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Transgender youth are at increased risk for a number of psychiatric morbidities. Gender identity conversion therapy can make them worse.
“You can imagine if you're regularly hearing in the media that trans people are risks to other people in bathrooms, that you're a risk to your peers on sports teams, that really you're just confused about your gender identity—over time, you may internalize these ideas and start to have self-hatred or low self-esteem,” said Jack L. Turban, MD, MHS, a Fellow in Child & Adolescent Psychiatry at Stanford University School of Medicine and Psychiatric TimesTM Advisory Board member.
In his session, “Evolving Treatment Paradigms for Transgender Youth,” Turban discussed the evolution of prepubertal transgender youth treatment over the past 2 decades, the current evidence base for pubertal suppression for transgender adolescents, and the rationale for gender-affirming hormone treatment for transgender adolescents.
Transgender youth, Turban explained, have an array of psychiatric morbidities, including mood disorders (12.4 to 64%), anxiety disorders (16.3 to 55%), and prior suicide attempts (9.3 to 30%). Additionally, about 80% have been a victim of bullying.1
Another topic Turban found important to approach is the dangers of gender identity conversion therapy. In his research published in JAMA Psychiatry, Turban took a sample size of more than 27,000 American transgender adults who had spoken to a therapist about their gender identity, and compared those whose therapy involved trying to make them cisgender with those whose therapy did not have any conversion efforts.2 The results showed exposure to conversion efforts before age 10 led to increased suicidal ideation, increased lifetime cigarette use, increased lifetime illicit drug use, as well as more suicide attempts.2
“We had a ton of data that trying to change sexual orientation was dangerous, but this is the first study to look at trying to change someone's gender identity and the mental health outcomes,” said Turban.
Furthermore, Turban noted it seems like childhood is particularly vulnerable time period for being exposed to conversion efforts. Conversion therapy is still legal in 29 states and 4 territories,3 and approximately 13.5% of transgender individuals report lifetime exposure to gender identity conversion efforts.4
Instead, Turban believes a social transition might be a good idea for a prepubertal child. In a social transition, transgender children or adolescents adopt the name, pronouns, and gender expression (like clothing or haircuts) that match their gender identity.
“Banning social transition is likely dangerous and can send a message to a child that being transgender is bad. This can essentially instill shame and damage relationships between the child and the therapist, and the child in the family,” Turban said.
1. Turban JL, Ehrensaft D. Research review: gender identity in youth: treatment paradigms and controversies. J Child Psychol Psychiatry. 2018;59(12):1228-1243.
2. Turban JL, Beckwith N, Reisner SL, Keuroghlian AS. Association between recalled exposure to gender identity conversion efforts and psychological distress and suicide attempts among transgender adults. JAMA Psychiatry. 2020;77(1):68-76.
3. Movement Advancement Project. Updated 2021. Accessed October 2, 2021. https://www.lgbtmap.org/equality-maps/conversion_therapy
4. Turban JL, King D, Reisner SL, Keuroghlian AS. Psychological attempts to change a person's gender identity from transgender to cisgender: estimated prevalence across US states, 2015. Am J Public Health. 2019;109(10):1452-1454.