Tag: american college of pediatricians

Information and Misinformation on Gender Dysphoria from Wallbuilders and the American College of Pediatricians, Part One

Tuesday on Wallbuilders Live, Dr. Michelle Cretella represented tiny pediatric breakaway group the American College of Pediatricians. She briefly discussed the organization’s position paper on responding to gender identity issues. In doing so, she said something which caught my irony sensor. It also occurred to me, as it repeatedly has in the discussion of gender dysphoria, how difficult it is to avoid taking extreme positions.
Listen to her response to a question from host Rick Green about how much harm gender dysphoria is causing.

I want to address two claims that came up in this segment. In this post, I address the claim that 80% of gender dysphoric children will accept their biological sex with therapy. In a future post, I will write about the claim about suicide rates.
Cretella says:

They’re [advocates for transgender children] cooperating with, at least, mental confusion.  You know, initially, we know that there is psychiatric literature that shows if you work with these children one on one and with their families, the vast majority, over 80% will come to accept their biological sex after puberty before adulthood. So yes, to put these children to reaffirm their confused thinking, to put them on puberty blockers, and then cross-sex hormones to make them quote unquote the other gender, you are permanently sterilizing children. It’s insanity.

Cretella is correct that persistence rates are low (gender dysphoria continuing into adulthood) among gender dysphoric children, but this is not the case with adolescents who remain gender dysphoric or those who experience it with an adolescent onset. In their paper, ACP uses the American Psychiatric Association’s DSM-V as an authority. The section of the DSM-V cited by ACP supports the claim about persistence but does not fully support Cretella’s claim about the role of therapy.

Rates of persistence of gender dysphoria from childhood into adolescence or adulthood vary. In natal males, persistence has ranged from 2.2% to 30%. In natal females, persistence has ranged from 12% to 50%. Persistence of gender dysphoria is modestly correlated with dimensional measures of severity ascertained at the time of a childhood baseline assessment. In one sample of natal males, lower socioeconomic background was also modestly correlated with persistence. It is unclear if particular therapeutic approaches to gender dysphoria in children are related to rates of long-term persistence. Extant follow-up samples consisted of children receiving no formal therapeutic intervention or receiving therapeutic interventions of various types, ranging from active efforts to reduce gender dysphoria to a more neutral, “watchful waiting” approach. It is unclear if children “encouraged” or supported to live socially in the desired gender will show higher rates of persistence, since such children have not yet been followed longitudinally in a systematic manner. For both natal male and female children showing persistence, almost all are sexually attracted to individuals of their natal sex. For natal male children whose gender dysphoria does not persist, the majority are androphilic (sexually attracted to males) and often self-identify as gay or homosexual (ranging from 63% to 100%). In natal female children whose gender dysphoria does not persist, the percentage who are gynephilic (sexually attracted to females) and self-identify as lesbian is lower (ranging from 32% to 50%). (APA, DSM-V, p. 455)

To the DSM-V, I can add the description of persistence developed by the World Professional Association for Transgender Health (WPATH) in their standards of care.

An important difference between gender dysphoric children and adolescents is in the proportion for whom dysphoria persists into adulthood. Gender dysphoria during childhood does not inevitably continue into adulthood.V Rather, in follow-up studies of prepubertal children (mainly boys) who were referred to clinics for assessment of gender dysphoria, the dysphoria persisted into adulthood for only 6–23% of children (Cohen-Kettenis, 2001; Zucker & Bradley, 1995). Boys in these studies were more likely to identify as gay in adulthood than as transgender (Green, 1987; Money & Russo, 1979; Zucker & Bradley, 1995; Zuger, 1984). Newer studies, also including girls, showed a 12–27% persistence rate of gender dysphoria into adulthood (Drummond, Bradley, Peterson-Badali, & Zucker, 2008; Wallien & Cohen-Kettenis, 2008).
In contrast, the persistence of gender dysphoria into adulthood appears to be much higher for adolescents. No formal prospective studies exist. However, in a follow-up study of 70 adolescents who were diagnosed with gender dysphoria and given puberty-suppressing hormones, all continued with actual sex reassignment, beginning with feminizing/masculinizing hormone therapy (de Vries, Steensma, Doreleijers, & Cohen-Kettenis, 2010).
Another difference between gender dysphoric children and adolescents is in the sex ratios for each age group. In clinically referred, gender dysphoric children under age 12, the male/female ratio ranges from 6:1 to 3:1 (Zucker, 2004). In clinically referred, gender dysphoric adolescents older than age 12, the male/female ratio is close to 1:1 (Cohen-Kettenis & Pfäfflin, 2003). (WPATH, p. 11).

