Position Statement Regarding 303 Creative v. Elenis

AGLP is deeply concerned about the recent Supreme Court ruling in the case of 303 Creative v. Elenis, which for the first time in the Court's history, grants a business open to the public a constitutional right to refuse to serve members of a protected class. In addition to promoting discrimination, this decision poses a significant threat to the mental health and well-being of LGBTQ+ individuals by relegating them as second class citizens, unable to freely and openly participate in society. AGLP remains committed to advocating for the rights and well-being of the LGBTQ+ community. We urge policymakers to address the harmful implications of this ruling and promote policies that prioritize mental health and equality for all.

AGLP Position Statement on “Woke” Legislation

May 21, 2023.  The Florida legislature, led by presidential hopeful, Ron DeSantis, is in a war against an imaginary enemy in the form of “Woke Policy,” loosely defined as progressives’ focus on social construction affecting racial and social justice.  Legislation is being proposed and passed in conservative states that profoundly affect the mental health and development of minority sexual orientation and transgender people.  LGBTQ+ studies are being eliminated at public universities. Schools are being forbidden to discuss gender and sexual orientation in the classroom.  School libraries are being forced to remove books that discuss LGBTQ+ issues.  Conversion therapy restrictions are being removed.  Institutions, such as Disney, which sponsor diversity, have been targeted with political retribution.  Transgender care is being eliminated for minors with felony penalties to any physician who participates in such.  Requirements are being passed to mandate the use of pronouns for gender that match gender documentation at birth.  Employment protections for LGBTQ+ workers are being removed.  Tennessee passed a law forbidding any public displays by drag queens, defining their displays as sexual abuse of children.  Trans affirming care will be prohibited in Tennessee along with similar bills in Arkansas, Georgia, Indiana, Iowa, Kentucky, Mississippi, Missouri, Nebraska, Oklahoma, Utah, South Dakota, and West Virginia

Much of the “Woke” legislation targets transgender people, who constitute about 1.6% of the population (Pew Research).  Transgender people are a convenient target for scapegoating by right wing politicians to further marginalize transgender people and use as a rallying cry against manufactured dangers to America.  The scapegoating is a social construction, dividing society into a “We/They” construct to pull in disciples for the “We.”  It is a dangerous social construction which is devoid of any consideration of the human dignity that everyone deserves.  The mere proposal of anti-LGBTQ+ legislation – even if not passed or declared unconstitutional – has profoundly affected the mental health of transgender people – as well as lesbian, gay, and bisexual people – who are next on the chopping block.  The number of transgender people being murdered in the United States is concerning (37 in 2020, 57 in 2021, 32 in 2022, HRC).   As public attacks on transgender issues escalate, the stress on the transgender population has increased to the point that multiple studies report suicidal ideation rates of 50-55% and suicide attempt rates of 20-40% in the transgender population (The Trevor Project, CDC Prevention’s Youth Risk Behavior Survey).
      
On April 27, 2023 the Centers for Disease Control and Prevention (CDC) released the results of a 2021 survey of 17,508 high school students across the country regarding the incidence of LGB identities among high school students.  24.5% of high school students identified as something other than heterosexual.  12.2% identified as bisexual, 5.2% as questioning, 3.9% as other, 3.2% as gay or lesbian, with 1.8% indicating that they did not understand the question.  High school students live in a different world than their grandparents when such a study would likely have not have broken 1% for alternative identities.  High school students are becoming much more open about their gender and sexual identities, which is a product of the changing culture and Supreme Court decisions decriminalizing homosexual behavior and allowing gay marriage.  While rates may be partially inflated due to high school peer dynamics and pressure, it is likely that the rates have risen primarily due to social acceptance rather than any fundamental change in the true incidence of diverse gender and sexual identities in the high school population.  The social acceptance, however, is at best partial.  High school students with diverse gender and sexual identities face substantial discriminatory hurdles which undermine their mental health, leading to profound increases (as compared to their peers) in the incidence of depression, anxiety, drug abuse, suicidal ideation, and suicide for those who are exposed to parental and societal hostility (Ryan, C., Pediatrics, 2009; 123.346-352)

A study of 208 transgender girls and 109 transgender boys in 2021 undergoing social, nonsurgical transitioning (with the average age at start of the study being 8 years old) found that five years later, 94% retained a transgender identification.  (Olson, et al., Gender Identity Five Years After Social Transition, Journal of Pediatrics, 150:2, August 2022).  The study is at odds with older studies which suggested that most transgender youth abandoned their transgender identity by early adulthood.  The older studies did not factor in the effect of social construction.

It is the position of AGLP, the Association of LGBTQ+ Psychiatrists, that all people, regardless of race, ethnicity, gender, gender identity, or sexual orientation, deserve respect and dignity and a safe environment to develop with a healthy and productive life in which mental health is not assaulted by political ambitions. 

It is the position of AGLP, the Association of LGBTQ+ Psychiatrists that current data suggest that the mental health of minors is facilitated by early introduction to LGBTQ+ identities that they themselves may have to come to terms with.  Such early exposure should be age and developmentally appropriate, based on competent psychiatric principles and unbiased, evidenced-based scientific studies.   Early educational efforts to acquaint students with diverse sexual and gender identities reduces bullying, and benefit the dignity and the mental health of those students who do have diverse sexual and gender identities.

Florida HB1557
Passed: March 9, 2022

HB1557, the “Don’t Say Gay Bill” prohibits classroom instruction by school personnel or third parties on sexual orientation or gender identity from kindergarten through grade 3 or in a manner that is not age-appropriate or developmentally appropriate for students in accordance with state standards.  The legislation was designed to allow parents to determine when and in what way to introduce LGBTQ topics to their children and allows parents to sue a school district in which the policy is violated.  HB1223 proposes to expand the prohibition to grade 12.

Florida HB7
Passed: April 22, 2022

HB7 bans certain types of diversity, equity, and inclusion training or instruction in schools or workplaces that could make individuals feel responsible or guilty for past actions based on their race, gender, or national origin.  The stop the wrongs to our kids and employees act (Stop WOKE Act), amends the Florida Civil Rights Act and applies to businesses and schools banning teaching or training that suggests that some people are inherently or unconsciously racist, sexist, or oppressive, or that they bear personal responsibility or guilt for historical wrongdoings based on race, gender, or national origin.  According to Florida governor, Ron DeSantis, the bill is designed to “give businesses, employees, children, and families tools to stand up against discrimination and woke indoctrination.”

