The United States Supreme Court recently

overturned a ban on gay conversion

therapy. So, this was a case where there

was a therapist who was trying to do gay

conversion therapy and the state of

Colorado has banned gay conversion

therapy. They said they've said you're

not allowed to do it. And the therapist

made the argument that you cannot

regulate my right to free speech. So,

basically, you as the state cannot

police what I say in my sessions with a

patient. The Supreme Court found this to

be a valid argument and basically

overturned the ban. So today we're going

to talk about gay conversion therapy or

in the scientific literature as it's

known, sexual orientation change

efforts, but we're going to talk about

it in the way that we do with most

things on the channel, which is from a a

place of evidence. So what does the

science show about gay conversion

therapy? And let me be clear about this.

I know this is a hot button issue. I

know people have strong religious

beliefs that homosexuality may be a sin.

All that stuff is fine. We are not I'm

not a constitutional scholar. It's not

my job to say the Supreme Court ruling

is right or wrong. I'm also not a

religious authority to say that a

certain religious belief is right or

wrong. What I am is a medical doctor.

And so today, what we're going to be

talking about, if you're interested in

sending your son or daughter to gay

conversion therapy, if you are someone

who is considering gay conversion

therapy or sexual orientation change

efforts, or if you're just someone in

our audience at large, my job today is

to equip y'all with the information so

that you can make the most informed

decision about what kind of therapeutic

treatment is right for you. Today we're

going to be looking at a handful of

review studies on sexual orientation

change efforts. And when we look at

these studies, we're going to present

what they find, but then we also need to

talk about the limitations of the study.

This is something that's really

important. I learned when I when I

trained at Harvard Medical School, which

is, you know, I was interested in

evidence-based complimentary alternative

medicine. We would study things like

acupuncture and meditation and stuff

like that. And sometimes those trials

don't have great findings or they do

have great findings. And it's important

to be critical of science just like we

should be critical of all of our

thinking. So, not only are we going to

present the evidence, we will also look

at potential reasons for why the studies

show what they show. Let's start with

efficacy. Does gay conversion therapy

work? Well, according to the evidence,

not really. So, one study on 1600 people

from the Church of Latter-day Saints

basically found that 3.1%

of people found some kind of benefit or

reduction in homosexual thoughts,

feelings, behaviors, etc. So, for 97% of

people in this particular study, it

basically didn't work. There are some

studies that show some degree of

efficacy in this, but these are usually

fraught with methodological problems. I

would call them weak studies. So, for

example, they have small sample sizes.

