Science, Sex, and Suicide

Scientific American started off the new year—the publication’s 175th—with an editorial that unintentionally demonstrates the reality that science is not simply the dispassionate determination of the laws of nature. A great deal more than genetics and biology seems to be involved when the subject is LGBTQ-related, particularly when it concerns young people who are questioning their sexual identity.

The editorial, “Time’s Up for ‘Anti-Gay Therapy,’” calls for a federal resolution banning “conversion therapy.” The editors begin by referring to the story of a man named McKrae Game, a former champion of conversion therapy who recently left his wife and his ministry, “Hope for Wholeness.” Game has now come out as gay, pleading forgiveness for the harm he did by promoting what his organization called “freedom from homosexuality through Jesus Christ.” Game joins a growing number of former leaders of so-called “anti-gay therapy” who have recently disavowed the practice.

“It might be assumed from this refutation,” the editors write, “that any attempts to forcibly change a young person’s sexual orientation are about to go the way of bloodletting, frontal lobotomy, and trepanation.” In their view, the proposed ban has nothing to do with partisan politics or religious belief. Rather, the ban is a rational response to a therapy that is “rooted in bad science” and does “irreparable harm,” evinced in a survey that finds that 42 percent of LGBTQ youth who had undergone conversion therapy had attempted suicide in the past year, substantially more than the “nearly 30 percent” cited in a 2019 American Medical Association issue paper. The same survey to which Scientific American alluded, however, also reported that “39 percent of LGBTQ youth surveyed have seriously considered suicide in the past twelve months, with more than half of transgender and non-binary youth having seriously considered suicide,” apart from any intervention.

Obviously, we should make every effort to help those who are caught up in the depression and hopelessness that lead so many to consider, let alone attempt, suicide. Suicide is a national epidemic: more than twice as many people die by suicide as by homicide in the United States each year; in 2017, suicide was the second leading cause of death among individuals between the ages of ten and thirty-four. Notably, youth who identify as part of a sexual minority (lesbian, gay, bisexual, transgender, or questioning) have more than twice the rate of suicidal ideation; and transgender youth report significantly higher rates of depression, suicidality, and victimization compared to their cisgender peers.

Since the editors at Scientific American seem to be very concerned with preventing suicide among teens, one would imagine that they would give significant attention to how best to help young people who experience gender dysphoria. Yet the Scientific American website shows little caution regarding the questionable validity of gender affirmation and of social or medical transitioning as treatments for gender-dysphoric children and teens. Instead, its articles strongly affirm both: see for instance “Sex as a Spectrum” and “How to Meet the Needs of Transgender Kids.”

Why would Scientific American urge a ban on therapies that may free some from a lifestyle that is associated with greater depression and suicide, and yet never question “treatments” for gender dysphoria that lead to increased confusion, depression, and suicidal tendencies?

The Development of Gender Identity

Anatomy and physiology textbooks assert what most people thought they knew: the SRY gene on the Y chromosome plays a decisive role in determining someone’s sex:

Females are considered the “fundamental” sex—that is, without much chemical prompting, all fertilized eggs would develop into females. To become a male, an individual must be exposed to the cascade of factors initiated by a single gene on the male Y chromosome. This is called the SRY (Sex-determining Region of the Y chromosome). Because females do not have a Y chromosome, they do not have the SRY gene. Without a functional SRY gene, an individual will be female.

These texts also affirm what other standard textbooks in maternal–newborn nursing and women’s health assert: that “at the moment of fertilization” “the sex of the zygote [the fertilized egg] is determined.” It is, therefore, rather bewildering to learn from many in the academy that “decades of science” repudiate the claim that simple genetic binaries are determinative of gender identity. They rather say that “the official program for ‘maleness’” is only “initiated” by SRY, while those who do not have that gene “start down the pathway” to femaleness that is subsequently conditioned by other genetic, hormonal, and environmental factors.

The rate of persons identifying as transgender (and now non-binary) and seeking help with transition has been rising steeply since 2000 across Western countries. It is presently thought to be at most 0.6 percent in the US population. Gender dysphoria as defined in the DSM-5, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, is a disconnect between one’s felt gender and one’s bodily sex, and the distress and discomfort that this disconnect creates. It is often present along with comorbid psychiatric disorders that should be examined and treated. It has become common to offer hormonal treatment to those who present with gender dysphoria, in order to delay or suppress pubertal development and/or to masculinize or feminize the body; but recent research maintains that “a large percentage of adolescents referred for gender dysphoria have a substantial co-occurring history of psychosocial and psychological vulnerability, thus supporting a ‘proof of principle’ for the importance of a comprehensive psychologic–psychiatric assessment that goes beyond an evaluation of gender dysphoria per se.”