Arkansas SB 43
Passed: February 27, 2023

SB 43 prohibits an “adult-oriented performance” from taking place on public property or using public funds, and also bans minors from being admitted to such shows.
The bill originally called out drag queens explicitly and sought to classify all drag performances as “adult-oriented.” The final draft was changed to avoid court challenges and removed any explicit mention of drag and gender. Instead, the final bill defined an “adult-oriented performance” as one featuring “a person who appears in a state of nudity or is seminude”; “the purposeful exposure, whether complete or partial, of: a specific anatomical area; or prosthetic genitalia or breasts; or a specific sexual activity.”
While this version no longer specifically targets the LGBTQ+ community, the ACLU of Arkansas explained that it could still be used to discriminate against drag queens, adding that its broad language could also affect mainstream performers.
“It still inherently invites abuse in enforcement,” the organization stated, “especially considering the anti-LGBTQ rhetoric from sponsors and supporters of the bill.”

Mississippi HB 1125
Passed: February 28, 2023

Known as the “Regulate Experimental Adolescent Procedures (REAP) Act,” HB 1125 bans all types of gender-affirming care – including reversible puberty blockers – to trans people under 18.
Under the new law, healthcare workers who provide gender-affirming care to minors will have their licenses revoked. It also allows patients to sue healthcare providers up to 30 years after receiving treatment and denies state or federal funding to state organizations that provide gender-affirming care to minors.

South Dakota HB 1080
Passed: February 14, 2023
This trans health care ban forbids doctors from providing gender-affirming care, including puberty blockers and hormone replacement therapy, to minors. It also requires trans youth to detransition.

The procedures are only banned in the context of transitioning. That is, state lawmakers didn’t ban a set of medical procedures because they believed that the procedures were too dangerous; they only banned a class of people from getting the procedures for a specific purpose.
The law also says that any minor who’d be harmed by stopping their use of puberty blockers or HRT must systematically reduce their use and stop using these treatments entirely by December 31, 2023.
If a doctor provides any of the forbidden types of care, they can have their professional state licenses and certifications revoked. They can also be sued for civil damages up to three years after providing the care or until their minor patient reaches the age of 25. This would allow parents to sue if they disapprove of their children’s transitions.

Tennessee SB 3
Passed: March 2, 2023
This law targets drag performers banning “male or female impersonators who provide entertainment that appeals to a prurient interest” from appearing “on public property” or “in a location where the adult cabaret performance could be viewed by a person who is not an adult.”

Tennessee SB 1
Passed: March 2, 2023

SB1 bans gender-affirming care for minors and requires them to detransition.
The bill outlaws treatments like puberty blockers and hormone replacement therapy for people under the age of 18, forcing transgender youth to go through the puberty of their sex assigned a birth. The legislation allows for the same medications to be used by cisgender youth for other conditions. 
The bill takes effect this summer and gives trans youth until March 31, 2024 to end their current medical treatments.

Utah SB 100
Passed: February 16, 2023

This bill allows schools to out trans kids to their parents and requires parental consent for their gender identity to be affirmed at school.

Utah SB 16
Passed January 28, 2023
This bill bans gender-affirming care for minors in the state. Except in limited cases, it outlaws gender transition surgery and prohibits the use of hormone therapy.

West Virginia HB 3042
Passed March 9, 2023
Called the Religious Freedom Restoration Act (RFRA), this bill says West Virginia cannot “burden a person’s exercise of religion” except when it is “essential to further a compelling governmental interest.” Advocates say the law essentially gives people a license to discriminate.

Arkansas SB 199
Passed March 13, 2021
This law attempts to get around a federal court’s injunction against the state’s ban on gender-affirming care for trans youth by making it much easier for people who received gender-affirming care to sue medical practitioners for malpractice. Legal experts expect the law will make it impossible for doctors to get malpractice insurance if they practice gender-affirming care in the state.

Arkansas SB 294
Passed March 14, 2023
This sweeping education reform bill includes a provision prohibiting teachers below the 5th grade level from providing classroom instruction on topics related to sexual orientation and gender identity.

Wyoming SF 133
Passed March 17, 2023
This law prevents trans girls in 8th through 12th grade from competing in women’s sports. It passed without the signature of Gov. Mark Gordon (R), who opposed the legislation but decided not to veto it because he did not want to “prolong these very divisive debates.”

Arkansas HB 1156
Passed March 21, 2023
This law bans transgender students from using facilities associated with their gender identity and instead requires them to use those associated with their sex assigned at birth.

Iowa SF 538
Passed March 22, 2023
This law prohibits medical professionals from “attempting to alter the appearance of, or affirm the minor’s perception of, the minor’s gender or sex, if that appearance or perception is inconsistent with the minor’s sex” assigned at birth. In other words, it bans all gender-affirming care for minors, including reversible puberty blockers.

Iowa SF 482
Passed March 22, 2023
This law prohibits people from using school bathrooms that don’t correspond with the gender they were assigned at birth.

Georgia SB 140
Passed March 23, 2023
This law bans doctors from providing gender-affirming hormone replacement therapy and surgery to trans youth under the age of 18. There is an exemption for cisgender youth who want to access the same treatments and the law does not cover puberty blockers.

Idaho SB 1100
Passed March 23, 2023
This law bans transgender students from using facilities associated with their gender identity and instead requires them to use those associated with their sex assigned at birth. It allows cisgender students to sue for $5000 for each instance of sharing a facility with a trans student as well as attorney’s fees and damages for “psychological, emotional, and physical harm suffered.”

Utah SB 93
Passed March 23, 2023
This bill bans minors from changing their name or gender on their birth certificates.

West Virginia HB 2007
Passed March 26, 2023
This bill bans transgender minors from accessing gender-affirming care. The bill bans puberty blockers, hormone replacement therapy, and surgery.
The bill contains an exemption if a doctor thinks that a trans young person may self-harm or attempt suicide if their gender dysphoria is left untreated. This exception requires a diagnosis of “severe gender dysphoria” from two doctors and parental permission.

Idaho SB 1016
Passed on March 28, 2023
This bill exempts state contractors from federal anti-discrimination requirements by allowing those who receive no federal funding to require that workers use facilities based on sex assigned at birth.

Kentucky SB 150
Passed March 29, 2023
This omnibus bill attacks trans young people on multiple fronts. It bans gender-affirming surgeries, puberty blockers, and hormone therapy for minors, as well as a mandate that doctors stop treating young patients who are currently receiving gender-affirming care.
It also bans Kentucky teachers from using pronouns that “do not conform to a student’s biological sex as indicated on the student’s original, unedited birth certificate,” bans instruction on sexuality in grades K through six, and bans discussion of gender identity and sexual orientation at all grade levels.
The bill was vetoed by Gov. Andy Beshear (D) but the state’s General Assembly overrode his veto.

Idaho HB 71
Passed April 4, 2023
This is one of the most punitive bans on gender-affirming care for minors in the country. It bans surgery, hormone replacement therapy, and puberty blockers for transgender people under the age of 18, and it makes it a felony to provide such care to transgender minors in the state. The felony carries a maximum sentence of 10 years in prison.

