Transgender Health (WPATH) and its US chapter, the United States Professional Association for Transgender Health (USPATH), vehemently oppose the legislation being proposed in Florida (HB 1365), South Carolina (HB 4716), South Dakota (HB 1057), Colorado (HB 20-1114), and similar legislation in other states.  These bills seek to deny evidence-based care for transgender people under 18 years of age and to penalize professionals who provide that medical care.  These bills will punish practitioners of gender affirming care with revocation of their medical license, or up to 15 years in prison in some states.  These bills will treat health care providers as if they committed manslaughter or arson.  

Many of the procedures mentioned by these bills are not even offered to transgender youth, revealing these bills to be alarmist expressions of ill-informed opinion. Guidance for the provision of medical care for transgender youth is outlined within the 7th edition of Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender-Nonconforming People created by the World Professional Association for Transgender Health (Coleman et al. 2012). The guidelines differentiate between children and adolescents with regard to the provision of care. 

Under the SOC, children do not receive any of the medical care identified within these bills, but mental health and social supports are provided to them along with their families.  Surgeries on genitals and reproductive systems are considered for people who are typically over 18 years of age (depending on the age of consent and other relevant factors in the pertinent jurisdiction) and have been living in their affirmed gender for at least 12 months. Medical treatments that might be recommend for certain adolescents include puberty-blocking medication and – in carefully selected cases – hormone replacement therapies and surgery, most often non-genital. These treatments are not offered without conscientious medical attention and informed clinical evaluation.

Puberty suppression has been found to be very beneficial for transgender adolescents, and it is reversible (Mahfouda et al. 2017; Olson-Kennedy et al. 2018; Hodax et al. 2019; Salas-Humara et al. 2019).  Further, a recently published study has concluded that transgender adults who had access to pubertal blockers had a lower risk of suicidal ideation compared to those transgender adults who did not have access to pubertal blockers (Turban et al. 2020).

We are disturbed by these attempts to legislate medical treatment without expert guidance from the relevant national medical organizations or even testimony from experienced, qualified local or regional providers and patients for whom these treatments have been beneficial, if not lifesaving. Given the climate in which these bills are presented, however, we can imagine that few young patients or their parents would be willing to present themselves for the scrutiny of potentially hostile legislators and the activists who are promoting these damaging bills. 

All medical treatment is a crucial and very personal service that virtually everyone depends upon at some point in their lives, and it should not be delivered or restricted according to the whims of distant lawmakers who know little or nothing about the circumstances of an individual’s life. Proper medical care for any condition is a matter best negotiated between patients and their trained and qualified medical providers who are relying on clinical evidence and experience. 

These bills attempt to criminalize treatments or at best restrict medical professionals from helping their patients and their families. Since transgender children, adolescents, or adults cannot be legislated out of existence, these bills seem to be a misguided attempt to prevent transgender people from coming forward for services they need in order to live healthy lives. 

We urge you to reject these harmful bills and assure your transgender constituents and their families that their health and well-being is just as important as your own.

Click here for an additional WPATH Statement in Response to Calls for Banning Evidence-Based Supportive Health Interventions for Transgender and Gender-Diverse Youth.

References

Coleman E, Bockting W, Botzer M, et al (2012) Standards of care for the health of transsexual,

transgender, and gender-nonconforming people, version 7. Int J Transgenderism 13:165–232

Hodax JK, Wagner J, Sackett-Taylor AC, et al (2019) Medical options for care of gender diverse and

Transgender youth. J Pediatr Adolesc Gynecol S1083-3188(19)30206–2.

https://doi.org/10.1016/j.jpag.2019.05.010

Mahfouda S, Moore JK, Siafarikas A, et al (2017) Puberty suppression in transgender children and

adolescents. Lancet Diabetes Endocrinol 5:816–826. https://doi.org/10.1016/S2213-8587(17)30099-2

Olson-Kennedy J, Okonta V, Clark LF, Belzer M (2018) Physiologic Response to Gender-Affirming

Hormones Among Transgender Youth. J Adolesc Health 62:397–401.

