Published August 23, 2016
A stunning new report on sexuality and gender exposes the shaky science behind the LGBT “born that way” narrative and the push to label young kids as “transgender.” The report comes as the health-care industry, pressured by the Obama administration, imposes new protocols pertaining to “sexual orientation and gender identity” grounded in faulty science and often dismissive of parents’ rights and children’s well-being.
The report, “Sexuality and Gender: Findings from the Biological, Psychological and Social Sciences,” is co-authored by two psychiatric experts affiliated with Johns Hopkins University School of Medicine, Dr. Paul McHugh and Dr. Lawrence Mayer. Published by The New Atlantis (a journal of technology and society) and dedicated to “the LGBT community” and “children struggling with their sexuality and gender,” the report aims to prompt further research to help provide the LGBT population with “the understanding, care, and support they need to lead healthy, flourishing lives.”
“This report is about science and medicine, nothing more and nothing less,” the lead author, Mayer, writes. A “sober assessment of the science” led the authors to decry the “great chasm” between “public discourse” and “what science has shown” about sexual orientation and gender identity, particularly among children. Indeed, the report indicates that many of our prevailing cultural narratives and health-care practices regarding the LGBT population have little or no sound scientific basis.
Here Are the Key Findings
The full report deserves to be read in its entirety. Several years in the making, it’s a careful, nuanced analysis of the weight of scientific evidence on sexual orientation, gender identity, and LGBT mental health. The report doesn’t shrink from findings perhaps more palatable to progressives than conservatives or vice-versa, and the authors are quick to point out existing gaps in the research. They conclude with a call for more high-quality research and “an ongoing public conversation regarding human sexuality and identity.”
That said, the report’s conclusions clearly challenge many progressive LGBT talking points. Major findings are summarized below. (Note: all quotations are from the report.)
“Born that way” is a myth. “The understanding of sexual orientation as an innate, biologically fixed property of human beings—the idea that people are ‘born that way’—is not supported by scientific evidence…Genes constitute only one of the many key influences on behavior in addition to environmental influences, personal choices, and interpersonal experiences.”
Sexual orientation is fluid, hard to measure, and has multiple dimensions.The view that “homosexuality or heterosexuality is in any given person unchangeable and determined entirely apart from choices, behaviors, life experiences, and social contexts…is not a view that is well-supported by research…Sexual orientation may be quite fluid.” An “ambiguous” term, “sexual orientation” may refer to one or more measurable dimensions: “attractions, behaviors, identity” and “belonging to a certain community.”
Further research should assess correlations between childhood sexual abuse and sexual orientation. Non-heterosexuals are two to three times as likely as heterosexuals to have experienced childhood sexual abuse.
Non-heterosexuals are at “elevated risk” for mental health problems and suicide.Compared to the general population, non-heterosexual sub-populations have an “elevated risk for a variety of adverse health and mental health outcomes,” with “nearly 2.5 times the risk of suicide.” “[T]he rate of lifetime suicide attempts across all ages of transgender individuals is estimated at 41%” (compared to under 5 percent in theoverall U.S. population).
Social stigma and stress are incomplete explanations for poor mental health.“The social stress model probably accounts for some of the poor mental health outcomes experienced by sexual minorities, though the evidence supporting the model is limited, inconsistent and incomplete.” Further studies are needed.
Science does not support de-linking gender identity and biological sex. “The hypothesis that gender identity is an innate, fixed property of human beings that is independent of biological sex—that a person might be ‘a man trapped in a woman’s body’ or ‘a woman trapped in a man’s body’—is not supported by scientific evidence.” Brain studies “do not provide any evidence for a neurobiological basis for cross-gender identification.”
Sex-reassignment surgery is not a panacea. Compared to the general population, adults who underwent sex-reassignment surgery continued to have a higher risk of experiencing poor mental health outcomes, including being 19 times more likely to die of suicide.
Most children desist from childhood cross-gender identification. “Only a minority of children who experience cross-gender identification will continue to do so into adolescence or adulthood.” “[N]o one can determine the gender identity of a two-year-old.”
“Premature” interventions for gender-dysphoric children are alarming. “The severity and irreversibility of some interventions being publicly discussed and employed for children” are alarming and disturbing. “Therapies, treatments, and surgeries seem disproportionate to the severity of the distress being experienced by these young people, and are…premature since the majority of children who identify as the gender opposite their biological sex will not continue to do so as adults.”
“[L]ittle scientific evidence” supports the value of therapeutic intervention to “delay puberty or modify the secondary sex characteristics of adolescents,” although some children may experience “improved psychological well-being if they are encouraged … in their cross-gender identification.” However, the report urges “caution” because of the “lack of reliable studies on the long-term effects” of those interventions.
Young kids are not transgender. Other factors likely explain their gender difficulties. “There is no evidence that all children who express gender-atypical thoughts or behavior should be encouraged to become transgender.” At least one “Diagnostic and Statistical Manual of Mental Disorders” criterion for diagnosing gender dysphoria (e.g., child exhibits a “strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender”) is “unsound,” according to the report.
Furthermore, even when children do “identify as a gender opposite their biological sex, diagnoses of gender dysphoria are simply unreliable. The reality is that they may have psychological difficulties in accepting their biological sex as their gender” for other reasons, including uncomfortable gender expectations or trauma.
What Could This Change?
So what does this report mean, in practical terms? For starters, it gives all of us greater insight on the extent to which ideology has been driving health-care policies.