Kansas HB 2238
Passed April 5, 2023
The Republican-dominated legislature overrode Gov. Laura Kelly’s (D) third veto of the “Fairness in Women’s Sports Act” and passed it into law in April. The law bans transgender girls and women in kindergarten through college from participating in girls’ and women’s school sports.

Indiana SB 480
Passed April 5, 2023
This law not only prohibits trans youth from both gender-affirming medication and surgery, but it also requires youth already undergoing care to detransition.

North Dakota HB 1249
Passed April 11, 2023
This law bans trans girls in kindergarten through 12th grade from participating on women’s sports teams.

North Dakota HB 1489
Passed April 11, 2023
This law bans trans women in college from participating on women’s sports teams.

Kansas SB 180
Passed April 27, 2023
This law bans trans people from using the appropriate facilities in a number of areas, including restrooms, locker rooms, women’s shelters, rape crisis shelters, and prisons. It also bans them from updating the gender marker on their driver’s licenses.

(2023 laws courtesy of LGBTQ Nation Newsletter).

 

AGLP Position Statement on Criminalization of Parents and Clinicians Providing Gender Reassignment Care to Minors

BACKGROUND:  In 2021 the Texas State Legislature failed to pass a law declaring gender reassignment of minors as child abuse.  On August 23, 2021 Rep. Matt Krause (Republican), Chair of the Texas House Committee on General Investigating wrote a letter to Mr.  Ken Paxton, the Texas State Attorney General, asking for a legal opinion regarding whether gender reassignment procedures and treatments constituted child abuse under Chapter 261 of the Texas Family Code.  Atty. Gen. Paxton rendered an opinion on February 18, 2022 that gender reassignment procedures and treatments did indeed meet the legal requirements under the law to be construed as child abuse because children are deprived of the constitutional right for procreation before they have the legal capacity to consent to such treatments.  Atty. Gen. Paxton wrote:

“The medical evidence does not demonstrate that children and adolescents benefit from engaging in these irreversible sterilization procedures.  The prevalence of gender dysphoria in children and adolescents has never been estimated and there is no scientific consensus that these sterilization procedures and treatment even serve to benefit minor children dealing with gender dysphoria.  As stated by the Centers for Medicare and Medicaid services, ‘There is not enough high-quality evidence to determine whether gender reassignment surgery improves health outcomes for Medicare beneficiaries with gender dysphoria and whether patient’s most likely benefit from these types of surgical interventions can be identified prospectively.’  Also, ‘several studies show a higher rate of regret at being sterilized among younger women than those who were sterilized at a later age.  [43 Fed. Reg. at 52, 151;52, 152].’  This further indicates that minor children are not sufficiently mature to make informed decisions in this context.”

On February 24, 2022 Texas Governor Greg Abbott issued a directive to the Texas Department of Family and Protective Services to investigate children undergoing gender reassignment procedures, warning that the parents of those children and any clinicians involved in their care could be criminally charged with child abuse.

       In a decision by the United States Department of Health and Human Services Appeals Board (2014) overturning a previous Medicare national coverage determination denying transsexual surgery, the Appeals Board wrote that true randomized studies may not be feasible and may be unethical in the context of gender affirming surgery.  In its decision invalidating the national coverage determination, however, the department Appeals Board stated that general acceptance of the medical necessity of such surgeries in the international medical community provide a sound scientific basis for coverage despite the lack of randomized studies.  The Department Appeals Board held that, regardless of whether evidence regarding the medical necessity of gender affirming surgery “meets the first option for meeting the evidentiary standard set forth in the guidance…it clearly meets the second option because it indicates a consensus among researchers and all mainstream medical organizations that transsexual surgery is an effective, safe, and medically necessary treatment for transsexualism.”

The Centers for Medicare and Medicaid Services, in fact, covers gender reassignment hormonal and surgical treatment.

       The Board of Trustees of the American Psychiatric Association, representing nearly 40,000 psychiatrists, took the official position in July 2020 that the American Psychiatric Association:

“Supports access to affirming and supportive treatment for transgender diverse youth and their families including appropriate mental health services, and when indicated, puberty suppression and medical transition support.  The American Psychiatric Association opposes all legislative and other government attempts to limit access to the services for transgender diverse youth or to sanction or criminalize the actions of physicians or other clinicians who provide them.”

       On April 26, 2021, in a letter to the National Governors Association, the Chief Executive Officer, James Madara, M.D., on behalf of the American Medical Association, representing nearly 250,000 physicians, wrote:

“Empirical evidence has demonstrated that trans and non-binary gender identities are normal variations of human identity and expression.  Standards of care and accepted medically necessary services that affirm gender or treat gender dysphoria may include mental health counseling, nonmedical social transition, gender affirming hormone therapy, and/or gender affirming surgeries.  Clinical guidelines established by professional medical organizations for the care of minors promote supportive interventions based on the current evidence and that enable young people to explore and live the gender that they choose.  Every major medical association in the United States recognizes the medical necessity of transition- related care for improving the physical and mental health of transgender people.”

       The American Psychological Association, representing over 130,000 psychologists, writes in its Guidelines for Psychological Practice with Transgender and Gender Nonconforming People:

“Research has primarily shown positive treatment outcomes when transgender nonconforming adults and adolescents receive transgender nonconforming affirmative medical and psychological services (i.e., psychotherapy, hormones, surgery) [Byrne et al, 2012; R. Carroll, 1999;Cohen-Kettenis, Delemarre-Van de Wall & Gooren, 2008; Davis & Meier, 2014; DeCuypere et al. 2006; Gooren, Giltay & Bunck, 2008; Kuhn et al 2009], although sample sizes are frequently small with no population-based studies.  In a meta-analysis of hormone therapy treatment with transgender nonconforming adults and adolescents, researchers reported that 80% of participants receiving trans affirmative care experience an improve quality of life, decreased gender dysphoria, and a reduction in negative psychological symptoms [Murad et al, 2010].”

It is the position of the Association of LGBTQ+ Psychiatrists:

            The decision by the Texas Department of Criminal Justice and the Texas Governor’s Office to investigate parents of transgender youth undergoing gender reassignment procedures and treatment, as well as associated clinicians and caregivers, for prima facia child abuse is predicated on the false premise that such treatment is harmful to minors and not based in scientific fact.  Every major medical and mental health association has endorsed the benefits of affirming and supportive treatment for gender diverse youth.  Failing such interventions, transgender youth have a disproportionately higher risk than cisgender youth of depression, suicide risk, victimization, and substance abuse.  To deny and criminalize the gender reassignment procedures and treatments is patently discriminatory and cruel and harmful to Texas children.  The Association of LBGTQ+ Psychiatrists therefore opposes the intrusion of the Texas Department of Criminal Justice into the healthcare of Texas children and the right of their parents to guide such healthcare, motivated by thinly disguised political pretense. 

