Psychological Attempts to Change a Person's Gender Identity From Transgender to Cisgender

Estimated Prevalence Across US States, 2015

Jack L. Turban, MD, MHS; Dana King, ALM; Sari L. Reisner, ScD; Alex S. Keuroghlian, MD, MPH

Disclosures

Am J Public Health. 2019;109(10):1452-1454. 

In This Article

Abstract and Introduction

Abstract

Objectives: To examine exposure to psychological attempts to change a person's gender identity from transgender to cisgender (PACGI) among transgender people in the United States, lifetime and between the years 2010 and 2015, by US state.

Methods: We obtained data from the 2015 US Transgender Survey, a cross-sectional nonprobability sample of 27 716 transgender people in the United States, to estimate the percentage exposed to PACGI in each US state.

Results: Overall, 13.5% of the sample indicated lifetime exposure to PACGI, ranging across all US states from 9.4% (South Carolina) to 25.0% (Wyoming). The percentage of transgender adults in the United States reporting exposure to PACGI between 2010 and 2015 was 5% overall, and across all states ranged from 1.2% (Alaska) to 16.3% (South Dakota).

Conclusions: Despite major medical organizations identifying PACGI as ineffective and unethical, 13.5% of transgender people in the United States reported lifetime exposure to this practice. Findings suggest that this practice has continued in every US state as recently as the period 2010 to 2015.

Introduction

Transgender people have a sex assigned at birth that does not align with their gender identity. Approximately 1 million individuals in the United States identify as transgender.[1] These individuals suffer elevated risks of anxiety, depression, and suicide attempts compared with the US general population.[2,3] These disparities are often conceptualized through a minority stress framework, in which mental health is adversely affected by societal nonacceptance and antitransgender legislation.[4] Models of care in which transgender people are affirmed in their identities can result in favorable mental health outcomes.[4]

In contrast, some providers have initiated psychological attempts to change a person's gender identity from transgender to cisgender (PACGI).[4] Professional organizations, including the American Academy of Child & Adolescent Psychiatry, have referred to therapeutic strategies that include PACGI as "conversion therapy," a term that originally referred to attempts to change a person's sexual orientation to heterosexual.[5] More recently, the term "conversion therapy" has also been used to refer to the practice of attempting to change a person's gender identity to cisgender.[5] Some states have passed broad conversion therapy bans that define the practice as any effort to change a person's gender identity or sexual orientation.[6]

Because rejection based on gender identity is a known risk factor for poor mental health, some experts have raised concern that PACGI may lead to adverse mental health outcomes.[4] Lifetime exposure to PACGI is associated with a greater risk of serious psychological distress and suicide attempts.[7] Major professional organizations, including the American Medical Association,[8] have labeled PACGI ineffective and unethical.

There has been considerable policy debate regarding whether PACGI should be legislatively banned. Although several states have outlawed such therapies,[6] others have deferred enacting similar legislation.[6] One argument used against state-level legislative bans has been the claim by state elected officials that PACGI do not occur in their states,[6] rendering such legislation unnecessary. For example, in Maine, after a gender identity and sexual orientation conversion therapy ban was approved by the state House and Senate, the former governor vetoed the bill in 2018, citing "no evidence" that conversion therapy "is being used by anyone, including licensed professionals, in the state of Maine."[6] Using the 2015 US Transgender Survey, the largest existing survey of transgender adults, this study aimed to (1) examine the percentage of transgender adults in each US state who report exposure to PACGI and (2) use recent estimates of the number of transgender people in each state[9] to estimate the number of transgender people exposed to PACGI in each US state.

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