Utah to Ban Conversion Therapy for LGBT Youth

After considerable back-and-forth with the Church of Latter-Day Saints, the governor of Utah has announced a rule that would ban conversion therapy for LGBT youth. The rule will be published December 15 and likely go into effect by the end of January. It has been endorsed by the Church of Latter-Day Saints, which has significant political influence in the state.

Conversion therapy historically referred to attempts to make non-heterosexual people heterosexual. The practice has been widely discredited by major medical organizations including The American Medical Association, The American Psychiatric Association, and The American Academy of Child & Adolescent Psychiatry. A study last year provided the first concrete evidence that conversion therapy for sexual orientation is associated with suicide attempts.

More recently, conversion therapy has also referred to attempts to make transgender people cisgender. This is often referred to as gender identity conversion therapy. It has also been labeled unethical by organizations like The American Academy of Child & Adolescent Psychiatry. Research from our group at Harvard Medical School and The Fenway Institute have shown that gender identity conversion therapy is widespread, with approximately 200,000 transgender people in the U.S. being exposed. It is also associated with suicide attempts.

The rule will make Utah the 19th state to ban conversion therapy. It comes during a contentious political period, as state legislators in several states have introduced legislation that would make gender-affirming care for transgender youth illegal.

In the past, physicians believed conversion therapy for gender identity to be a legitimate approach for transgender youth, with the publication of manuals such as "Gender Identity Disorder in Boys: A Parent- and Peer-Based Treatment Protocol," produced in 2012 by a team at Columbia University. Such manuals recommend a range of behavioral interventions that work to push a child toward being cisgender and following traditional gender norms. They include keeping boys away from typically feminine activities like gymnastics, scheduling more play dates with other males, and encouraging the “letting go” of the boy by the mother. The hope was that early treatment would “diminish the risk of a continuation of gender identity disorder into adulthood” — in other words, make children stop being transgender.

As evidence has emerged that such approaches are associated with poor mental health outcomes, physicians have moved toward affirmative approaches that include allowing young people to express their gender identity in any way that feels natural for them. For a minority of these youth, medical interventions may be offered in line with protocols from The Endocrine Society. Notably, these interventions are not offered for children who have not yet reached puberty. The interventions progress in a careful step-wise fashion from most to least reversible. Genital surgery is reserved for adulthood.

Professional organizations including The American Academy of Pediatrics and The American Academy of Child & Adolescent Psychiatry have noted that these protocols from The Endocrine Society and The World Professional Association for Transgender Health represent the most appropriate approach for transgender youth, highlighting that attempts to make transgender youth cisgender are unethical and dangerous. They note, however, that not all transgender youth will necessarily desire medical intervention. The American Academy of Child & Adolescent Psychiatry released a statement condemning any legislation that would make such medical care illegal.