The irony of Cretella’s confidence in psychiatric intervention relates to the expulsion from ACP membership of George Rekers who was infamous for his own personal decline and his discredited treatment approach to what was then called gender identity disorder. In fact, we don’t know the role, if any, therapy plays in influencing the current persistence rates. While there is reason to think parental permission to transition in childhood might increase the persistence rates, there isn’t sufficient research to say for sure.
After listening to Cretella and reading the ACP paper, I wonder what the ACP recommends for the 10-20% of people with gender dysphoria persisting into the late teens. Do they favor reassignment for those persons? They focus on the data which make their point but don’t seem to have an answer for the rest of the people involved.
Another problem with ACP’s confidence in psychiatric interventions for gender dysphoria is that they also oppose a frequent end point in the trajectory of many gender dysphoric children: homosexuality (see image at the end of the post). One of the reasons George Rekers tried to re-orient gender dysphoria was to prevent homosexuality. Furthermore, one of the prime objectives of reparative therapists like Joseph Nicolosi is to prevent homosexuality via the alteration of parenting behaviors toward gender nonconforming children. ACP should stop pretending to sympathize with gender dysphoric children when they also write letters to school personnel promoting reparative change therapy for gay people.
Summary
Cretella is right that studies of gender dysphoric children (mostly with boys) find low rates of persistence of gender dysphoria into adulthood. However, she should have distinguished between prepubescent children and teens. The outcomes for these two groups do not appear to be the same. No doubt her listeners will not make that distinction.
Cretella was wrong to invoke psychiatric treatment as the reason for low persistence rates. If anything, some treatments have been shown to be harmful in some cases while others may not be harmful but may not cause a reduction in gender dysphoria. From her presentation, one could get the impression that advocates for gender dysphoric children know these treatments work but are motivated to undermine the natural family and therefore withhold appropriate medical care. While there is strong disagreement among experts and some advocates might oppose traditional families, it is simply not true that gender dysphoria could be easily treated if only activists would get out of the way.
Another important factor is that the treatment advocated by Cretella and the ACP is an outdated, discredited, psychoanalytically based approach which has not shown success. Even among those in the mainstream who are skeptical of puberty blocking drugs, the treatments advocated by ACP are rejected.
Gender Dysphoria After Childhood
The following image comes from a 2012 study by Devita Singh on gender dysphoric boys. Note the columns titled “sexual orientation in fantasy” and “sexual orientation in behavior.” By far, the most common end point for gender dysphoric children across studies is some level of same sex attraction. Gay advocates have in the past confided to me that they are ambivalent about supporting interruption of puberty because such interventions may interfere with a natural homosexual outcome. Please see this common sense article by Michael Bailey and Eric Vilain on the dilemma many parents of gender dysphoric children face.
Singh table

Wallbuilders Tells Audience One Thing and Pediatricians Another Thing

Yesterday, I posted a note from Wallbuilder’s Caroline Henry to the American Academy of Pediatrics. The note addressed a previous Wallbuilder’s show during which David Barton claimed that the leading association of pediatricians in America warned schools to stop indoctrinating students into homosexuality. See the original post for details; in short the real leading association (the American Academy of Pediatrics) did not issue any such warning. The American College of Pediatricians a small group of socially conservative pediatricians and related professionals did so over a year ago. They are not a leading group of pediatricians.
The AAP wrote to Barton in order correct him and and via Caroline Henry, he wrote back to the AAP with the following message:

Hi Debora (sic),
Thank you for your email to WallBuilders Live, I apologize for the delay in response but I hope I can address your concerns!
After airing the episode about ACP David and Rick were informed that the news source they quoted during the episode was mistaken. David and Rick sent a letter to the news source addressing the mistaken information in the story. We apologize for the mix up and appreciate your notification as well.
If you have any further question or concerns please feel free to contact us. Many blessings!
Caroline Henry
wallbuilderslive.com

However, today, David Barton and co-host Rick Green addressed their earlier error but did not blame a faulty news source. Instead, they did not admit the error and declined to retract their earlier statements. You can hear the entire segment at the Wallbuilder’s site here; listen between 10:00 and 12:35. Right Wing Watch has most of the audio segment transcribed which I reproduce here:

