Sexuality and Gender - The New Atlantis

~ 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 ¡ª 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 ¡ª 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 children 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

Executive Summary

7

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.

Introduction

10

Part 1: Sexual Orientation

13

Abstract 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

Part 2: Sexuality, Mental Health Outcomes, and Social Stress

59

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

Stigma 79

Concealment 81

Testing the model 82

Conclusion 85

Part 3: Gender Identity

86

Abstract 86

Key Concepts and Their Origins 87

Gender Dysphoria 93

Gender and Physiology 98

Transgender Identity in Children 105

Therapeutic Interventions in Children 106

Therapeutic Interventions in Adults 108

Conclusion

114

Notes

117

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).

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Preface

T

his report was written for the general public and for mental

health professionals in order to draw attention to ¡ª and offer

some scientific insight about ¡ª 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

4 ~ The New Atlantis

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