https://doi.org/10.1016/j.jadohealth.2017.08.005

Salas-Humara C, Sequeira GM, Rossi W, Dhar CP (2019) Gender affirming medical care of transgender

youth. Curr Probl Pediatr Adolesc Health Care 49:100683.

https://doi.org/10.1016/j.cppeds.2019.100683

Turban JL, King D, Carswell JM, Keuroghlian AS. Pubertal Suppression for Transgender Youth and Risk of

Suicidal Ideation. Pediatrics. 2020 Jan 23. pii: e20191725

Yadegarfard M, Meinhold-Bergmann ME, Ho R (2014) Family rejection, social isolation, and loneliness as

predictors of negative health outcomes (depression, suicidal ideation, and sexual risk behavior) among

Thai male-to-female transgender adolescents. J LGBT Youth 11:347–363

CLICK HERE TO DOWNLOAD FULL POLICY STATEMENT

WPATH Board of Directors

USPATH Board of Directors

STAFF

President

Vin Tangpricha, MD, PhD

President

Erica Anderson, PhD

Executive Director

Sue O’Sullivan; sue@wpath.org

President-Elect

Walter Pierre Bouman, MD, PhD

President-Elect

Madeline Deutsch, MD, MPH

Executive Director of Global Education & Development

Donna Kelly; donna@wpath.org

Secretary

Randi Ettner, PhD

Secretary/Treasurer

Emilia Lombardi, PhD

Deputy Executive Director

Blaine Vella; blaine@wpath.org

Treasurer

Baudewijntje Kreukels, PhD

Immediate Past-President

Gail Knudson, MD, MEd, FRCPC

BOARD OF DIRECTORS

Tamara Adrian, JD Marci Bowers, MD

Tone Maria Hansen, MSN Ren Massey, PhD

Asa Radix, MD, PhD, MPH

Loren Schechter, MD Jaimie Veale, PhD

Immediate Past-President Joshua Safer, MD, FACP BOARD OF DIRECTORS

Dana (Thomas) Bevan, PhD John Capozuca, PhD

Lisa Griffin, PhD

Johanna Olson-Kennedy, MD, MS

Asa Radix, MD, PhD, MPH

Student Representative

Nova Bradford, BA

Communications Director

Jamison Green; jamison@veritasmeetingsolutions.com

EPATH Representative

Walter Pierre Bouman, MD, PhD

USPATH Representative

Erica Anderson, PhD

GEI Representative (Ex-Officio)

Lin Fraser, EdD

Student Representative (Ex-Officio)

Penelope Strauss, BA, MPH

Understanding lesbian, gay, bisexual and trans (LGBT) adolescents’ suicide, self-harm and help-seeking behaviour

Understanding lesbian, gay, bisexual and trans (LGBT) adolescents’ suicide, self-harm and help-seeking behaviour 

Another report, this one from the UK, again documenting that hostile social forces and lack of social supports – not the LGBTQ+ identity – are the primary driver of LGBTQ+ suicide.  Create a more affirming and nurturing environment, and these youth can thrive. 

Department of Health Policy Research Programme Project Understanding Lesbian, Gay, Bisexual and Trans (LGBT) Adolescents' Suicide, Self-Harm and Help-Seeking Behaviour. June 30, 2016.  Authors: Elizabeth McDermott (Lancaster University), Elizabeth Hughes (University of Huddersfield) & Victoria Rawlings (Lancaster University).

“Executive summary 

“Background 

“International research demonstrates that LGBT youth are at much higher risk of suicide and self-harm compared to their heterosexual or cisgender counterparts. Evidence in the UK is sparse and only beginning to establish sexual and gender identity as a risk factor for adolescent suicide and self-harm, and as a result of this research scarcity we also know very little about help seeking behavior. The Suicide Prevention Strategy (2012) has identified LGBT youth as a high risk group but currently there is limited evidence to develop effective suicide prevention policy and practice.”