Before beginning hormonal treatments that are irreversible (and which in California can now be administered to foster children as young as twelve years of age without any parental consent), efforts should be made to help young people resolve their confusion in consultation with their parents. This is particularly vital given that, “as many as 88 percent of gender-dysphoric girls and 98 percent of gender-dysphoric boys will identify with their biological sex by late adolescence with watchful waiting and/or therapy that affirms a child’s sex,” according to the American College of Pediatricians.

The Dangers of Rapid-Onset Gender Dysphoria

If such a large percentage of young people will natural rectify their gender identity with their bodily sex, why is the rate of transgender identification rising so rapidly?

It appears that this increase is owed, to a substantial degree, to adolescent angst and social influence. Rapid-onset gender dysphoria seems to be occurring with increasing frequency among youth who have previously exhibited a marked increase in internet and social media consumption, or who belong to a peer group in which one, multiple, or even all of the friends have become gender-dysphoric and transgender-identified during the same time frame. Parents report that their children sound scripted, as they label all who would question their newfound identity “evil,” “toxic,” or “transphobic.”

If social influences, parental conflict, and maladaptive coping mechanisms underlie the onset of this dysphoria and are symptomatic of deeper mental health issues, such as trauma or social maladjustment, these factors should be more closely examined. Unfortunately, it is far more common for clinicians to refuse to explore mental health, trauma, or alternative causes of gender dysphoria. Too often, parental views are discarded and dismissed in a rush to urge transition.

The results are tragic. Those who identify as transgender endure staggering rates of depression and anxiety, and suicide attempts of up to 50 percent (for female-to-male adolescents). The American College of Pediatricians reports: “In Sweden, which is among the most LGBQT-affirming countries, transgender adults have rates of suicide nearly twenty times greater than that of the general population several years after transitioning, despite initial feelings of happiness and relief.”

Is “Conversion Therapy” a Straw Man Here?

Given the extraordinary levels of depression and suicide associated with gender dysphoria and sex reassignment, it would seem scientifically responsible to urge caution toward movement in that direction, not simple affirmation. Instead, Scientific American urges a ban on conversion therapy, because of “the irreparable harm it causes.” What harm could be more “irreparable” than heightened suicidal ideation from gender dysphoria and transition?

“Conversion therapy” has become a pejorative term. The Scientific American editorial calls to mind “electroshock, chemical therapies such as the forced hormone treatments infamously inflicted on British mathematician Alan M. Turing, and the hiring of prostitutes for ‘behavioral’ interventions.” One can be quite confident that such practices have indeed “gone the way of bloodletting and frontal lobotomies.” Most organizations, both secular-scientific and faith-based, have eschewed the nomenclature of “conversion therapy” and any association with “forcible change”; they rather favor supportive and reparative approaches for those who seek freedom from a variety of addictive behaviors, which may include those associated with homosexuality.

The organization that Game previously headed, Hope for Wholeness, does not even “subscribe to therapies that make changing attractions the main focus.” Instead, it seeks to help its members live a life consistent with biblical faith.” The group’s supportive approach assists the individual “through mentoring relationships, curriculum, affiliate ministries, other established networks, and the Church” so as to achieve “a growing capacity to turn away from temptations, a reconciling of one’s identity with Jesus Christ, being transformed into His image.” It expressly rejects “fringe therapies,” such as nudity, touch therapy, and EMDR (Eye Movement Desensitization and Reprocessing, which was specifically designed for post-traumatic stress disorder), as uses of pornography and related mental imagery are “inappropriate and unbiblical.” It was the use of gay pornography that undoubtedly compromised Game’s own marriage, family, and faith commitments, as it does with so many others.

Good science requires good ethics. If science wishes to be “in the public interest,” it must properly represent data and others’ views. Clinical diagnosis, parental care, and caution in advocating or allowing radical changes for those who are confused about their sexual identity, must prevail if LGBTQ youth are to be genuinely helped. The data show that those who suffer from gender dysphoria have much higher rates of depression and suicide than those who accept their biological sex. Too often these youth are swept up in a dysphoric fervor apart from serious diagnostic, clinical, and parental intervention and support. To caricature as “pseudoscientific” any therapies that seek to provide hope and support for those who struggle with sexual confusion or gender dysphoria is neither ethical nor in the public interest. Instead, it only furthers barriers to potential relief that many have found to be real.