       The determination of the stage of development when permanent gender reassignment is most likely to be beneficial is evolving as the research progresses.  The Association of LGBTQ+ Psychiatrists supports continuing research into medical and psychological interventions for transgender youth based on scientific analysis unfettered by political interference and inflammatory rhetoric.

AGLP Position Statement on the Texas Antiabortion Law

Medical professionals have the ethical burden to defend the right to access health healthcare and oppose any intervention leading to disastrous health outcomes. Therefore, AGLP opposes any law that interferes with a physician’s ability to effectively deliver an evidence-based standard of care.

In May 2021 Texas Governor Greg Abbott signed SB-2 into law which forbids abortions in Texas once a fetal heartbeat can be detected – typically at six weeks and often before pregnancy is even known.  AGLP is alarmed about the mental health impact of a bill on individuals experiencing unwanted pregnancies.  Higher levels of anxiety, depression, suicidality, child abuse/neglect, and poverty have been found in women with unwanted pregnancies that are compelled to go to term with their pregnancy. Pregnancy, either unintentional or due to rape, leads to additional barriers for transgender and non-binary pregnant patients. The law represents an egregious intrusion into the physician-patient relationship and the autonomy of individuals to govern their own body medically.

The bill also allows anyone to sue an individual who facilitates an abortion in any way for a minimum of $10,000; in effect, making the general public vigilantes to enforce the law designed to stop abortions despite the precedence of Roe v. Wade which made abortions a constitutional right.  AGLP is concerned that the framework of the law will be used to abrogate constitutional rights of LGBTQ+ peoples such as the as the right to marry or participate in the National Guard (state militia); and could undermine equal protection of the law for employment, housing, and health care as guaranteed by the due process clauses of the Fifth and Fourteenth Amendments of the Constitution of the United States. The mental health consequences to LGBTQ+ people would be profoundly adverse if LGBTQ+ lives come under attack by laws which make facilitating LGBTQ+ equality a compensable tort for anyone who witnesses such facilitation. AGLP, therefore is opposed to all laws which deputize common citizens to enforce social prejudices and discriminatory laws designed to undermine Constitutional guarantees and the mental health of the people in America.

AGLP Position Statement on Suppression of LGBTQ+ Affirming Media Presentations and Affirming Child and Adolescent Education

Self-awareness of same sex attraction or transgender/gender non-binary orientation typically occurs in early adolescence but may occur earlier in development or in later in life.  Educational and supportive interventions before that self-awareness occurs have a profound beneficial effect on the subsequent development of lesbian, gay, bisexual, transgender, and questioning (LGBTQ+) children.  Lower levels of depression, suicidality, anxiety, drug abuse, and homelessness are well documented as positive outcomes of early intervention. 

Concerns that such educational and supportive interventions will cause same sex attraction or transgender orientation in children not otherwise prone to develop such, have long been shown to be unfounded.  Educational and supportive interventions may lead to earlier recognition of alternative sexual attraction and gender identification, but there are no evidence-based scientific studies validating that either is altered by early educational or supportive interventions for LGBTQ+ children. 

AGLP opposes the continued unscientific conflation of pedophilia with LGBTQ+ identities which contributes to worsening health outcomes and increased violence against LGBTQ+ individuals worldwide.  AGLP therefore strongly opposes misguided efforts, like those in Russia and Hungary, to suppress LGBTQ+ affirming presentations in the media.  AGLP continues to advocate for LGBTQ+ affirming efforts designed to promote healthy child and adolescent development. 

AGLP Statement on Combating White Supremacy in the United States 

AGLP: The Association of LGBTQ+ Psychiatrists, recognizes the intersectionality of race, ethnicity, and sexual and/or gender identity. We therefore acknowledge that the continued existence of white supremacy beliefs within the United States threatens the physical and mental well-being of many of the patients we serve, including LGBTQ+ identified individuals. AGLP is disheartened by continued violence towards people of color in this country. AGLP also acknowledges that recent acts of violence towards non-white individuals are a reflection of more ubiquitous forms of systemic oppression that are deeply engrained in this country’s history and present environment. AGLP strongly opposes and publicly condemns white supremacy ideology in all forms, acknowledges the profound negative mental health impacts of said forces, and calls upon the medical community to genuinely invest its resources and training towards combating racism and implicit racial biases.

AGLP Statement on Combating the rise of Anti-trans legislation in the United States

AGLP: The Association of LGBTQ+ Psychiatrists, recognizes the unprecedented surge of discriminatory legislation targeting transgender and gender non-conforming identified individuals. By March of 2021 a total of 82 discriminatory anti-trans bills have been introduced in state legislatures across the country, marking a new and disheartening record. These radical proposed laws are widely unpopular according to multiple surveys, harmful, and plainly not evidenced based. Bills, ranging from attempts to impede access to healthcare to barring the use of gender-aligned bathroom facilities, jeopardize the physical well-being of transgender patients across the country. Irrespective of such proposed legislation, the propagation and normalization of non evidence-based questioning of the validity of a transgender or gender non-conforming identity yields undue psychological harm. AGLP strongly opposes the introduction and enactment of legislation that adversely targets the transgender and gender non-conforming community, and calls upon the medical community to both recognize and combat this ongoing crisis.

APA Position Statement on Treatment of Transgender (Trans) and Gender Diverse Youth

Approved by the Board of Trustees, July 2020
Approved by the Assembly, April 2020
“Policy documents are approved by the APA Assembly and Board of Trustees. . . These are . . . position statements that define APA official policy on specific subjects. . .” – APA Operations Manual
Issue:
Transgender and gender non-conforming youth often experience an intensification of emotional distress when the physical changes of puberty occur in opposition to the adolescent’s gender identity and sense of self. The onset of menses, for example, is unwanted and psychologically devastating for an adolescent transman (assigned female at birth). Worsening dysphoria may manifest as depression, anxiety, poor relationships with family and peers, self-harm and suicide. Racism, misogyny, economic disadvantage and neurodiversity can compound the risk of negative outcomes. Due to the dynamic nature of puberty development, lack of gender-affirming interventions (i.e. social, psychological, and medical) is not a neutral decision; youth often experience worsening dysphoria and negative impact on mental health as the incongruent and unwanted puberty progresses. Trans-affirming treatment, such as the use of puberty suppression, is associated with the relief of emotional distress, and notable gains in psychosocial and emotional development, in trans and gender diverse youth.

