«Lawrence S. Mayer, M.B., M.S., Ph.D. Paul R. McHugh, M.D. Number 50 ~ Fall 2016 ~ $7.00. Number 50 ~ Fall 2016 Editor’s ...»
~ Special Report ~
Sexuality and Gender
Findings from the Biological,
Psychological, and Social Sciences
Lawrence S. Mayer, M.B., M.S., Ph.D.
Paul R. McHugh, M.D.
Number 50 ~ Fall 2016 ~ $7.00.......
Number 50 ~ Fall 2016
Editor’s Note: Questions related to sexuality and gender bear on
some of the most intimate and personal aspects of human life. In
recent years they have also vexed American politics. We offer this
report — written by Dr. Lawrence S. Mayer, an epidemiologist trained in psychiatry, and Dr. Paul R. McHugh, arguably the most important American psychiatrist of the last half-century — in the hope of improving public understanding of these questions.
Examining research from the biological, psychological, and social sciences, this report shows that some of the most frequently heard claims about sexuality and gender are not supported by scientific evidence. The report has a special focus on the higher rates of mental health problems among LGBT populations, and it questions the scientific basis of trends in the treatment of chil- dren who do not identify with their biological sex. More effort is called for to provide these people with the understanding, care, and support they need to lead healthy, flourishing lives.
4 Preface Lawrence S. Mayer 7 Executive Summary Sexuality and Gender Findings from the Biological, Psychological, and Social Sciences Lawrence S. Mayer, M.B., M.S., Ph.D. and Paul R. McHugh, M.D.
10 Introduction 13 Part 1: Sexual Orientation
13 Problems with Defining Key Concepts 15 The Context of Sexual Desire 19 Sexual Orientation 21 Challenging the “Born that Way” Hypothesis 25 Studies of Twins 26 Molecular Genetics 32 The Limited Role of Genetics 33 The Influence of Hormones 34 Sexual Orientation and the Brain 39 Misreading the Research 41 Sexual Abuse Victimization 42 Distribution of Sexual Desires and Changes Over Time 50 Conclusion 57 59 Part 2: Sexuality, Mental Health Outcomes, and Social Stress Abstract 59 Some Preliminaries 60 Sexuality and Mental Health 60 Sexuality and Suicide 66 Sexuality and Intimate Partner Violence 70 Transgender Health Outcomes 73 Explanations for the Poor Health Outcomes: The Social Stress Model 75 Discrimination and prejudice events 77 Sti
Lawrence S. Mayer, M.B., M.S., Ph.D. is a scholar in residence in the Department of Psychiatry at the Johns Hopkins University School of Medicine and a professor of statistics and biostatistics at Arizona State University. Paul R. McHugh, M.D. is a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and was for twenty-five years the psychiatrist-in-chief at the Johns Hopkins Hospital. He
is the author or coauthor of several books, including, most recently, Try to Remember:
Psychiatry’s Clash over Meaning, Memory, and Mind (Dana Press, 2008).
The New Atlantis (1627) was the title Francis Bacon selected for his fable of a society living with the benefits and challenges of advanced science and technology. Bacon, a founder and champion of modern science, sought not only to highlight the potential of technology to improve human life, but also to foresee some of the social, moral, and political difficulties that confront a society shaped by the great scientific enterprise. His book offers no obvious answers; perhaps it seduces more than it warns. But the tale also hints at some of the dilemmas that arise with the ability to remake and reconfigure the natural world: governing science, so that it might flourish freely without destroying or dehumanizing us, and understanding the effect of technology on human life, human aspiration, and the human good. To a great extent, we live in the world Bacon imagined, and now we must find a way to live well with both its burdens and its blessings. This very challenge, which now confronts our own society most forcefully, is the focus of this journal.
T his report was written for the general public and for mental health professionals in order to draw attention to — and offer some scientific insight about — the mental health issues faced by LGBT populations.
It arose from a request from Paul R. McHugh, M.D., the former chief of psychiatry at Johns Hopkins Hospital and one of the leading psychiatrists in the world. Dr. McHugh requested that I review a monograph he and colleagues had drafted on subjects related to sexual orientation and identity; my original assignment was to guarantee the accuracy of statistical inferences and to review additional sources. In the months that followed, I closely read over five hundred scientific articles on these topics and perused hundreds more. I was alarmed to learn that the LGBT community bears a disproportionate rate of mental health problems compared to the population as a whole.
As my interest grew, I explored research across a variety of scientific fields, including epidemiology, genetics, endocrinology, psychiatry, neuroscience, embryology, and pediatrics. I also reviewed many of the academic empirical studies done in the social sciences including psychology, sociology, political science, economics, and gender studies.
I agreed to take over as lead author, rewriting, reorganizing, and expanding the text. I support every sentence in this report, without reservation and without prejudice regarding any political or philosophical debates. This report is about science and medicine, nothing more and nothing less.
Readers wondering about this report’s synthesis of research from so many different fields may wish to know a little about its lead author. I am a full-time academic involved in all aspects of teaching, research, and professional service. I am a biostatistician and epidemiologist who focuses on the design, analysis, and interpretation of experimental and observational data in public health and medicine, particularly when the data are complex in terms of underlying scientific issues. I am a research physician, having trained in medicine and psychiatry in the U.K. and received the British equivalent (M.B.) to the American M.D. I have never practiced medicine (including psychiatry) in the United States or abroad. I have testified in dozens of federal and state legal proceedings and regulatory hearings, in ~ The New Atlantis
most cases reviewing scientific literature to clarify the issues under examination. I strongly support equality and oppose discrimination for the LGBT community, and I have testified on their behalf as a statistical expert.