Green: Actually David I got a—actually it’s not a retraction at all actually—we got a letter that wanted a retraction. Remember when we did the show? There was a great paper that was put out by the American Academy—I mean the American College of Pediatricians, and they were saying look some of this stuff you’re doing on homosexuality in schools is dangerous for kids, this homosexual agenda is not a good idea and bringing it into the classroom and that sort of thing. We did a whole program on this. In the program we talked about hey this is one of the leading pediatric associations in the nation, and we got a letter from one of the other pediatric associations, let’s see the American Academy of Pediatrics, which has more members and has been around a little longer and they I guess took offense to that so they sent us a letter and they said they wanted to make sure we knew that the ACP was not the leading pediatric association in America and they put some of their papers in here and there position is a little different I would say—
Barton: Oh yeah, oh yeah.
Green: Much more liberal on this. As we pointed out to them directly and we’ll put it out here on the show: leading does not mean largest, leading means, sometimes it takes a newer, leaner more responsive organization—
Barton: And they are one of the leading organizations. Now the fact that this other organization may not like them and may disagree with them doesn’t mean they’re not a leading organization. They are a credentialed organization made up of credentialed people and the fact that they don’t agree with them doesn’t make them less than leading. And if they’re expecting a retraction, sorry, ain’t happening!

Then, at 11:56, Barton says, “We didn’t get this one wrong.”
The closest thing to the sentiment expressed in the email to the AAP was this statement at 12:19, from Rick Green:

No, we do apologize if the American Academy of Pediatrics was offended by us calling the American College of Pediatricians a leading pediatrics association, but uh, sorry that you were offended, but we still think they’re leading and love the good work they are doing.

In their note to the AAP, Wallbuilder’s Caroline Henry called the earlier broadcast an error based on a faulty news source. On their broadcast to listeners, however, Barton and Green said there was no error. Which is it?
If Barton and Green were referring to the ACP all along, then they needs to issue a retraction to the ACP. About the ACP, they said:

Barton: What’s interesting is, you know medical groups do not tend to be very conservative. Any professional medical group, the American Psychiatric Association, the association of psychologists, even the American Medical Association is a particularly friendly conservative group, they’re not a pro-life group and what’s really interesting is the American College of Pediatricians; now think about that, is that a conservative group?
Green: You’d think they would be, looking out for the kids, right?
Barton: But yeah, don’t spank your kid, don’t touch your kid, you know, and think of the way pediatric stuff has gone, and you don’t want to help shape these kids, let ‘em be what they want to be. And so, all that anti-parental influence, and it’s remarkable that you have the American College of Pediatricians, who has just, they sent a letter to all 14,800 school superintendents in the United States and it’s a letter warning about what’s happening in the schools and the American College of Pediatricians is cautioning educators about what they do with same-sex attraction or symptoms of gender identity confusion in schools.
Green: You’re kidding, this is the pediatric association?
Barton: The American College of Pediatricians is cautioning educators about what they do with same-sex attraction or symptoms of gender identity or gender confusion in schools.
Green: You’re kidding, this is the Pediatric Association?
Barton: Got it, get this. The letter reminds school superintends that it is ‘not uncommon for adolescents to experience transient,’ that’s a big word, ‘transient confusion about their sexual orientation,’ and is telling 14,800 superintendents that ‘most students will ultimately adopt a heterosexual orientation if not otherwise encouraged.’ And they’re saying, guys, back off. This indoctrination you’re doing—
Green: You plant that stuff in their minds, your leading them down that path.
Barton: If you’ll just let this develop naturally, they’ll end up being heterosexual unless you force them to be homosexual. Well that’s a remarkable letter coming from the leading pediatric association in America. And this is what it says, ‘for this reason schools should avoid developing policies that encourage non-heterosexual attractions among students who may be experimenting or experiencing temporary sexual confusion.’ The discouraging program, so all this bullying stuff–

(emphasis mine)
A visit to the ACP website will make it clear that they are pro-life and not anything like the picture painted by Barton about medical groups. Since the ACP had been taking the same position on homosexuality from the beginning of the group, the letter to superintendents was not at all remarkable. It was just par for their course. It is also clear that Barton referred to the ACP as the leading group not just one of several groups.