They are surveys and retrospectives. So

no one has done like anything like a

randomized controlled trial on gay

conversion therapy like so we haven't

taken 200 people right and set the

control group as therapy as usual set

the uh intervention group as gay

conversion therapy and measured

outcomes. So we I wasn't able to find a

single randomized control trial on

something like this that has an

appropriate control. So most of the

studies will be retrospective. There'll

be surveys and their recruitment is

pretty problematic. So they'll recruit

from places like you know specifically

exgay ministry communities and then

assess sexual orientation change

efforts. That's a methodological problem

when you're studying something. So it's

sort of like if I take everyone who

joined a Buddhist meditation circle and

then asked them is meditation helpful

for you what do you think the answer

would be? A better way to study

meditation, which is how we've studied

meditation, generally speaking, as a

scientific community, is we take a lot

of people who are meditation naive,

haven't done meditation, we teach a

meditation, and then we measure

outcomes. Another huge problem with

these studies is that they don't even

measure negative outcomes. So, for

example, if I'm putting a new drug on

the market, the early phases of clinical

trials aren't even about the efficacy of

the medication, how well it works. The

first thing that we tend to study is, is

it harmful for people to begin with? And

when we look at a lot of these studies,

the studies that do examine harm, what

we find is really scary. That gay

conversion therapy or sexual orientation

change efforts are associated with a lot

of negative outcomes. Increases in

depression, increases in in anxiety,

lowering of self-esteem, difficulty with

familial relationships, other

non-romantic relationships, difficulties

with issues like sexuality, an increased

sense of something called hom

negativity, which is viewing homosexual

people in a bad way. And one of the most

troubling things of all, gay conversion

therapy is associated with an increase

in suicidality. What's more troubling to

me as a psychiatrist is an a 75%

increase in suicidal planning. So this

is something that I I just want to

explain a little bit. So it is somewhat

normal for people to sometimes want to

go to sleep and never wake up. What we

really get worried about as

psychiatrists is when people start

making plans. The making of a plan is a

strong risk factor for actually

completed suicide. And several studies

are showing that there are strong

negative effects from gay conversion

therapy or sexual orientation change

efforts. So this is sort of a situation

where irrespective of your religious

beliefs, it's not for me to say that it

is a sin or isn't a sin. We'll get to a

little bit about homosexuality in

general in a second, but my stance as a

psychiatrist is that this is a terrible

intervention to use with anyone. The

studies that say that it's good are

fraught with methodological flaws. I

don't really trust their clinical

outcomes. I could not find a single

solid prospective study to support good

outcomes with gay conversion therapy.

There is plenty of evidence that is

ineffective and even harmful. So based

on that, I don't think it's a good idea

to do. And this is why organizations

like the American Psychiatric

Association and the American Medical

Association have come out against these

sorts of things. This is why we as a

field don't recommend this stuff. And I

want to be super clear about this. So

there's absolutely an element of

advocacy, right? So the APA and the AMA

do advocacy work. I've gone to Congress

and the White House and lobbyed for like

$2 billion of funding to train addiction

professionals because we have an

addiction crisis in the United States.

So we are involved in some degree of

political activism, but I want to be

super clear about where our activism as

a field comes from. It comes from data.

It comes from patients. It comes from

people who are going through this stuff.

And as medical professionals, we

advocate for basically stuff that works

and advocate against stuff that is

harmful. And the evidence for gay

conversion therapy suggests that it is

both of those things, not helpful and

harmful. Now, the question is why? So,

this is where an argument could be made

that something about the way that we are

studying gay conversion therapy because

remember we've never done a a good

clinical randomized control trial,

right? So, there's a possibility it

could work. Now what we have to do is be

a little bit critical of these findings

and try to understand why. Why is it if

so many people believe in it, why is it

that it's so damn ineffective and

harmful? So let's start with a couple of

basics. The first is variation in the

way that gay conversion therapy is

practiced. It is practiced by some

licensed professionals like licensed

mental health professionals. It's

practiced by some pastors or lay people.

So there's a variety of practice. So

anytime you don't have a standard of

practice, you are going to get different

kinds of outcomes. The second thing is

if you actually look at like so you know

one study actually uh cited when people

would reach out to someone who does gay

conversion therapy and they ask them

like okay what do you all do and the

answer that they got is that we help

them develop a clearer relationship with

Christ. Other studies will say we'll

incorporate techniques from cognitive

behavioral therapy, emotional

regulation. Um, some people will include

things like Bible study or retreats. And

so there's a lot of variety to what

constitutes gay conversion therapy,

which could explain part of the reason

that we can't see an effect. There are

some studies that show some benefits of

sexual orientation change efforts. So

people will describe benefits from uh

social support. So they sort of join an

exgay community and once they join that

community, they find camaraderie, they

find friendship. Some of these

interventions are associated with uh

mentor relationships, things like

weekend men's retreats where there's a

lot of same-sex non-romantic platonic

bonding. So, there are some benefits

that have been noted uh related to gay

conversion therapy. Interestingly

enough, what we don't see is benefits

like reductions in depression,

reductions in anxiety, improvements in

self-esteem, or reductions in

suicidality. So, from a medical

treatment standpoint, I think there's

not a whole lot of evidence for it. The

other main reason why we may not find

good evidence that gay conversion

therapy is effective is because being

gay isn't a pathology. So generally

speaking, when we do a medical

treatment, someone is ill in some way.

We are fixing something that's broken.

So if we're like giving you a kidney

transplant because your kidneys don't

work, there is a baseline pathology that

is negatively affecting you. And by

fixing that pathology, we will improve

things. But if this isn't a pathology to

begin with, then there's nothing to fix

and therefore treatments won't work.

