It is with great dismay that we recognise the suggestions made by a South African medical professional, advocating in favour of reparative (or, as it is more widely known, conversion) therapy, specifically with reference to transgender children and youth. 

In 2020, reparative or conversion therapy has no role in the healthcare of trans or gender diverse people regardless of age. The practice is one that has been universally denounced by professional medical bodies the world over as being not just unethical and ineffective, but barbaric, and the suggestion that these modalities should be employed in the best interests of a trans or gender diverse patient is a harmful one.

What is conversion therapy?

Conversion or reparative therapy refers to any kind of intervention that aims to alter a person’s sexual orientation, or gender identity or expression. Techniques used under this umbrella have been known to include, amongst others: ice-pick lobotomies, electric shock treatments, “nausea inducing drugs... administered simultaneously with the presentation of homoerotic stimuli”, and masturbatory reconditioning. Psychotherapeutic techniques can also be employed as conversion or reparative therapy. 

Does conversion therapy work?

Conversion or reparative therapy has been conclusively shown to be ineffective in scientific studies. Furthermore, additional studies have provided ample proof that the practice is harmful to people in the LGBTQIA+ community. Conversion therapy can lead to loss of self-esteem, anxiety, depression, social isolation, intimacy difficulty, self-hatred, shame and guilt, sexual dysfunction, suicidal ideation and suicide attempts and symptoms of post-traumatic stress disorder in those exposed to it.

Conversion therapy is founded on the idea that there is something inherently pathological about same-gender attraction and/or transgender identity - concepts that have been rejected by the medical community. 

Professional bodies and legal status of conversion therapy

Numerous professional bodies the world over have condemned conversion or reparative therapy, including: the American Academy of Child & Adolescent Psychiatry, the American Academy of Pediatrics, the American College of Physicians, the American Medical Association, the American Psychological Association, the American Psychiatric Association, the British Psychological Society, the World Psychiatric Association, the Royal Australasian College of Physicians, the Psychological Society of South Africa, the South African Society of Psychiatrists, and the World Health Organisation, amongst many others. 

Conversion and reparative therapy has been prohibited by legislature in California, Massachusetts, New York, Washington, Argentina, Brazil, Ecuador, Fiji, Germany, Malta, Taiwan, and Uruguay, amongst others. 

Affirmative treatment saves lives

Healthcare services that allow for the exploration and free development and affirmation of gender identity and/or sexual orientation should be accessible and available to all members of the LGBTQIA+ community. Affirmative models of healthcare result in improved outcomes for LGBTQIA+ patients, whilst also being ethically sound. Patients who have access to affirmative care benefit from improvement in their mental health, and a decreased risk of self-harm and suicide. 

As a group of professionals with vast experience in treating trans and gender diverse patients of all ages, we unequivocally condemn the practice of conversion or reparative therapy as unethical, scientifically unsound, and ineffective, and insist that such treatments have no role in the management of such patients, and should under no circumstances be employed. We further believe that conversion and reparative therapy should be prohibited under law, as barbaric and inhumane. 

We encourage all clinicians to employ affirmative models of care, that are both scientifically and ethically sound, with a view to improving the health and outcomes of those in this marginalised and vulnerable population group.

Issued by: Dr Anastacia Tomson, on behalf of PATHSA 

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