British proposal to ban ‘conversion therapy’ is not what it seems

ohDO NOT PIONEER tried to transplant testicles from heterosexual men into homosexuals. Sigmund Freud believed that hypnosis could work. Priests and imams have tried to “make homosexuals disappear”; doctors administered electric shocks while erotic images were shown to patients, in an attempt to turn pleasure into pain.

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Psychologists, psychiatrists and charlatans have been trying to “cure” homosexuality for at least a century. Fortunately, “conversion therapy” is much less common today than it used to be. Part of it is because it doesn’t work. But above all, it is because society has changed. While homophobia still exists, people across the West increasingly see same-sex attraction as normal and trivial. But the British government still wants to crack down on conversion therapy. A bill to make the practice illegal will soon be submitted to parliament, after hasty consultation.

Such therapy is always unnecessary, often cruel and sometimes dangerous. Yet the government should rethink its plans because the bill is muddled. He confuses sexual orientation with the nebulous and shifting concept of “gender identity”. The government wants “conversion therapy” to include talking treatments that explore why a person’s gender identity conflicts with their biological sex. A ban would leave the realm of gender medicine to those who are happy to guide patients – including the growing number under the age of 18 who consider themselves transgender – into a ‘gender affirmation’, in which their gender identity intersects is treated as permanent. This approach speeds up many children on strong drugs and sometimes surgery.

It would be a bad idea. There is little evidence that the affirmative approach alleviates gender dysphoria – the misery of feeling at odds with one’s biological sex. Key to transforming medicine in the 20th century from guesswork to science was the notion that physicians should only prescribe treatments when there is good reason to believe they are working. Still, the evidence base for the affirmative approach is thin. The drugs he uses have not been clinically tested for this type of therapy. Clinics lose track of patients, making it difficult to assess results. Putting the force of law behind unproven medical treatments is a mistake.

What is more, the evidence that does exist is not reassuring. Clinics and psychologists report that many trans-identified patients also suffer from depression and anxiety. Some have had abusive childhoods; many are gay or lesbian and may confuse their emerging sexuality with a crossed gender identity. A few appear to have homophobic parents for whom the idea of ​​having a heterosexual (trans) “daughter” is preferable to a homosexual son. Between 60% and 90% of children identified as trans seem to eventually come to terms with their biological sex, as long as their cross-gender identity is not uncritically affirmed. Talking to patients about their feelings shouldn’t be illegal.

The onset of puberty blockers often triggers what doctors call a “treatment cascade.” Data from European clinics suggests that the vast majority of prescribed puberty blockers continue to take cross-sex hormones. The drugs are strong and therefore have strong side effects. Puberty blockers can stunt growth and weaken bones. (A recent case in Sweden documented a teenager with osteopenia, a debilitating disease of fragile bones usually reserved for older people.) Cross-sex hormones produce irreversible changes, including growth of facial hair and a deep voice in men. women, and breast growth in men. Long term use may affect fertility. Breast removal surgery is permanent, as is surgery on the genitals, which also guarantees sterility. As the growing number of “detransitioners” shows, some of those who undergo such treatment come to bitterly regret it.

A ban on talk therapy would leave the government against the grain. Much of what passes for gender medicine has been carried on recklessly, with little regard for the long-term well-being of patients. Yet even on the ground, doubts spread. Finnish and Swedish hospitals have given up on prescribing drugs for people under the age of 18 in favor of speech therapy. In America, where any deviation from gender assertion risks sparking attacks on social media, prominent gender doctors are starting to worry that drugs and surgery have been distributed too easily. An exception is Canada, where a similar ban on conversion therapy has been in place since 2017 and is now being tightened.

For some trans-identified patients, drugs and hormonal treatments will be the right outcome. But for many others, perhaps most, no. That is why talk therapy must be available in the treatment. The UK health service recently embarked on a review of pediatric medicine like this, which the new law would prevail. Ministers should think again.

This article appeared in the Leaders section of the print edition under the headline “Bad Medicine”

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