It is with great concern that the Professional Association for Transgender Health, South Africa (PATHSA) has become aware of claims that a health care professional has motivated for a type of conversion/reparative therapy for trans and gender diverse youth.

Accordingly, the founding members and Board of PATHSA, consider it not only important, but also our responsibility to speak out regarding our position on reparative and conversion therapy/practices.

PATHSA is “an interdisciplinary health professional organisation working to promote the health, wellbeing and self-actualisation of trans and gender diverse people.”

PATHSA’s constitution states:

• “Develop, advocate for and promote best practices and clinical resources for gender-affirming health care.”
• “To disseminate awareness around power dynamics that are typically inherent to all health care seeker/provider interactions involving people who are part of the trans and gender-diverse communities, to acknowledge the damage that has been done by such dynamics, and to insist that gender-affirming clinicians must take steps to dismantle these typical power hierarchies.”

Historically many health care professionals have played an active role in stigmatisation, marginalisation and oppression of trans and gender diverse people. Health care and mental health care practices are often influenced by the dominant hetero-cis-normative discourse which permeates our society. As PATHSA’s members we work towards affirming practices where gender diversity is seen as a normal variation within the gender spectrum (Oliphant et al., 2018; Victor, Nel, Lynch & Mbatha, 2014). “Research indicates that through accessing gender affirming care, the trans and gender diverse client is able to alleviate gender dysphoria and live a more fulfilling life.” (McLachlan, 2019, p.13).

Reparative therapy and conversion therapy interventions have been proven to be unsuccessful with trans and gender diverse people and deemed against medical ethics (American Counselling Association, 2010; British Psychological Society, 2012; PsySSA, 2017). Research has found that reparative therapy can lead to increased self-hatred and anxiety, decreased self-esteem, social isolation, depression and suicidality (ASSAF, 2015, American Counselling Association, 2010; PsySSA, 2017).

Conversion and reparative therapies are seen as unethical and contra-indicated in the treatment and/or support of trans and gender diverse people.

• The World Professional Organisation for Transgender Health (2011, p.16) states: “treatment aimed at trying to change a person’s gender identity and expression to become more congruent with sex assigned at birth has been attempted in the past without success... such treatment is no longer considered ethical.”
• The Psychological Society of South Africa (2013, p.10) position statement cautions “against interventions aimed at changing a person’s sexual orientation or gender expression, such as ‘reparative’ or conversion therapy”.
• “It is particularly harmful when offered to or forced onto children and adolescents. Children displaying any kind of gender-atypical behaviour could be subject to such therapy by parents, schools or religious organisations. Besides the harm such efforts could cause to the individual, it could also put family ties and bonds under pressure, and could lead to alienation from close relatives. For the gender-diverse adolescent, the onset of irreversible and possibly unwanted physiological changes can be a cause of much distress (Bateman, 2011; McLachlan, 2010). According to Wilson et al. (2014), non-intervention in this context could cause much harm and the possibility to delay puberty needs to be explored.” (PsySSA, 2013, p.52-53)
• World Health Organisation (2015, p.25) publication states: “Not being able to live according to one’s self-identified gender is likely to be a source of distress, exacerbating other forms of ill health.”

Although some mental health care providers do attempt to assist the gender questioning child to actualise various aspects of themselves related to their sex assigned at birth, Vanderburgh (2009) states that this is ineffective and cautions that it can be dangerous and cause harm.

Health care professionals must affirm, respect, understand, and not judge their clients/ patients (De Vries, Kathard & Müller 2020). Furthermore, the health care provider needs to uphold medical ethics (Tomson, 2018).

PATHSA strongly supports ethical and accountable ways of care and supports health care that focusses on the best interest of the trans and gender diverse person. Evidence based research does not support reparative/conversion therapy.

Many countries are now looking at banning and outlawing these therapies. As an interdisciplinary health professional organisation working to promote the health, wellbeing and self-actualisation of trans and gender diverse people, we support the call for the ban of all therapies that attempt to change a person’s inherent gender identity.

Signed by the board and founding members of PATHSA

Chris McLachlan

Ron Addinall-van Straaten

Sakhile Msweli

Jean-Ré Jones

Elma de Vries

Anastacia Tomson

Kevin Adams

Simon Pickstone-Taylor

Mershen Pillay

John Torline

Jenna Bayer

Qhawekazi Thengwa

Elliott Kotze

Dulcy Rakumakoe

Chantal Fowler

References

Academy of Science of South Africa (2015). Diversity in human sexuality: Implications for policy in Africa. Pretoria: Academy of Science of South Africa.

American Counseling Association (2010). American Counseling Association competencies for counselling with transgender clients. Journal of LGBT Issues in Counseling, 4, 135‐159.

Bateman, C. (2011). Transgender patients side-lined by attitudes and labelling. South Africa Medical Journal, 101(2), 91-93.

British Psychological Society (2012). Guidelines and literature review for psychologists working therapeutically with sexual and gender minority clients. Retrieved from http://www.bps.org.uk

De Vries, E., Kathard, H. & Müller, A. (2020). Debate: Why should gender-affirming
health care be included in health science curricula? BMC Medical Education, 20(51), 1-10, https://doi.org/10.1186/s12909-020-1963-6

McLachlan, C. (2019). Que(e)ring trans and gender diversity. South African Journal of Psychology, 49(1), 10-13.

Oliphant, J., Veale, J., MacDonald, J., Carroll, R., Johnson, R., Harte, M., … Manning, P. (2018). Guidelines for Gender-affirming Health care for Gender Diverse and Transgender Children, Young People and Adults in Aotearoa, New Zealand. New Zealand Medical Journal, 131(1487), 86–96.

Psychological Society of South Africa. (2013). Sexual and gender diversity position statement. Retrieved from http://www.psyssa.com/documents/PsySSA_sexuality_ gender_position_statement_2013.pdf

Psychological Society of South Africa. (2017). Practice guidelines for psychology professionals working with sexually and gender diverse people. Johannesburg: Author.

Tomson, A. (2018). Gender-affirming care in the context of medical ethics – gatekeeping v. informed consent. South African Journal of Bioethics, 11(1), 24-28.

Vanderburgh, R. (2009). Appropriate therapeutic care for families with pre-pubescent transgender /gender-dissonant children. Child Adolesc Social Work Journal, 26, 135-154.

Victor, C.J., Nel, J.A., Lynch, I. & Mbatha, K. (2014). The Psychological Society of South Africa sexual and gender diversity position statement: contributing towards a just society.  South African Journal of Psychology, 44(3), 292-302.

Wilson, D., Marais, A., De Villiers, A., Addinall, R., & Campbell, M.M. (2014). Transgender issues in South Africa, with particular reference to the Groote Schuur Hospital Transgender Unit. South Africa Medical Journal, 104 (6), 449-451.

World Health Organization (2015b). Sexual health, human rights and the law. Geneva, Switzerland: World Health Organization.

World Professional Association for Transgender Health (2011). Standards of care for the health of transsexual, transgender and gender non-conforming people. Retrieved 8 August 2014, from http://www.wpath.org/documents/SOC%20V7%2003-17-12.pdf