Exposure to "conversion therapy" — efforts by a secular or religious professional to change a transgender person’s gender identity — is associated with thoughts of and attempts at suicide, according to a study published Wednesday in the journal JAMA Psychiatry.

Dr. Jack Turban, the study’s lead author and a resident physician in psychiatry at Harvard Medical School, said it was the first study "to show that gender identity conversion efforts are associated with adverse mental health outcomes, including suicide attempts.”

Turban said that previous reports showing the negative effects of conversion therapy, also known as “ex-gay therapy” or “reparative therapy,” have focused on efforts to change a person’s sexual orientation.

But this was novel, he said, because of its large sample size — over 27,000 transgender people responded to the survey — and its broad approach to identifying past efforts to change participants’ gender identity.

Seventy-one percent of respondents recalled speaking to a religious adviser or secular therapist about their gender identity, and of those, roughly 20 percent said these interactions involved efforts to change their gender identity from transgender to cisgender.

“The rate of previous suicide attempts among transgender people in the United States is extremely high, with 41 percent reporting that they have had that experience,” said study co-author Dr. Alex Keuroghlian, director of the National LGBT Health Education Center at The Fenway Institute and the Massachusetts General Hospital Psychiatry Gender Identity Program.

“What this new study shows is that transgender people who are exposed to conversion efforts anytime in their lives have more than double the odds of attempting suicide compared with those who have never experienced efforts by professionals to convert their gender identity, he said.

Turban said one of the most alarming findings from the study was the even higher risk of psychological distress for those who reported exposure to conversion therapy during childhood. Those who were subjected to the practice before age 10 were four times more likely to report lifetime suicide attempts than the general transgender population, according to the findings.

“This is important because some experts continue to advocate for gender identity conversion efforts for young children,” Turban said in a statement. “We hope our findings contribute to ongoing legislative efforts to ban gender identity conversion efforts.”

Currently 18 states, along with the District of Columbia, ban the practice of conversion therapy on minors. And nearly every major health association — including the American Medical Association, the American Psychological Association and the American Academy of Pediatrics — has spoken out against the practice.

"The term 'conversion therapy' is a misnomer,” Keuroghlian noted. “It suggests that conversion efforts are a legitimate therapeutic practice, even though we are finding that this practice is associated with significantly increased risk of harm, including serious psychological distress and potentially fatal suicide attempts.”

The study found no difference in the outcome based on whether the effort to change a person’s gender identity was conducted by a religious adviser or secular professional. According to the findings, the vast majority of conversion therapy is conducted by secular professionals, like psychologists or counselors, with religious efforts accounting for roughly a third of all conversion therapy efforts reported by this cohort.

"Current training of mental health clinicians in the U.S. does not usually include gender-affirming care as standard curriculum,” Keuroghlian said. “We hope this study will inspire clinical training programs to revise their standard curricula.”

“All clinicians need to be trained in concepts and terminology related to gender identity, how stigma is related to mental health disparities and best practices for gender affirmation grounded in scientific evidence,” he added.

This latest study builds on previous work published last month by Turban, Keuroghlian and their colleagues that found nearly 200,000 transgender people in the United States have been exposed to conversion therapy at some point in their lives.

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