Conversion therapy bans seek to protect gay, lesbian and bisexual (LGB) people from unethical and harmful practices that attempt to change their sexual orientation. The controversial addition of “gender identity” to such bills however is problematic for LGB people. This inclusion completely ignores the complex reasons why some people experience gender dysphoria and become trans-identified.
The Conversion Practices Prohibition Bill, tabled in the NSW Parliament by independent MP Alex Greenwich on August 24th, is a based on a similar law in Victoria that includes gender identity.
The proposed bill would make it an offence to “suppress” or “change” a person’s gender identity. This means that once a person is trans-identified, a clinician will be restricted in the kind of support they can provide, potentially criminalising ethical, conventional therapy for people with gender dysphoria.
At a minimum, the law would create a climate that compels therapists (and parents) to “affirm” patients as transgender, even though their client might be just an emerging gay adolescent whose trans-identification is temporary.
As clinical psychologist Dr Anna Hutchinson has put it “One person’s affirmation therapy might be another person’s conversion therapy”. This is why critics of gender affirming model call it “transing the gay away”.
Let’s take a closer look at the issues involved…
Most Youth With Gender Dysphoria Later Identify as Gay, Lesbian or Bisexual
In the “pre-affirmation” era, follow up data on prepubescent youth with gender dysphoria overwhelmingly show that the most common outcome is to identify as gay, lesbian or bisexual (not transgender) in adulthood (1,2,3,4,). This means that for some LGB youth, a temporary, yet prolonged period of gender dysphoria is a common experience in their development (5,6).
Clinicians who only practice a gender affirming treatment model for gender dysphoria however do not take this established understanding of LGB experience into account. Consequently, LGB people are being prematurely “affirmed” as “transgender” before they have had an opportunity to gain an understanding of their sexual orientation and explore issues relating to homophobia and societal pressure to conform.
An investigation by Time to Think author and journalist Hannah Barnes revealed that many clinicians at GIDS (a gender identity clinic in London) simply ignored evidence that their patients might be LGB. In the following interview excerpt Barnes explains the evidence for LGB over representation in gender dysphoric youth and the relevance of homophobia to this cohort.
Most Detransitioned Women are Lesbian or Bisexual
Predictably, many LGB people who were affirmed by clinicians who practice the affirmation model have since desisted or detransitioned. A survey of 100 detransitioned people, that included Australian respondents, showed that approximately 48% of detransitioners are same-sex attracted (LGB). This was particularly the case for women, with 54% saying they are lesbian, bisexual, or pansexual.
Internalised Homophobia Motivates Transgender Identification and Transition
Reports from LGB people who have received gender affirming treatment for gender dysphoria and subsequently detransitioned show that internalised homophobia is often a contributing factor to their decision to transition (7,8,9,). A survey participant explains:
“… being a ‘gay trans man’ (female dating other females) felt better than being a lesbian, less shameful”. And another “I felt being the opposite gender would make my repressed same-sex attraction less scary”. (7)
Irreversible Harm
Prior to detransition, many LGB people who were affirmed also received surgical and/or hormonal interventions that have negatively impacted their physical and mental health. Interventions such as mastectomy, hysterectomy and vaginoplasty are permanent and cannot be reversed. Ollie Davies, a bisexual Australian man who identified as transgender for six years before he detransitioned, has been left infertile by the “gender affirming” hormone treatment he received.
Gender Affirmation is a Conversion Practice for LGB People
The irony of conversion practice bans that include “gender identity” is that gender affirmative “care” is a conversion practice for LGB people (and others) who are gender distressed. Despite the very real possibility that their trans-identification is temporary, clinicians are obliged to affirm, thus convert LGB people to be “straight”, if the individual insists they are trans when gender distressed. A cautious, more enlightened approach is required.
Therapists and clinicians working with gender distressed people ought to employ an ethical, neutral approach to clinical care that is LGB informed, and neither affirms nor disaffirms a patient’s gender identity. In other words – affirm the person, not the identity. But this approach falls into a legal grey area under the proposed ban.
Ethical Therapy for Gender Dysphoria Criminalised
Given that the bill does not appear to acknowledge the complexities of gender dysphoria, offering neutral therapy over a period of time that explores non-affirming options could be interpreted as a “sustained effort” to “change” or “suppress” a person’s gender identity – an offence that risks the possibility of legal action. To avoid this risk, some therapists may affirm against their clinical judgement, for fear of being subject to spurious complaints from those who object to a cautious approach.
This fear is not without foundation.
Dr Jillian Spencer, a child and adolescent psychiatrist in Queensland, was stood down for her refusal to automatically affirm patients with gender dysphoria. She warns that “a significant proportion of them end up being gay” and advocates for a cautious approach. In Dr Spencer’s professional judgement the affirmative model is not consistent with her obligations as a health practitioner to do no harm. Yet she has still been subject to a complaint and is now engaged in multiple legal actions to clear her name.
Greenwich’s bill is supposed to enable clinicians to act in accordance with their professional judgement. But given the failure to acknowledge that many people experience gender dysphoria temporarily, it is not clear that this will be permitted in practice. Consequently, conscientious health care professionals are likely to face the same fate as Dr. Spencer in Queensland.
In Victoria, where conversion practice bans for “gender identity” are already in place, parents of gender distressed children report that it has become extremely difficult to find clinicians who are prepared to offer a neutral, exploratory approach for their children. This has left parents and patients with few options outside of the closed loop of affirmation.
Australian Woman Sues Gender Affirming Psychiatrist for Negligence
A more cautious approach may have prevented the devastating consequences endured by a formally trans-identified woman in Sydney. Jay Langadinos is suing the psychiatrist who affirmed her as transgender in a single appointment, and subsequently provided referrals for a bilateral mastectomy and hysterectomy without a proper psychological evaluation. Langadinos explained in a newspaper interview that the realisation she was same-sex attracted contributed to her feelings of gender dysphoria.
Conversion Practices Ban Will Not Protect LGB People From Harm
If Greenwich’s bill becomes law, ethical therapists working with LGB and T people in NSW will be plunged into a complex legal grey area that will compel them to affirm any person who is trans-identified, irrespective of the circumstances in which this occurs.
The gender affirmative approach to gender dysphoria is already harming LGB people in New South Wales. Ignorant conversion practice bans that include gender identity will only make the situation worse.
Genspect, an organisation that advocates for a non-medicalised approach to gender diversity, is critical of conversion bans for gender identity:
“…governments should reject these new expansive conversion therapy bans that make the practice of conventional therapy a crime or leave so much doubt that therapists will avoid working with an underserved population for fear of putting themselves and their professional license at risk.”
The NSW Labour government is planning to introduce a rival conversion practice ban bill to the one recently proposed by Alex Greenwich. LGB Alliance, the foremost LGB group in Australia with almost 2000 members, was inexplicably excluded from the secretive consultation process for this bill.
The voices of LGB people, especially those who have been harmed by gender affirming “care”, need to be heard on this issue. When will Alex Greenwich and the Labor government start listening?
Any person who receives professional help for gender distress must be treated with the up most care and respect. This care ought to be consistent with ethical therapeutic standards and conducted without the presumption of any particular outcome. Punitive, coercive tactics should never be used in any therapeutic setting.
Implementing bills that misunderstand the complex issues surrounding sexual orientation and gender identity, however, will restrict ethical, evidence based care for those with gender distress, and harm the very people they are supposed to protect.
Learn more about the issues with conversion practice bans at Genspect.
Support LGB youth in NSW – Contact your local MP and tell them you do not support the inclusion of gender identity in a Conversion Practices Ban.
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