Wallbuilders blames unnamed news source for error about pediatricians

Remember when David Barton and Rick Green told their audience that the leading pediatricians association in the nation urged school staff to stop indoctrinating kids into homosexuality? The initial response from Rick Green to a listener was to claim that there was nothing wrong in what they said on the broadcast when they referred to the American College of Pediatricians as the leading group. Of course, the real leading group, the American Academy of Pediatrics, denied giving any such advice.
Today, I received an email from the American Academy of Pediatrics, alerting me that Wallbuiders had retreated from their earlier position. Here is the email forwarded by the AAP and reproduced with permission:

Hi Debora (sic),
Thank you for your email to WallBuilders Live, I apologize for the delay in response but I hope I can address your concerns!
After airing the episode about ACP David and Rick were informed that the news source they quoted during the episode was mistaken. David and Rick sent a letter to the news source addressing the mistaken information in the story. We apologize for the mix up and appreciate your notification as well.
If you have any further question or concerns please feel free to contact us. Many blessings!
Caroline Henry
wallbuilderslive.com

I took a quick look through Google for anyone else who might have called the American College of Pediatricians the leading association of pediatricians. Can’t find it. If anyone sees something to that effect, let me know.
I wonder if this news will make it on WallbuildersLive.

Wallbuilder's Rick Green defends comments about pediatrics associations

Early last week, I pointed out that David Barton and Rick Green identified the American College of Pediatricians as “the leading pediatric association in America.” In fact, ACP is a group of around 200 members which, in 2003, split off from the real leading group, the American Academy of Pediatrics. The AAP commented briefly later in the week.
I also mentioned that a reader, Bernie, wrote to Wallbuilders to ask why Barton and Green identified the ACP as the leading group. Rick Green responded and defended their characterization of ACP as the leading pediatric association. Reader and commenter Bernie, included this part of the conversation and asked why they described ACP in the way they did.

David: “The American College of Pediatricians is cautioning educators about what they do with same-sex attraction or symptoms of gender identity or gender confusion in schools.”
Rick: “You’re kidding, this is the Pediatric Association?”
Later, David: “Well that’s a remarkable letter coming from the leading pediatric association in America.”

Bernie pointed out that the ACP is a tiny group compared the AAP. Mr. Green replied with this explanation.

I am not aware of anything from our broadcast that was inaccurate. Nothing in the transcript you sent is wrong or false. We may disagree on what constitutes “leading,” but neither David or I said the ACP was the largest. As often happens, the larger associations become either stagnant or politically correct and lose the leadership qualities that make an organization “leading” in their profession. Meanwhile, a perhaps smaller, but more professional and cutting edge organization begins to lead by stating facts and putting forth truthful research the older organization is afraid to release due to political correctness.

Green said they may revisit the issue in a future broadcast.
None of what Green has to say about the ACP and the AAP is relevant to what it means to lead a profession. The ACP is hardly more cutting edge than the AAP but that even misses the point. A leading group in a profession speaks for the profession to the public and government. The leading group in a profession sets standards for training new members of the profession. The leading group in a profession provides continuing medical education for practicing members of the profession. The ACP does none of that.
While I have not checked this out, I would be willing to bet that no medical school uses any of the standards or materials from the ACP. I strongly suspect that no training programs seek approval or recognition from the ACP. The ACP is not a player in the profession. 
Green’s narrative makes no sense when one considers the way David Barton led into the segment. Here is the lead:

Barton: What’s interesting is, you know medical groups do not tend to be very conservative. Any professional medical group, the American Psychiatric Association, the association of psychologists, even the American Medical Association is a particularly friendly conservative group, they’re not a pro-life group and what’s really interesting is the American College of Pediatricians; now think about that, is that a conservative group?
Green: You’d think they would be, looking out for the kids, right?
Barton: But yeah, don’t spank your kid, don’t touch your kid, you know, and think of the way pediatric stuff has gone, and you don’t want to help shape these kids, let ‘em be what they want to be. And so, all that anti-parental influence, and it’s remarkable that you have the American College of Pediatricians, who has just, they sent a letter to all 14,800 school superintendents in the United States and it’s a letter warning about what’s happening in the schools and the American College of Pediatricians is cautioning educators about what they do with same-sex attraction or symptoms of gender identity confusion in schools.

Barton leads his listeners to think that he is about to tell them some news about physicians who are not conservative, not pro-life, say “don’t spank your kid,” and are “anti-parental influence.” He names the ACP as that group, asking:

…what’s really interesting is the American College of Pediatricians; now think about that, is that a conservative group?

Yes, actually, it is a very conservative group.
The ACP is pro-life, advocates spanking as an option and is pro-parents’ rights. Go check out their policy pages (parenting issues, abortion, and sexuality) and it is clear that the ACP is a conservative, but not leading, group.