Interestingly enough, Freud didn't think

that homosexuality was an illness. So he

sort of thought that, you know, they are

basically normal variants of the

population. They shouldn't be treated

any differently. And if anything, he

said that gay people are potentially

highly intelligent and cultured, which

is kind of weird. There are

psychoanalytic perspectives that do

believe that homosexuality is a

pathology of of some kind. So there's a

analyst named Roto in the 1940s who

basically said that homosexuality arises

out of a phobia of heterosexual

attraction. So if I'm a dude and I'm

attracted to women, but I'm also scared

of women, then maybe that can manifest

as homosexuality towards men. I think a

lot of those theories are not really

taken very seriously now. They've been

basically disproven. And this sort of

gets to the general idea of

homosexuality in human species in living

organisms to begin with because for a

long time people have been sort of

wondering right so even from a Darwinian

or evolutionary perspective how is it

that homosexuality exists within a

population to begin with. So if we sort

of think about being gay, let's say we

take the case of men or women, doesn't

matter. If you're engaging with sexual

activity with someone that you you can't

result in a pregnancy and bringing a

child into the world, how do those

traits get passed on? Right? So how can

we select for homosexual behavior if

those people never reproduce? And there

are some studies uh there are some

theories about this. So, one example is

sort of like the gay uncle hypothesis,

which is this idea that, okay, if I have

like five siblings and one of them is

homosexual and they don't have their own

children to take care of, does having

one extra adult to take care of, let's

say, 10 kids improve the survival of

those 10 kids? So, this is something

called kin selection. There's a lot of

like theories around this, but I

actually think the strongest evidence

for why people are gay goes way deeper

than that. It's actually basic biology.

And this is going to kind of blow your

mind, but bear with me for a second.

It's that same sexual behavior is

actually the default state. It's not

that homosexuality is aarent. That it is

actually very, very common in the animal

kingdom. Know it sounds weird, but hear

me out. So, first of all, homosexual

behavior has been observed in more

than500 species. And the really

interesting thing is the more primitive

the organism is, the more likely that

organism is is to engage in in same-sex

behavior. So if you look at very

primitive organisms like sea urchins and

starfish that don't have something

called sexual dimmorphism where you

can't tell the difference between boys

and girl, male and female starfish very

easily, they engage in a lot of same sex

behavior because they can't tell the

difference. They can't tell if it's a

male starfish or a female starfish. So

let me just mate with it anyway. And

this is what's really interesting. If

you think about sexual dimmorphism, i.e.

males and females being very different,

that happened later in the evolutionary

tree. So the earlier you go, the more

same-sex behavior you find. And so

there's also all kinds of like really

fascinating like examples of this. So

you know, the common toad will mate with

other male toads. And this is what's

really fascinating. Male toads will

actually have a specific call to signal

to other male toads when they are being

mounted that I'm not a female. So like

literally toads will say no homo when

they're engaging in in sexual activity.

There's, you know, some evidence that

some animals will give each other bros.

So animals will lick the erect penises

of other animals. And I'm not trying to

be like clickbaity here or anything like

that. My point is that it appears that

homosexuality is well present in the

animal kingdom and the more primitive

organisms you get to the more common it

is. So there's actually a strong

argument to be made that homosexuality

is actually a leftover from earlier same

sexual behavior. Or you can go with the

gay uncle hypothesis. We're not really

sure. Key thing here is that if we're

trying to understand why gay conversion

therapy doesn't work, it's simply

because there's nothing for it to work

on. There's not no pathology there to

begin with. So, I know that this video

touches a really hot topic. I know that

a lot of people very feel very strongly

about homosexuality, gay conversion

therapy, etc. If you're a parent who is

really uh pushing your child or you're

concerned that your child may be

homosexual, I strongly encourage you to

consider this evidence. If you're

someone who is struggling with thoughts

of homosexuality and you think it's bad

or a sin or whatever, once again, I'm

not a religious authority, right? It's

not my place to say what is a sin or

what isn't a sin, but please be informed

about the potential consequences of

engaging in this treatment. And the last

thing that I'd like to advocate for is

treatment in general. If you're someone

who's struggling, you don't have to go

to a gay conversion therapist first or

ever. You could just go to a regular

therapist and share your thoughts, your

struggles, your feelings. Right? I've

had people in my office who are very

religious, have homosexual feelings, and

I don't take a um valuebased stance when

I work with them. I don't take the I

don't take the stance that homosexuality

is right or is wrong. My job as a

therapist is to help this other person

come to their own conclusions free of

pressure, free of their emotions, and

really try to find the answer that's

right for them.