Gender-affirming treatment of trans and gender diverse youth who experience gender dysphoria due to the physical changes of puberty, may include suppression of puberty development with GnRH (gonadotropin releasing hormone) agonists, commonly referred to as “puberty blockers.” Use of GnRH agonists, despite potential side effects (e.g., hot flashes, depression) can allow the adolescent a period of time, often several years, in which to further explore their gender identity and benefit from additional cognitive and emotional development. During this time, the youth and family can receive mental health and social support services, if needed, to navigate the gender affirmation process including the consideration of whether gender affirming hormone therapy is an appropriate next step. If during this discernment period further adolescent development leads to increased comfort with the birth-assigned gender, the GnRH agonist can be discontinued, and puberty allowed to resume. If the developmental trajectory affirms the trans identity, treatment with estrogen or testosterone can be instituted to facilitate development of affirmed secondary sex characteristics, if desired. Gender-affirming surgeries may follow in later adolescence or young adulthood. However, affirmation of gender identity is a highly individualized process. For gender diverse youth and their families, decisions to which gender-affirming medical, surgical, social, and/or legal procedures to purse are best managed via an informed consent approach.

APA Position:
The American Psychiatric Association:
© Copyright, American Psychiatric Association, all rights reserved.
1. Supports access to affirming and supportive treatment for trans and gender diverse youth and their families, including appropriate mental health services, and when indicated puberty suppression and medical transition support.
2. Opposes all legislative and other governmental attempts to limit access these services for trans and gender diverse youth, or to sanction or criminalize the actions of physicians and other clinincians who provide them.

AGLP Statement on HHS Bans on Diversity Training

AGLP: The Association of LGBTQ+ Psychiatrists, opposes the recent Executive Order “Executive Order on Combating Race and Sex Stereotyping” that was issued on September 22, 2020. 

AGLP is committed to diversity and to the mental health of LGBTQ+ Psychiatrists as well as LGBTQ+ Patients. It is the position of this organization that this Executive Order is harmful to all LGBTQ+ people, and particularly LGBTQ+ people of color, and runs counter to our mission.

In particular, we vehemently oppose the Executive Order’s assertion that Systemic Racism is a “pernicious and false belief” and that it is a “divisive concept” that the United States is a country that is fundamentally built on racist and sexist beliefs. In addition, this order says that evidence-based Diversity Trainings are unnecessary and harmful.

This Order runs counter to reams of evidence throughout many fields, including Psychiatry but also law enforcement and sociology. It is opposed by many organizations, including non-profits such as the NAACP, and for profit companies such as Microsoft and Apple who have found benefits from Diversity Trainings.

AGLP: The Association of LGBTQ+ Psychiatrists, opposes this Executive Order. We believe it is detrimental to the Mental Health of all minority groups, and will only exacerbate our racial and other divisions in this country. 

AGLP Statement on HHS LGBTQ+ Protection Removal

AGLP: the Association of LGBTQ+ Psychiatrists, opposes discrimination against LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer, etc.) individuals based on religious proscriptions, bigotry, or lack of comfort in dealing with LGBTQ+ individuals.  AGLP opposes efforts by the United States Department of Health and Human Services to remove protections against discrimination in the provision of health services to LGBTQ+ individuals because of gender, gender identity, or sexual orientation based on religious proscriptions.  The scientific study cited by the United States of Department of Health and Human Services with regard to transgender individuals did not justify its conclusions that discrimination is warranted. It is the position of the AGLP, as experts in the provision of mental health care to LGBTQ+ individuals, that discrimination in the provision of health care to all individuals, for whatever justification, is improper and harmful.

AGLP Statement on Transgender Individuals in the Military

AGLP: The Association of LGBTQ+ Psychiatrists, recognizes and lauds the many sacrifices transgender military veterans and active duty service members have made to protect the security of the United States.  AGLP opposes the “2018 Presidential Memorandum for the Secretary of Defense and the Secretary of Homeland Security Regarding Military Service by Transgender Individuals” (DoD Instruction 1300.28 ) barring transgender individuals from enlistment in the United States Arm Forces. It is the position of AGLP that a transgender identity does not, per se, impair an individual’s ability to serve as a member of the United States Armed Forces. The arbitrary exclusion of transgender individuals from the United States Armed Forces serves to exacerbate historical discriminatory stigmatization of transgender individuals and contributes to the negative mental health consequences that follow such stigmatization.

APA: Position Statement on Access to Care for Transgender and Gender Diverse Individuals

(July 2018)

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APA: Position Statement on Discrimination Against Transgender and Gender Diverse Individuals

(July 2018) 

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Position Statement:
A statement concerning the rights of the Transgender and Gender Non-Conforming (TGNC) Community in response to Trump's recent executive order

Approved by the Executive Board of AGLP on February 23, 2017

AGLP: The Association of LGBTQ Psychiatrists firmly believes that gender identity is part of the natural spectrum of human experience and expression. The Transgender and Gender Non-Conforming (TGNC) Community has been marginalized and continues to fight for basic civil rights. On Friday February 10th, 2017, the Trump administration dropped the federal government’s appeal of a decision by Judge Reed O’Connor of the Federal District Court for the Northern District of Texas to block the Obama administration’s guidance that transgender students are legally entitled to use the school bathroom, locker rooms and other gender segregated areas that accord with their gender identity.  On February 22nd they dropped the guidance entirely.

AGLP believes that the dropping of the appeal directly contradicts President Trump's pledge to protect LGBTQ people, and specifically a previous statement he made during the election that he would “leave [the guidance] alone". Discrimination and harassment are a significant source of stress for trans youth who are navigating an especially challenging period of their life and are vulnerable to depression and suicide when not supported by family and schools.  We challenge President Trump to stand by his word and protect LGBTQ communities, specifically our most vulnerable trans and gender non-conforming youth.

Position Statement: AGLP:The Association of LGBTQ PsychiatristsDiscrimination against LGBTQ Citizens under the Guise of Religious Liberty

Approved by the Executive Board of AGLP on April 25, 2016

Issue:  in 2016 approximately twenty states have legislation pending which remove civil rights protections of LGBTQ (Lesbian, Gay, Bisexual, Transgender, Questioning) citizens based on the hypothesis that religious beliefs are protected by the First Amendment, thereby allowing discrimination against LGBTQ citizens when that discrimination is based on personal religious belief.  

It is the position of AGLP:
That all people, whether LGBTQ or not, deserve the equal protections provided by the Fifth and Fourteenth Amendments to the Constitution;

That religious liberty arguments are thinly disguised efforts to return to marginalization and stigmatization of same sex and transgender orientations and identities;

That the principle cited behind religious liberty arguments would threaten the equal protections of vast numbers of other minority citizens; 

That virtually every major mental health organization has concluded that there is no credible scientific evidence that LGBTQ citizens are psychologically impaired per se or need to change their orientations or identities;

That LGBTQ citizens represent no more burden on American society than any other minority group, and, in fact, have made substantive contributions to the arts, sciences, and businesses in America;

That discrimination and stigmatization of LGBTQ citizens adversely affects their mental health and right to happiness;

Therefore:
AGLP steadfastly condemns all legislative attempts to stigmatize and discriminate against LGBTQ citizens under the novel legal principle that religious beliefs supersede the equal protection of personal rights of American citizens.