American College of Pediatricians answers critics; removes Rekers

The American College of Pediatricians is the small breakaway group from the larger American Academy of Pediatrics. The ACP maintains the FactsAboutYouth website which I have critiqued here and which is the subject of this Minnesota City Pages article. Gary Remafedi is the main subject of the article, although it mentions Francis Collins letter as well as the concerns I expressed in my post on the subject.

In short, the article revives the request from Remafedi to alter the way the ACP reports his work:

The ACP argues that schools shouldn’t support gay teens because they’re probably just confused. “Most adolescents who experience same-sex attraction…no longer experience such attractions at age 25,” the letter says, citing a 1992 study by Remafedi.

Except that’s not what Remafedi’s research suggested at all. His work showed that kids who are confused about their sexuality eventually sort it out—meaning many of them accept being gay.

“What was so troubling was that these were fellow doctors, fellow pediatricians,” Remafedi says. “They knew better, and they have the same ethical responsibilities to their patients that I do, but they deliberately distorted my research for malicious purposes.”

On their website, the ACP has answered their critics. In letters to Francis Collins and Remafedi, the ACP justifies their work. The ACP also mentions my critique but did not respond to it. They say here that I did not contact them. I did not contact the headquarters but I did contact some of the committee members with various concerns. Their rebuttals are not persuasive to me.

In a related development, the ACP has removed George Rekers from their website and psychosocial committee. According to Rachel Maddow’s blog, the move was because Rekers won’t answer their contacts and not because they are distancing themselves from his actions. The ACP added NARTH luminary Neil Whitehead to the committee.

Factsaboutyouth.com: A critical review

Yesterday, Focus on the Family’s Citizenlink promoted a new website from the American College of Pediatrics, called Facts About Youth which purports to be 

a resource created by health professionals to provide policymakers, parents and youth with the most current medical and psychological facts about sexual development.

The website makes additional claims about the information presented.

Amid debate in the medical and mental health fields concerning the causes and proper approaches to youth with non-heterosexual attractions, Facts is a non-political, non-religious channel presenting the most current facts on the subject. Facts is committed to advancing a school environment in which all students will experience the opportunity to achieve optimal health and safety, even in the midst of differing worldviews. Facts is intended to be a resource to promote the factual and respectful discussion of these potentially divisive issues. This is a web site for and about youth and their needs.

 While there may be some useful information here, I do not agree with much of what is claimed. The essential claims are that the site is “a non-political, non-religious channel presenting the most current facts on the subject.” In fact, the presentation is one-sided with old research and reparative theory dominating the content.

Following the link “homosexuality,” one reads what seems like a fair statement regarding causes of same-sex orientation. 

Clinical and scientific research suggests that the causes of homosexuality, or same-sex attraction, are multi-factorial with environment and temperament playing the strongest roles.

If one understands environment broadly as nurture and temperament broadly as nature, then this is a pretty obvious statement about the influence of both experience and biology. However, pretty quickly you find out that on this website, the terms mean whatever reparative drive theory say they mean. More on that in a bit.

The website purports to offer current research in a non-political channel. However, the reference list on the homosexuality page negates that claim. The first two references come from the NARTH (National Association for Research and Therapy of Homosexuality) website and are not studies but summaries of studies and the third is from NARTH board member George Rekers, published in a book by Julie Hamilton, NARTH president. Whatever one thinks of NARTH, one must concede that the organization is most certainly not impartial on the subject.

The list of additional resources is anything but current. There are 13 references listed, all but two of them were published prior to 2001. Those older references have been updated by newer work but you wouldn’t know it by reading here. The most current facts are not here, nor are they referenced here.

The references are also quite selective with four pertaining to child abuse, four relating to gender nonconformity/gender identity, one being a very dated (1993) critique of biological theories, one being a reference which actually undermines one aspect of reparative theory, one 1988 review of the link between homosexuality and mental disorders and two non-research books on the politics of homosexuality. This page alone is enough to discredit the claim that the page is current and non-political. The references are old and very selectively presented. There are no references on this page to the recent brain studies (e.g., Savic and Lindstrom, 2008), the brain scan work of Safron, et al, Wilson and Widom’s prospective child abuse study, Andrew Francis’s 2008 study of family factors and sexuality, findings of greater than expected X chromosome skewing in mothers of some gay males, or attentional differences related to sexual orientation.

