Bottom Line: Gender identity conversion efforts to try to change a person's gender identity to match their sex assigned at birth were associated with increased likelihood of adverse mental health outcomes, including suicide attempts, in this study of nearly 28,000 transgender adults from across the United States. Professional organizations, including the American Psychiatric Association, have called conversion therapy for gender identity unethical and ineffective, and some states have outlawed the practice. This observational study is based on the results of a survey distributed through community outreach to transgender adults in all 50 states, the District of Columbia, some territories and overseas U.S. military bases. Of 27,715 transgender adults who responded, 19,741 (71.3%) reported having spoken to a secular or religious professional about their gender identity and of these 3,869 (19.6%) reported exposure to gender identity conversion efforts. That exposure was associated with severe psychological distress during the previous month and prior suicide attempts during their lifetime compared with transgender adults who reported talking about their gender identity with a professional but weren't exposed to conversion efforts. Reported exposure to conversion efforts before the age of 10 also was associated with greater lifetime odds of suicide attempts. Limitations of the study include its inability to determine causation; it didn't capture conversion efforts by others such as family members; and it's possible that some adults with worse mental health might have sought conversion therapy. The study findings support that gender identity conversion efforts should be avoided in children and adults.

Authors: Jack L. Turban, M.D., M.H.S., of the Massachusetts General Hospital, Boston, and coauthors

(doi:10.1001/jamapsychiatry.2019.2285)

Editor's Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Media advisory: To contact corresponding author Jack L. Turban, M.D., M.H.S., email Noah Brown at nbrown9@partners.org">nbrown9@partners.org. The full study is linked to this news release.