David L. Scasta, M.D., DLFAPA
Eric Yarbrough, M.D., President, AGLP
Amir Ahuja, M.D., Vice-President, AGLP
Kenneth Ashley, M.D., Immediate Past-President, AGLP
Serena Yuan Volpp, M.D., Treasurer, AGLP
Sarah Noble, D.O., Treasurer, AGLP

POSITION STATEMENT ON ISSUES RELATED TO HOMOSEXUALITY

Approved December 2013 by the APA Board of Trustees

APA Position:  While recognizing that the scientific understanding is incomplete and often distorted because of societal stigma, the American Psychiatric Association holds the following positions regarding same-sex attraction and associated issues. 

It is the American Psychiatric Association’s position that same-sex attraction, whether expressed in action, fantasy, or identity, implies no impairment per se in judgment, stability, reliability, or general social or vocational capabilities.  The American Psychiatric Association believes that the causes of sexual orientation (whether homosexual or heterosexual) are not known at this time and likely are multifactorial including biological and behavioral roots which may vary between different individuals and may even vary over time. The American Psychiatric Association does not believe that same-sex orientation should or needs to be changed, and efforts to do so represent a significant risk of harm by subjecting individuals to forms of treatment which have not been scientifically validated and by undermining self-esteem when sexual orientation fails to change.  No credible evidence exists that any mental health intervention can reliably and safely change sexual orientation; nor, from a mental health perspective does sexual orientation need to be changed.

The American Psychiatric Association opposes discrimination against individuals with same-sex attraction whether it be in education, employment, military service, immigration and naturalization status, housing, income, government services, retirement benefits, ability to inherit property, rights of survivorship, spousal rights, family status, and access to health services.  The American Psychiatric Association recognizes that such discriminations, as well as societal, religious, and family stigma, may adversely affect the mental health of individuals with same-sex attraction necessitating intervention by mental health professionals, for which, the American Psychiatric Association supports the provision of adequate mental health resources to provide that intervention.  The American Psychiatric Association supports same-sex marriage as being advantageous to the mental health of same-sex couples and supports legal recognition of the right for same-sex couples to marry, adopt and co-parent.

Support of Legal Recognition of Same-Sex Civil Marriage

Approved by the Assembly, May 2005
Approved by the Board of Trustees, July 2005

"Policy documents are approved by the APA Assembly and Board of Trustees…These are … position statements that define APA official policy on specific subjects…" -- APA Operations Manual.

As physicians who frequently evaluate the impact of social and family relationships on child development, and the ability of adults and children to cope with stress and mental illness, psychiatrists note the invariably positive influence of a stable, adult partnership on the health of all family members. Sustained and committed marital and family relationships are cornerstones of our social support network as we face life’s challenges, including illness and loss. There is ample evidence that long-term spousal and family support enhances physical and mental health at all stages of development.

This position statement is about the legal recognition of same-sex civil marriage, not religious marriage, and it does not pertain to any organized religion’s view of same-sex marriage.

Heterosexual relationships have a legal framework for their existence through civil marriage, which provides a stabilizing force. In the United States, with the exception of Massachusetts, same-sex couples are currently denied the important legal benefits, rights and responsibilities of civil marriage. Same-sex couples therefore experience several kinds of state-sanctioned discrimination that can adversely affect the stability of their relationships and their mental health.

The children of unmarried gay and lesbian parents do not have the same protection that civil marriage affords the children of heterosexual couples. Adoptive and divorced lesbian and gay parents face additional obstacles. An adoptive parent who is lesbian or gay is often prejudicially presumed as unfit in many U.S. jurisdictions. Furthermore, when unmarried couples do adopt, usually one parent is granted legal rights, while the other parent may have no legal standing. These obstacles occur even though no research has shown that the children raised by lesbians and gay men are less well adjusted than those reared within heterosexual relationships.

As the population ages, the denial of legal recognition of civil marriage has consequences for increasing numbers of older adults in same-sex relationships who face age-related health and financial concerns. Excluding these adults from civil marriage protections of survivorship and inheritance rights, financial benefits, and legal recognition as a couple in health care settings increases the psychological burden associated with aging.

The American Psychiatric Association has historically supported equity, parity, and non-discrimination in matters that have an impact on mental health. APA has also supported same-sex civil unions and the right of same-sex couples to adopt and co-parent children. This is because APA has a longstanding interest in civil rights and legal issues that affect mental health as well as a code of ethics that supports and respects human dignity. Educating the public about lesbian and gay relationships and supporting efforts to establish legal recognition of samesex civil marriage is consistent with the Association’s advocacy for minority groups.

Civil marriage is associated with a unique set of benefits that provide legal and economic protections to adults in committed relationships and to their children. Equal access to the institution of civil marriage is consistent with the APA’s opposition to discrimination based on sexual orientation. Therefore be it resolved that:

"In the interest of maintaining and promoting mental health, the American Psychiatric Association supports the legal recognition of same-sex civil marriage with all rights, benefits, and responsibilities conferred by civil marriage, and opposes restrictions to those same rights, benefits, and responsibilities.” Supporting Documents:

American Psychiatric Association (1973), Position statement on homosexuality and civil rights. American J. Psychiatry, 1974, 131:497. www.psych.org/edu/other_res/lib_archives/archives/730010.pdf

American Psychiatric Association (1990), Position statement on homosexuality and the armed services. www.psych.org/edu/other_res/ lib_archives/archives/900013.pdf

American Psychiatric Association (1991), Position statement:
Homosexuality and the Immigration and Naturalization Service. American J. Psychiatry, 148:1625.

American Psychiatric Association Committee on Gay, Lesbian, and Bisexual Issues (1993), Position statement on homosexuality. American J. Psychiatry, 150:686. www.psych.org/edu/other_res/ lib_archives/archives/ 730010.pdf

Resource Document on Controversies in Child Custody: Gay and Lesbian Parenting; Transracial Adoptions; Joint v. Sole Custody and Custody Gender Issues: Approved by Board of Trustees, December 1997.

Resource Document on Same Sex Marriage: Approved by the Board of Trustees, December 1998.

American Psychiatric Association (1998), Position statement on psychiatric treatment and sexual orientation. American J. Psychiatry, 1999; 156:1131. www.psych.org/edu/other_res/ lib_archives/archives/ 980020.pdf

American Psychiatric Association (2000), Commission on Psychotherapy by Psychiatrists (COPP): Position statement on therapies focused on attempts to change sexual orientation (Reparative or conversion therapies). American J. Psychiatry, 157:1719-1721. www.psych.org/edu/other_res/ lib_archives/archives/200001.pdf

American Psychiatric Association (2000), Position statement on same sex civil unions. December 2000American Psychiatric Association (2002),

Position Statement on Adoption and Co-Parenting of Children by Same Sex Couples. November 2002.