I have been a full-time tenured professor for over four decades. I have held professorial appointments at eight universities, including Princeton, the University of Pennsylvania, Stanford, Arizona State University, Johns Hopkins University Bloomberg School of Public Health and School of Medicine, Ohio State, Virginia Tech, and the University of Michigan.
I have also held research faculty appointments at several other institutions, including the Mayo Clinic.
My full-time and part-time appointments have been in twenty-three disciplines, including statistics, biostatistics, epidemiology, public health, social methodology, psychiatry, mathematics, sociology, political science, economics, and biomedical informatics. But my research interests have varied far less than my academic appointments: the focus of my career has been to learn how statistics and models are employed across disciplines, with the goal of improving the use of models and data analytics in assessing issues of interest in the policy, regulatory, or legal realms.
I have been published in many top-tier peer-reviewed journals (including The Annals of Statistics, Biometrics, and American Journal of Political Science) and have reviewed hundreds of manuscripts submitted for publication to many of the major medical, statistical, and epidemiological journals (including The New England Journal of Medicine, Journal of the American Statistical Association, and American Journal of Public Health).
I am currently a scholar in residence in the Department of Psychiatry at Johns Hopkins School of Medicine and a professor of statistics and biostatistics at Arizona State University. Up until July 1, 2016, I also held part-time faculty appointments at the Johns Hopkins Bloomberg School of Public Health and School of Medicine, and at the Mayo Clinic.
A n undertaking as ambitious as this report would not be possible without the counsel and advice of many gifted scholars and editors.
I am grateful for the generous help of Laura E. Harrington, M.D., M.S., a psychiatrist with extensive training in internal medicine and neuroimmunology, whose clinical practice focuses on women in life transition, including affirmative treatment and therapy for the LGBT community.
She contributed to the entire report, particularly lending her expertise to the sections on endocrinology and brain research. I am indebted also to Bentley J. Hanish, B.S., a young geneticist who expects to graduate medical school in 2021 with an M.D./Ph.D. in psychiatric epidemiology.
He contributed to the entire report, particularly to those sections that concern genetics.
I gratefully acknowledge the support of Johns Hopkins University Bloomberg School of Public Health and School of Medicine, Arizona State University, and the Mayo Clinic.
In the course of writing this report, I consulted a number of individuals who asked that I not thank them by name. Some feared an angry response from the more militant elements of the LGBT community;
others feared an angry response from the more strident elements of religiously conservative communities. Most bothersome, however, is that some feared reprisals from their own universities for engaging such controversial topics, regardless of the report’s content — a sad statement about academic freedom.
I dedicate my work on this report, first, to the LGBT community, which bears a disproportionate rate of mental health problems compared to the population as a whole. We must find ways to relieve their suffering.
I dedicate it also to scholars doing impartial research on topics of public controversy. May they never lose their way in political hurricanes.
And above all, I dedicate it to children struggling with their sexuality and gender. Children are a special case when addressing gender issues. In the course of their development, many children explore the idea of being of the opposite sex. Some children may have improved psychological well-being if they are encouraged and supported in their cross-gender identification, particularly if the identification is strong and persistent over time. But nearly all children ultimately identify with their biological sex. The notion that a two-year-old, having expressed thoughts or behaviors identified with the opposite sex, can be labeled for life as transgender has absolutely no support in science. Indeed, it is iniquitous to believe that all children who have gender-atypical thoughts or behavior at some point in their development, particularly before puberty, should be encouraged to become transgender.
As citizens, scholars, and clinicians concerned with the problems facing LGBT people, we should not be dogmatically committed to any particular views about the nature of sexuality or gender identity; rather, we should be guided first and foremost by the needs of struggling patients, and we should seek with open minds for ways to help them lead meaningful, dignified lives.
Lawrence S. Mayer, M.B., M.S., Ph.D.
6 ~ The New Atlantis Copyright 2016. All rights reserved. See www.TheNewAtlantis.com for more information.
Executive Summary This report presents a careful summary and an up-to-date explanation of research — from the biological, psychological, and social sciences — related to sexual orientation and gender identity. It is offered in the hope that such an exposition can contribute to our capacity as physicians, scientists, and citizens to address health issues faced by LGBT populations within our society.
Some key findings:
Part One: Sexual Orientation ● The understanding of sexual orientation as an innate, biologically fixed property of human beings — the idea that people are “born that way” — is not supported by scientific evidence.
● While there is evidence that biological factors such as genes and hormones are associated with sexual behaviors and attractions, there are no compelling causal biological explanations for human sexual orientation. While minor differences in the brain structures and brain activity between homosexual and heterosexual individuals have been identified by researchers, such neurobiological findings do not demonstrate whether these differences are innate or are the result of environmental and psychological factors.
● Longitudinal studies of adolescents suggest that sexual orientation may be quite fluid over the life course for some people, with one study estimating that as many as 80% of male adolescents who report same-sex attractions no longer do so as adults (although the extent to which this figure reflects actual changes in same-sex attractions and not just artifacts of the survey process has been contested by some researchers).
● Compared to heterosexuals, non-heterosexuals are about two to three times as likely to have experienced childhood sexual abuse.
Part Two: Sexuality, Mental Health Outcomes, and Social Stress ● Compared to the general population, non-heterosexual subpopulations are at an elevated risk for a variety of adverse health and mental health outcomes.
● Members of the non-heterosexual population are estimated to have about 1.5 times higher risk of experiencing anxiety disorders than members of the heterosexual population, as well as roughly double the risk of depression, 1.5 times the risk of substance abuse, and nearly 2.5 times the risk of suicide.
● Members of the transgender population are also at higher risk of a variety of mental health problems compared to members of the non-transgender population. Especially alarmingly, the rate of lifetime suicide attempts across all ages of transgender individuals is estimated at 41%, compared to under 5% in the overall U.S. population.