Conversion Therapy Targeting LGBTQ People Costs Over $9 Billion Per Year in US

By Lorraine L. Janeczko

April 07, 2022

NEW YORK (Reuters Health) - Conversion therapy targeting lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) youth in the U.S. carries not only physical and psychological harms, but huge financial costs as well, researchers report.

Conversion therapy, also called sexual-orientation and gender-identity-change efforts (SOGICE), attempts to convert LGBTQ individuals to heterosexuality and/or cisgender identity, Dr. Anna Forsythe of Purple Squirrel Economics in Waltham, Massachusetts, and colleagues explain in JAMA Pediatrics.

"Our economic analysis estimated the total cost of conversion therapy in the U.S. at $9.23 billion each year. Only a fraction of these costs, $650 million, are attributable to the costs of actual therapy. The rest of the economic burden is the quantification of harms associated with undergoing conversion therapy, such as depression, anxiety, substance abuse, and suicide attempts," Dr. Forsythe told Reuters Health by email. "These consequences are over 13 times more costly than the direct costs of conversion therapy itself - an estimated $8.58 billion annually."

"We knew the practice is dangerous and detrimental from clinical and humanistic standpoints, but we did not expect the yield of our economic model to show annual costs in the billions of dollars," she added.

Dr. Forsythe and her colleagues conducted a systematic literature review and economic evaluation of published evidence on SOGICE among LGBTQ individuals of any age in the U.S.

Their economic model evaluated use of SOGICE by licensed or religion-based practitioners vs. no intervention; affirmative therapy by licensed practitioners that provides LGBTQ individuals with skills and strategies to counteract minority stress vs. no intervention; and affirmative therapy vs. SOGICE. They estimated the costs and adverse outcomes for each scenario and assessed SOGICE's overall U.S. economic burden.

Overall, 12% of the 190,695 LGBTQ people in the 28 published studies included in the analysis experienced SOGICE.

SOGICE began at a mean age of 25 years, lasted a mean of 26 months, and 43% of people exposed to SOGICE received at least two types of conversion therapy. Greater percentages of people who underwent SOGICE suffered physical and psychological harms than those who did not undergo SOGICE (depression: 65% vs. 27%; serious psychological distress: 47% vs. 34%; substance abuse: 67% vs. 50%; and attempted suicide: 58% vs. 39%).

The researchers estimated lifetime direct medical costs and indirect costs - including mortality and productivity loss - per person exposed to SOGICE at $206,159, compared with $108,174 for no therapy and $67,844 for affirmative therapy.

Based on 2021 numbers, replacing SOGICE with affirmative therapy would save over $6 billion each year, the researchers estimate.

"Our research shows that increased access to affirmative therapy that empowers LGBTQ youth to accept themselves for who they are can both promote health and well-being and also reduce the economic burden of SOGICE," Dr. Forsythe said.

Dr. Forsythe acknowledged limitations to the study, including uncertainty regarding costs associated with adverse events over a lifetime.

"The model accounts for costs and outcomes associated with adverse events for three years after conversion therapy, even though harms and their costs may persist much longer, leading to higher costs," she noted.

Dr. N. Christine Moser, an associate professor in the department of pediatrics at the University of Missouri-Kansas City School of Medicine, called this study "a compelling attempt to estimate the societal cost of inflicting harm on LGBTQ adolescents and young adults in the US."

"The authors clearly show that affirmative therapy . . . is associated with the least likelihood of harm to LGBTQ youth compared to no intervention or to SOGICE," Dr. Moser told Reuters Health by email.

"This finding is timely, given the legislative efforts in many U.S. states to ban access to affirming healthcare for transgender youth, and the stigmatizing efforts in states including Florida, with its 'Don't Say Gay' bill," she noted.

Dr. Ilan H. Meyer, a researcher at the Williams Institute for Sexual Orientation Law and Public Policy at the UCLA School of Law in Los Angeles, California, said, "This study supports what has been known from clinical observations and research, which is that sexual-orientation and gender-identity-change efforts have the potential to cause harm to LGBTQ individuals."

"This new research shows the economic burden to the nation of the continued practice of SOGICE," Dr. Meyer, who also was not involved in the study, told Reuters Health by email.

In an accompanying editorial, Dr. Johanna Olson-Kennedy of the Keck School of Medicine of the University of Southern California in Los Angeles writes, "Although conversion therapy has been demonstrated to be ineffective, and often harmful, it is still being used in 2022."

"The human toll is unimaginable but has apparently not been high enough for the practice to be thoroughly banned across the United States," Dr. Olson-Kennedy adds. "Only 20 states and Washington, D.C., have legally banned this practice; 5 states and 1 U.S. territory (Puerto Rico) have partial bans; and 25 states and 2 U.S. territories have no bans on this ineffective and harmful practice."

"Now that there has been a substantial cost identified with the practice of SOGICE, perhaps humanity might redirect its reparative efforts toward dismantling the harmful hetero and cisgender normative chokehold that continues to asphyxiate social evolution," she concluded.

The study was funded by the Trevor Project, a suicide-prevention and mental-health organization for LGBTQ young people.

SOURCE: and JAMA Pediatrics, online March 7, 2022.