“Key findings 

“Understanding LGBT youth self-harm and suicide 

“Similar to findings from other studies on youth suicide, those who had self-harmed and/or had a disability had an increased likelihood of planned or attempted suicide. Gender identity was also a risk factor for self-harm and suicide. Those who were gender diverse (Trans/unsure) were nearly twice as likely to have self-harmed and one and a half times more likely to have planned or attempted suicide than cisgender participants. Cisgender males were the least likely to plan or attempt suicide, or self-harm compared to other gender identities. There were five interconnecting areas which explained the elevated risk of suicide and self-harm in LGBT youth: 1) homophobia, biphobia or transphobia; 2) sexual and gender norms; 3) managing sexual orientation and gender identity across multiple areas of life; 4) being unable to talk and; 5) other life crises.” 

“1. Homophobia, biphobia and transphobia 

“The majority (70.8%, n=527) of the sample had experienced direct abuse or negative interactions about their sexual or gender identity when they were self-harming or feeling suicidal. A great number of these incidents had occurred in schools but the participants experienced this hostility across all areas of life e.g. in public, leisure spaces, work, religious places and on the internet. Those who experienced abuse were one and a half times more likely to plan or attempt suicide. Bisexual participants were least likely to experience abuse compared to other sexual orientation groupings. Trans and disabled participants were twice as likely to experience abuse related to their sexual orientation/ gender identity than those who were not. They were also more likely to indicate that the abuse influenced their self-harm and suicidal feelings. Those who reported they were affected by homophobic abuse had double the odds of planning or attempting suicide.” 

“2. Sexual and gender norms 

“Sexual and gender norms that made many participants feel that something was wrong with them (because they were not heterosexual or cisgender), without being told or abused directly, also caused distress. Almost half the questionnaire participants felt negative about their sexual or gender identity during the time they were self-harming or felt suicidal; a far lower proportion felt positive about their sexual orientation or gender identity. Gender diverse participants were most likely to feel negative, and bisexual young people least likely to feel negative, about their sexual orientation and gender identity. Those who felt negative about their sexual and/or gender identity were more likely to have planned or attempted suicide.”

“3. Managing sexual orientation and gender identity across multiple areas of life 

“Making decisions about whether to disguise or hide their sexual orientation or gender identity in different contexts (e.g. school, home, public, internet, leisure places) and to a variety of people, impacted negatively on the participants’ mental health. The majority of young people found hiding their sexuality and gender identity distressing. Gender diverse participants were over three and a half times more likely to feel distressed about hiding their sexual orientation/gender identity compared to cisgender young people. Bisexual  participants were significantly less distressed than other sexual identity groupings. Those who found hiding their sexual orientation and gender identity distressing were nearly two times more likely to self-harm. Young people who reported that keeping their sexual orientation/ gender identity a secret strongly affected their self-harm and suicidal feelings were significantly more likely to attempt or plan suicide.” 

“4. Being unable to talk 

“Almost three quarters of participants (74.1%, n=533) indicated that not being able to talk about their feelings and emotions (in relation to their mental health, sexuality and gender identity) strongly influenced their self-harm and suicidal feelings. Those young people who felt more affected by not being able to talk about their emotions had significantly higher rates of self-harm and were nearly two and a half times more likely to report they had attempted or planned suicide” 

“5. Other life crises 

“Participants experienced a range of additional reasons for distress that were unrelated to sexual orientation/ gender identity. The most common were academic pressure, problems with friends, bullying, family breakdown, participant illness, financial problems, romantic relationships ending, and previous experiences of abuse…”

“Conclusions 

“To develop effective public health policy to prevent suicide in LGBT young people, the social factors that heighten risk need to be addressed, and supportive services put in place. As a priority this would entail tackling homophobic, biphobic and transphobic abuse in schools, addressing the continuing sexual and gender norms which marginalise those who are not heterosexual and cisgender, and providing support and space for LGBT youth to disclose and discuss their emotions and experiences in secure environments. Key policy areas to focus upon are schools and education, the role of the internet, increasing LGBT youth provision, developing online and face-to face LGBT youth specific mental health support, and improving mental health and gender identity NHS services…”

https://www.academia.edu/26625951/Understanding_lesbian_gay_bisexual_and_trans_LGBT_adolescents_suicide_self-harm_and_help-seeking_behaviour_Final_Report?email_work_card=title

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