As a medical professional who happens to be gay, I’ll be celebrating Dec. 15, the 50th anniversary of the American Psychiatric Association’s decision to remove homosexuality from its list of mental illnesses. The longstanding designation was based on prejudice, not medical research, and the revision marked the beginning of the end for so-called conversion therapy, which sought to “cure” gays and lesbians of a nonexistent malady.
Half a century later, the medical establishment is pushing a new kind of conversion therapy under the guise of transgender identity. No one is suffering more than gay kids. In Canada, where I practice, and in the U.S., physicians provide what’s euphemistically known as “gender-affirming care” to patients as young as 8, and the leading transgender health association has opened the door to interventions at even earlier ages. Under this framework, those who feel uncomfortable with their bodies may receive a medical regimen including puberty blockers, cross-sex hormones and sex-change surgeries. These interventions typically stunt, remove or irreversibly modify a patient’s sexual development, genitals and secondary sex characteristics. Any endocrinologist or other physician who rejects this approach is alleged to be endangering the health and even the life of his patients.
But are these patients really “transgender”? Research shows that some 80% of children with “gender dysphoria” eventually come to terms with their sex without surgical or pharmaceutical intervention. Multiple studies have found that most kids who are confused or distressed about their sex end up realizing they’re gay—nearly two-thirds in a 2021 study of boys. This makes sense: Gay kids often don’t conform to traditional sex roles. But gender ideology holds that feminine boys and masculine girls may be “born in the wrong body.”
In this light, “gender-affirming care” looks a lot like conversion therapy. In the past, it took the form of electroshock therapy, chemical castration and even lobotomy. Now it takes the form of rendering teenagers sterile and sexually dysfunctional for life. Clinicians from the main U.K. transgender service referred to prescribing puberty blockers as “transing the gay away”—a play on the description of old-fashioned conversion-therapy as “praying the gay away.” A clinician who resigned from the U.K. service accused it of “institutional homophobia.” Clinicians at the service had a “dark joke” that “there would be no gay people left at the rate Gids”—the Gender Identity Service—“was going.”
Consistent with conversion therapy, physicians are telling young gays and lesbians that something is wrong with them, based on a regressive view of what it is to be male or female. Also consistent with previous efforts to cure homosexuality: The resulting interventions often create lifelong medical problems, both physical and mental. Contrary to advocates’ claims, there’s no evidence that puberty blockers, cross-sex hormones, or surgeries reduce the risk of suicide.
Children who take this road face a lifetime of pain, infertility and anguish. They deserve real mental-health care to address common underlying comorbidities, not mind- and body-altering medical interventions that try to make them into something they aren’t.
Fifty years ago, the medical assault on homosexuals began to end. Now society has been told that accepting transgender identity is the same as accepting gays and lesbians. But it isn’t. Even well-intentioned acceptance of transgender identity disproportionately harms them. One day perhaps professional organizations like the Endocrine Society and the American Academy of Pediatrics will follow the evidence, as the APA did in 1973. Until then, gay kids will continue to suffer from an injustice that was supposed to end 50 years ago.
Dr. Eappen is a practicing endocrinologist in Montreal and a senior fellow at Do No Harm
