‘Political advocacy science at its worst’

Researchers claim to have completed the first study to prove that efforts to help people overcome gender dysphoria cause psychological harm. But critics argue the data is fundamentally flawed and the study doesn’t back its claims.

The study, published last month in JAMA Psychiatry by researchers from Harvard University and Massachusetts General Hospital, asked transgender survey participants if a professional psychologist, counselor, or religious adviser had ever tried to “make you identify only with your sex assigned at birth,” or tried to “stop you being trans.” Researchers lumped anyone who answered yes into a single category: “recalled exposure to gender identity conversion efforts.” The study found those people had ongoing severe psychological distress and more than double the odds of attempting suicide than transgender people who answered no.

Eighteen states and the District of Columbia ban any therapy for LGBT minors that could result in them embracing heterosexuality or their biological sex. That number likely will grow by the end of the year. In a rebuttal published by Public Discourse, University of Texas sociologist Mark Regnerus pointed out major methodological problems with the study, which used data from the 2015 United States Transgender Survey of more than 27,000 transgender adults.

Regnerus noted the study lumped together any treatment or therapy that did not involve unqualified affirmation of gender dysphoria into “one imprecise, binary measure.” Patients could interpret simple attempts to obtain ethical informed consent—such as counseling them about the medical, social, and psychological risks of gender-affirming treatment—as trying to discourage their transgender identity, he said.

Regnerus also said the study’s authors did not acknowledge the potential for bias in their data. Their sample came from a nonrandom, opt-in survey of self-identified transgender adults recruited by LGBT organizations, but the researchers presented their conclusions as if the survey was a random sample reflective of the general population.

“Rarely have researchers been so explicit about the political aims of their research,” Regnerus wrote. If the study was the first to show adverse outcomes from transgender identity change efforts, how could LGBT activists have previously justified government bans, and why would researchers support such laws before the study? “Simple,” he concluded. “It was never about science.”

The study’s lead author, Jack Turban of Harvard Medical School, admitted as much in an interview with Newsweek. “We wanted to provide concrete data to support these policy statements,” he said. “We hope that this research will help state legislators understand the magnitude of this problem and the need to pass bans on gender identity conversion efforts.”

Laura Haynes, a retired psychologist in California with more than 40 years of experience, compared the research to surveying divorced individuals to determine whether marriage therapy works. She said the study “omitted people who successfully changed and embraced their body sex through therapy, and who therefore are not found in transgender communities,” making its conclusions “fatally flawed” and “political advocacy science at its worst.”

Haynes is the chairwoman of research and legislative policy for the National Task Force for Therapy Equality, a coalition of licensed therapists that advocates for the rights of individuals to receive therapy for unwanted same-sex attraction or gender identity conflicts.

She said many psychological associations acknowledge that gender identity, like every other complex human trait, develops through a combination of both biological influences and life experiences. The World Professional Association for Transgender Health acknowledges gender dysphoria can have pathological causes and does not recommend gender-affirming treatment that neglects underlying psychiatric disorders. But in states with conversion therapy bans, therapists face a lose-lose situation. If they try to resolve underlying conditions, they risk losing their license, but failure to treat underlying conditions has its risks, including “persisting trauma, mental health problems, and suicide,” Haynes said.

What’s more, gender-affirming treatment often puts minors on a risky path toward experimental hormone blockers, opposite-sex hormones, and surgeries that can lead to a loss of fertility and sexual function, as well as higher rates of heart disease and cancer deaths.

“Who is causing health disparities, again?” asked Haynes.

A different kind of immigration battle

A same-sex couple sued the U.S. State Department last month for discrimination because the federal government refused to grant birthright citizenship to the daughter of one of the men.

Adiel and Roee Kiviti, both naturalized U.S. citizens born in Israel, used a donor egg and Adiel’s sperm to create a child who was born to a surrogate in Canada in February. When they tried to apply for a U.S. passport for the infant, named Kessem, the U.S. government refused to grant her citizenship. The Immigration and Nationality Act requires naturalized U.S. citizens to live here for five years before their child can obtain automatic birthright citizenship. Although Roee has been a U.S. resident since 2001, Adiel, the only parent with a biological connection to Kessem, moved to the United States in 2015.

The couple argues the State Department should treat them just like a heterosexual couple and assume both have a biological connection to the child. They also argue court precedent is on their side. A federal judge in February ruled in favor of a same-sex couple in a similar case involving a little boy born to a surrogate in Canada using the sperm of an Israeli man in a same-sex marriage with an American citizen.

But the State Department is appealing the February ruling, maintaining its policies do not discriminate against same-sex couples and have the Supreme Court’s backing. The high court has ruled in support of a biological connection between a child seeking to acquire citizenship and the U.S. citizen seeking to confer it.

“The State Department is correct to view parenthood through the lens of biology, not ‘intent’ to parent,” said Katy Faust, the founder and director of Them Before Us, a group that advocates for the rights of children in social policies. Faust opposes surrogacy as a child-commodification process. She said overseas surrogacy is especially problematic because it can result in stateless children.

“The problem is not that the State Department is scrutinizing same-sex couples who are using surrogates,” Faust said. “It’s that they should scrutinize anyone who uses a surrogate abroad, whether the intended parents are a same-sex couple or an opposite-sex couple.” —K.C.

Fewer twins

The rate of twins born in the United States is at its lowest point in a decade, according to the Centers for Disease Control and Prevention. Last year, about 124,000 U.S. babies were twins, about 1 in every 31 births. The rate peaked at 1 in 29 births in 2014. The CDC said the drop resulted mainly from advances in in vitro fertilization treatments. The success rate for a single embryo implantation has risen from 20 percent in the 1980s to around 50 percent today, making it much more common for doctors to implant just one embryo at a time. —K.C.