Brief for Amici Curiae in the case of Lawrence and Garner v. Texas (signed by American Psychiatric Association), January 2003. www.psych.org/edu/other_res/lib_archives/archives/amicus/02-102.pdf

American Psychological Association (2004), Resolution on Sexual Orientation and Marriage. http://www.apa.org/pi/lgbc/policy/marriage.pdf

Amended APA Resource Document on Same Sex Marriage; Approved by the Board of Trustees, December 2004.

American Psychiatric Association: Position statement on same sex civil unions (revised); Approved by Board of Trustees, December 2004.

Position paper of the Massachusetts Psychiatric Society on Gay Marriage, November 2004

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Position Statement on Same Sex Unions

Approved December 2000 by the APA Board of Trustees

The APA expresses a valid interest in the well being of heterosexual married couples in such areas as children's mental health and other aspects of family life. Heterosexual relationships have a legal framework for their existence, which provides a stabilizing force.

In the United States, with the recent exception of Vermont, same sex partners are currently denied the important benefits and responsibilities of legal marriage. Same sex couples therefore experience several kinds of state-sanctioned discrimination that affect the stability of their relationships.

The children of gay and lesbian parents do not have the same protection that legal marriage affords the children of heterosexual couples. Adoptive and divorced lesbian and gay parents face additional obstacles. An adoptive parent who is lesbian or gay is presumed unfit in many U.S. jurisdictions. Furthermore, when couples do adopt, usually one parent is granted legal rights, while the other parent may have no legal standing. These obstacles occur even though research has shown that the children raised by lesbian and gay men are as well adjusted as those reared within heterosexual relationships.

The American Psychiatric Association has historically supported equity, parity, and non-discrimination regarding legal issues affecting mental health. Educating the public about lesbian and gay relationships and supporting efforts to establish same sex legal unions is consistent with the Association's advocacy for other disadvantaged minority groups.

"The American Psychiatric Association supports the legal recognition of same sex unions and their associated legal rights, benefits, and responsibilities."

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"Reparative" Therapy

Position Statement on Conversion Therapy and LGBTQ Patients

Approved by the Board of Trustees, December 2018
Approved by the Assembly, November 2018

Issue:
Since 1998, the American Psychiatric Association has opposed any psychiatric treatment, such as "reparative" or conversion therapy, which is based upon the assumption that homosexuality per se is a mental disorder or that a patient should change his/her homosexual orientation1. This position statement updates and replaces previous position statements about conversion therapy regarding sexual orientation, furthermore it also comments on conversion therapy with gender diverse patients in an attempt to prevent harm to any lesbian, gay, bisexual, transgender, or queer person.

In the past, diversity of sexual orientation and gender identity (e.g. homosexuality, bisexuality, and transgender identities) were seen as a mental illness. This changed in 1973 when the American Psychiatric Association stated that homosexuality per se is not a mental disorder2. While Gender Dysphoria remains a part of the DSM-5, there is growing social acceptance that human sexuality and gender identity can present in a variety of ways as part of the human condition3,4,5,6,7,8,9,10,11,12,13.

The validity, efficacy, and ethics of clinical attempts to change an individual's sexual orientation have been challenged14,15,16,17,18. The literature also consists of anecdotal reports of people who claim that attempts to change were harmful to them, and others who claimed to have changed and then later recanted those claims19,20,21,22,23,24,25,26,27,28,29,30,31. Along a similar vein, gender diverse patients have been shown to benefit from gender-affirming therapies32,33,34,35,36,37,38,39.40, and given the documented harm of “reparative” or conversion therapies regarding sexual orientation, it would likely be seen as unethical to research reparative therapy outcomes with gender diverse populations.

While many might identify as questioning, queer, or a variety of other identities, “reparative” or conversion therapy is based on the a priori assumption that diverse sexual orientations and gender identities are mentally ill and should change.

POSITION:
1. APA reaffirms its recommendation that ethical practitioners refrain from attempts to change individuals’ sexual orientation.
2. APA recommends that ethical practitioners respect the identities for those with diverse gender expressions.
© Copyright, American Psychiatric Association, all rights reserved
3. APA encourages psychotherapies which affirm individuals’ sexual orientations and gender identities.
4. APA encourages legislation which would prohibit the practice of “reparative” or conversion therapies that are based on the a priori assumption that diverse sexual orientations and gender identities are mentally ill.
Authors:
Council on Minority Mental Health and Health Disparities

References:
1. Position Statement on Therapies Focused on Attempts to Change Sexual Orientation (Reparative or Conversion Therapies). (2000). Retrieved from http://file:///C:/Users/eyarbrough/Downloads/Position-2000-Therapies-Change-Sexual-Orientation%20(2).pdf