An ideological partnership among LGBT organizations, the progressive medical establishment, and the Obama administration has used erroneous narratives about sexuality and gender, based on thin science, to advance their policy agendas. (Expanding coverage for transgender surgeries under the Affordable Care Act, along with current pressure on states to extend coverage for assisted reproductive technology to “infertile” same-sex couples are recent examples.)
This new report gives us language and authority to push back, as it challenges these false narratives, and by extension, the policy protocols that rely on them. Although it’s impossible, in one column, to analyze the many policies implicated in the Left’s false narratives around sexuality and gender, we offer a few examples below, focused on children.
Federal Data Collection Violates Kids’ Privacy
The U.S. Department of Health and Human Services (HHS) released new rules in October 2015 “mandat[ing] the inclusion of sexual orientation and gender identity” (SOGI) data in the demographic section of Electronic Health Records systems. Although federal rules specify that clinicians do not have to ask every patient to provide this information, once the forms and intake procedures are standardized according to this protocol, patients (especially adolescents) are unlikely to realize they have the freedomnot to answer. LGBT organizations have pushed for SOGI intake questions for political reasons: by validating their numbers, they become “visible” and acquire increased leverage for targeted health benefits.
Their answers to these questions will follow them the rest of their lives.
Under HHS “best practices,” electronic health records willsoon include these questions on sexual orientation and gender identity: “Do you think of yourself as: Straight or heterosexual; Lesbian, gay, or homosexual; Bisexual; Something else, please describe. Don’t know.” “What is your current gender identity? (Check all that apply.) Male; Female; Transgender male/Trans man/Female-to-male; Transgender female/Trans woman/Male-to-female; Genderqueer, neither exclusively male nor female; Additional gender category/(or other), please specify; Decline to answer.”
Children, adolescents, and young adults, whose sexual attractions, feelings, and behaviors might be confused or in flux, will be pressured to self-identify according to ideological—not scientifically measurable—categories, using terms that are unclear, ambiguous, and subject to change. Their answers to these questions will follow them the rest of their lives. This is hardly fair to young children and adolescents, who will be asked prematurely to label sexual feelings or claim identities without fully understanding either what they mean or the implications of their responses.
Further, if the Family Equality Council, an LGBT advocacy organization, has its way, federal rules on data collection will soon require that children in the adoption and foster care systems be asked about their gender identity (including whether they are transgender) beginning at age three, and their sexual orientation beginning at age ten. What do you think: evidence-based policies? Or ideology?
LGBT-Friendly Offices Normalize LGBT Identities
Another example is as close as your pediatrician’s office. Most pediatricians now conduct a psychosocial interview (typically the HEEADSSS questionnaire) as part of a child’s physical—usually after showing parents the door, “because a parent’s presence is likely to limit how much sensitive information the patient will provide.” The psychosocial interview includes recommended questions about sexual attraction. “Are you interested in boys? Girls? Both? Not sure?”
That’s bad enough. But in 2013, the American Academy of Pediatrics (AAP) issued a policy statement (and technical guidance) on “Office-Based Care for Lesbian, Gay, Bisexual, Transgender, and Questioning Youth.” The policy advises physicians on how to create a welcoming environment for “sexual minority” youth—and reminds docs to jettison hetero-normative assumptions because any (or every) child might be LGBT.
If a child or adolescent admits to gender confusion, the AAP policy instructs pediatricians, in one smooth segue, to “provide the opportunity to acknowledge and affirm their feelings of gender dysphoria and desires to transition to the opposite gender.” The desire to transition is assumed, with no suggestion that the gender dysphoria might have other causes, or that transition might not be desirable.
LGBT Kids and Recalcitrant Parents
In 2014, Oregon began to sponsor puberty blockers for minors under Medicaid. It’s not terribly difficult to begin treatment: just visit a counselor to obtain a diagnosis of gender dysphoria, and then off to the endocrinologist. The only problem, it seems, comes from “recalcitrant” parents who slow the process down.
Unless something changes, parents will find it increasingly difficult to find clinicians willing to flout the ideology-based treatment protocols.
But at least Oregonian parents have the opportunity to be recalcitrant. In five states plus the District of Columbia, parents don’t even have that option. Their ability to choose treatment for a child’s sexuality-related psychological issues is restricted by bans on conversion therapy. Although such bans might be laudable in some respects, preventing truly abusive practices, they also likely have a chilling effect on a parent’s ability to pursue treatment for a child’s comorbid psychiatric disorders, and may prevent parents and the child from pursing desired treatment consistent with religious or moral beliefs.
Unless something changes, parents will find it increasingly difficult to find clinicians willing to flout the ideology-based treatment protocols. When accusations—even false ones—that a clinician practices “conversion” therapy are enough to get an international expert like Dr. Kenneth Zucker fired from his practice (because he happened to be successful in helping to resolve children’s gender dysphoria), you can be sure that the average clinician won’t go near treatment plans that even hint at client change, no matter what the research says.
The report by Dr. McHugh and Dr. Meyer is a valuable wake-up call, reminding us that when ideology, cloaked in the narrative of settled science, drives medical decision-making, it’s the vulnerable who will suffer most. In what may be the understatement of the year, the authors end their report by saying, “We anticipate that this report may elicit spirited responses, and we welcome them.” Let the sparks fly.
Mary Rice Hasson is a fellow at the Ethics and Public Policy Center. Theresa Farnan, PhD, is an adjunct professor at Franciscan University in Ohio.