2. Drescher, J. (2009). Queer Diagnoses: Parallels and Contrasts in the History of Homosexuality, Gender Variance, and the Diagnostic and Statistical Manual. Archives Of Sexual Behavior, 39(2), 427-460.
3. Kinsey, A., Pomeroy, W., & Martin, C. (2010). Sexual behavior in the human male. Bronx, N.Y.: Ishi Press Int.
4. Kinsey, A. (2010). Sexual behavior in the human female. Bronx: Ishi Press International.
5. Hooker, E. (1957). The adjustment of the male overt homosexual. [Glendale, Calif.]: Society of Projective Techniqes and Rorschach Institute.
6. Levounis, P., Drescher, J., & Barber, M. (2012). The LGBT casebook. Washington, DC: American Psychiatric Pub.
7. Bell, A., & Weinberg, M. (1979). Homosexualities. New York: Simon and Schuster.
8. Friedman, R., & MacKinnon, R. (1988). Male homosexuality. New Haven: Yale University Press.
9. Isay, R. (2009). Being homosexual. New York: Vintage Books.
10. Magee, M., & Miller, D. (2014). Lesbian lives. New York, NY: Routledge.
11. Erickson-Schroth, L., & Boylan, J. (2014). Trans Bodies, Trans Selves. New York: Oxford University Press.
12. Drescher, J. (2001). Psychoanalytic therapy and the gay man. Hillsdale, NJ: Analytic Press.\
13. Isay, R. (2009). Being homosexual. New York: Vintage Books.
14. Haldeman, D. (1991). Sexual orientation conversion therapy for gay men and lesbians: A scientific examination. Homosexuality: Research Implications For Public Policy, 149-161.
15. Haldeman, D. (1994). The practice and ethics of sexual orientation conversion therapy. Journal Of Consulting And Clinical Psychology, 62(2), 221-227.
16. Brown, L. (1996). Ethical concerns with sexual minority patients. Textbook Of Homosexuality And Mental Health, 897-916.
17. Drescher, J. (1997). What needs changing? Some questions raised by separative therapy practices. New York State Psychiatric Society Bulletin, 40(1), 8-10.
18. Walker, J., & Albert, G. (2018). U.S. JOINT STATEMENT BY PROFESSIONAL ORGANIZATIONS WARNING AGAINST CONVERSION THERAPY. Gaylesta: The Psychotherapist Association for Gender & Sexual Diversity. Retrieved 5 March 2018, from https://gaylesta.org/us-joint-statement
19. Isay, R. (2009). Becoming gay. New York: Vintage Books.
20. Shidlo, A., Schroeder, M., & Drescher, J. (2001). Sexual Conversion Therapy: Ethical, Clinical and Research Perspectives (pp. 51-67). New York, London, Oxford: The Haworth Medical Press.
© Copyright, American Psychiatric Association, all rights reserved
21. Beckstead, A., & Morrow, S. (2004). Mormon Clients’ Experiences of Conversion Therapy. The Counseling Psychologist, 32(5), 651-690.
22. Borowich, A. (2008). Failed Reparative Therapy of Orthodox Jewish Homosexuals. Journal Of Gay & Lesbian Mental Health, 12(3), 167-177.
23. Dehlin, J., Galliher, R., Bradshaw, W., Hyde, D., & Crowell, K. (2015). Sexual orientation change efforts among current or former LDS church members. Journal Of Counseling Psychology, 62(2), 95-105.
24. Fjelstrom, J. (2013). Sexual Orientation Change Efforts and the Search for Authenticity. Journal Of Homosexuality, 60(6), 801-827
25. Flentje, A., Heck, N., & Cochran, B. (2013). Sexual Reorientation Therapy Interventions: Perspectives of Ex-Ex-Gay Individuals. Journal Of Gay & Lesbian Mental Health, 17(3), 256-277.
26. Haldeman, D. (2002). Therapeutic Antidotes: Helping Gay and Bisexual Men Recover from Conversion Therapies. Journal Of Gay & Lesbian Psychotherapy, 5(3-4), 117-130.
27. Maccio, E. (2011). Self-Reported Sexual Orientation and Identity Before and After Sexual Reorientation Therapy. Journal Of Gay & Lesbian Mental Health, 15(3), 242-259.
28. Schroeder, M., & Shidlo, A. (2002). Ethical Issues in Sexual Orientation Conversion Therapies: An Empirical Study of Consumers. Journal Of Gay & Lesbian Psychotherapy, 5(3-4), 131-166.
29. Shidlo, A., & Schroeder, M. (2002). Changing sexual orientation: A consumers' report. Professional Psychology: Research And Practice, 33(3), 249-259.
30. Smith, G. (2004). Treatments of homosexuality in Britain since the 1950s--an oral history: the experience of patients. BMJ, 328(7437),
31. Weiss, E., Morehouse, J., Yeager, T., & Berry, T. (2010). A Qualitative Study of Ex-Gay and Ex-Ex-Gay Experiences. Journal Of Gay & Lesbian Mental Health, 14(4), 291-319.
32. Roehr, B. (2015). Comfortable in their bodies: the rise of transgender care. BMJ, 350(jun05 6), h3083-h3083.
33. PANDYA, A. (2014). Mental Health as an Advocacy Priority in the Lesbian, Gay, Bisexual, and Transgender Communities. Journal Of Psychiatric Practice, 20(3), 225-227.
34. Buchholz, L. (2015). Transgender Care Moves Into the Mainstream. JAMA, 314(17), 1785.
35. Deutsch, M., Bhakri, V., & Kubicek, K. (2015). Effects of Cross-Sex Hormone Treatment on Transgender Women and Men. Obstetrics & Gynecology, 125(3), 605-610.
36. Griffin, L. (2011). The Other Dual Role: Therapist as Advocate with Transgender Clients. Journal Of Gay & Lesbian Mental Health, 15(2), 235-236.
37. Ruppin, U., & Pfäfflin, F. (2015). Long-Term Follow-Up of Adults with Gender Identity Disorder. Archives Of Sexual Behavior, 44(5), 1321-1329.
38. WPATH. (2017). Wpath.org. Retrieved 6 May 2017, from http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1351&pk_association_webpage=4655
39. White Hughto, J., & Reisner, S. (2016). A Systematic Review of the Effects of Hormone Therapy on Psychological Functioning and Quality of Life in Transgender Individuals. Transgender Health, 1(1), 21-31.
40. Yarbrough, E. (2018). Transgender Mental Health. Arlington, VA: American Psychiatric Association Publishing.

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Adoption and Co-parenting of Children by Same-sex Couples

POSITION STATEMENT
Approved by the Board of Trustees, November 2002
Approved by the Assembly, November 2002

"Policy documents are approved by the APA Assembly and Board of Trustees…
These are position statements that define APA official policy on specific subjects…" -- APA Operations Manual.

Numerous studies over the last three decades consistently demonstrate that children raised by gay or lesbian parents exhibit the same level of emotional, cognitive, social, and sexual functioning as children raised by heterosexual parents. This research indicates that optimal development for children is based not on the sexual orientation of the parents, but on stable attachments to committed and nurturing adults. The research also shows that children who have two parents, regardless of the parents’ sexual orientations, do better than children with only one parent.

While some states have approved legislation sanctioning second parent adoption, other court judgments and legislation have prohibited lesbian women and gay men from adopting or co-parenting. Therefore, in most of the United States, only one partner in a committed gay or lesbian couple may have a legal parental relationship to a child they are raising together. Adoption by a second parent, however, would not only formalize a child’s existing relationships with both parents in a same-sex couple, it would also provide vital security for the child. Children could avail themselves of both parents’ health insurance benefits, access to medical care, death benefits, inheritance rights, and child support from both parents in the event of separation. Adoption protects both parents’ rights to custody and/or visitation if the couple separates or if one parent dies.

The American Psychiatric Association has historically supported equity, parity, and non-discrimination regarding legal issues affecting mental health. In 2000, APA supported the legal recognition of same sex unions and their associated legal rights, benefits, and responsibilities. APA has also supported efforts to educate the public about homosexuality and the mental health needs of lesbian women, gay men, and their families. Removing legal barriers that adversely affect the emotional and physical health of children raised by lesbian and gay parents is consistent with the goals of the APA.

The American Psychiatric Association supports initiatives which allow same-sex couples to adopt and co-parent children and supports all the associated legal rights, benefits, and responsibilities which arise from such initiatives.

This position statement was drafted and proposed by the Committee on Gay, Lesbian, and Bisexual Issues and was supported by the Council on Minority Mental Health and Health Disparities.

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Parenting Rights for Same-Sex Couples Advanced

On June 15, the American Medical Association became the latest organization to call for equal parenting rights for same-sex couples. Learn more about supportive policy statements of the following organizations:

American Academy of Child and Adolescent Psychiatry
American Academy of Family Physicians
American Academy of Pediatrics
American Anthropological Association
American Bar Association
American Medical Association
American Psychiatric Association
American Psychoanalytic Association
American Psychological Association
Child Welfare League of America
National Association of Social Workers
North American Council on Adoptable Children

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