Some newer research could have been presented which would have supported at least a broader environmental set of influences but these too were omitted. For instance, one of the newer and larger twin studies found

Overall, the environment shared by twins (including familial and societal attitudes) explained 0-17% of the choice of sexual partner, genetic factors 18-39% and the unique environment 61-66%. The individual’s unique environment includes, for example, circumstances during pregnancy and childbirth, physical and psychological trauma (e.g., accidents, violence, and disease), peer groups, and sexual experiences.

In fact, twin researchers are not sure what an individual’s unique environment involves. It may be that subtle differences (e.g., chorions) in the pre-natal environment of twins account for some of that variance. In any case, looking around the website reveals another bias which may limit even more what “facts” will be presented.

To wit, the two links which purport to provide a “more in depth analysis” about what causes homosexuality lead to Julie Hamilton’s Homosexuality 101 and a Family Research Councilarticle which defends reparative theory. The organizations which the ACP refer readers to are PFOX, NARTH, Freetobeme.com (a religious resource), the Ex-gay educators caucus of the NEA, and JONAH (Jewish – that’s religious, right?). All of these groups promote the same reparative narrative of how homosexuality develops.

There are so many problems with the site that I have to be selective. For instance, regarding lifespan of homosexuals, the site states:

The only epidemiological study to date on the life span of gay men concluded that gay and bisexual men lose up to 20 years of life expectancy.

One may think this is a reference to Paul Cameron but when one clicks the link, instead there is a summary of Hogg et al’s 1997 Canadian study. However, again this site does not live up to the claim of providing the most current facts on the topic. In a 2001 follow up letter commenting on their study, Hogg et al said:

In contrast, if we were to repeat this analysis today the life expectancy of gay and bisexual men would be greatly improved. Deaths from HIV infection have declined dramatically in this population since 1996. As we have previously reported there has been a threefold decrease in mortality in Vancouver as well as in other parts of British Columbia. (p. 1499).

In other words, the prior results may not be accurate in that location today nor were even these results meant to be generalized to all gay men. Furthermore, there is another epidemiological study which is more current. Morten Frisch and Henrik Brønnum-Hansen, in a 2009 issue of the American Journal of Public Health, evaluated data from Denmark and concluded that mortality for homosexual men marrying after 1996 is virtually the same as for heterosexual men in Denmark. This is the most current information but you won’t find it on the factsaboutyouth.com website.

Finally, the site has a section on change therapy. I am not sure why this is needed since the authors say most confused kids will end up straight. Anyway, the section here repeats NARTH’s views about change therapy and lo and behold references my 1998 review of the literature on conversion therapy — except now the link isn’t live since I recently asked NARTH to remove my articles from the NARTH website.  The mistake I made in that review is the same one NARTH makes in their recent paper and that this website makes. In my review, I summarized every study or anecdote I could find on reorientation without regard for the quality of the research methods (e.g., sampling, design, etc.). There are so many problems with the early research, most notably the absence of control groups, reliance on anecdotes and follow ups that I do not view that review as anything more than suggestive of the need for further research. If anything, I have come to see that efforts to change are most frequently efforts to bring one’s behavior and desires in line with religious beliefs or social expectations.

On the change therapy page, the statements about modalities would no doubt be confusing to a teen trying to get through this site, with unsubstatiated references to EMDR, reparative and Imago therapy. There are no controlled studies of these methods for purposes of sexual reorientation. Mentioning EMDR, etc., is all the more striking when you consider that a medical group hosts this project. Can you imagine pediatricians choosing drugs or medical treatments based on the kind of evidence provided here?

One more observation: I am confused by the denial of religious influence on this site. If done differently, I might support a conservative group of docs who wanted to encourage youth to consider the role of faith and family in making sense of their same-sex attractions. However, this site avoids that discussion and pretends that the resources listed are not associated with the religious right. I would prefer that the group simply declare their views directly. Physicians should recognize the important role of religious faith and for those people who believe at their core that homosexual behavior is wrong, there should be alternatives. This site however, provides only limited information and limited options and falls far short of the stated objectives.

An additional problem: The ACP website misrepresents Francis Collins. The website makes it seems as though Collins believes in sexual reorientation because he does not believe homosexuality is predetermined by a gene or genes. However, he actually said this to Exgaywatch:

It troubles me greatly to learn that anything I have written would cause anguish for you or others who are seeking answers to the basis of homosexuality. The words quoted by NARTH all come from the Appendix to my book “The Language of God” (pp. 260-263), but have been juxtaposed in a way that suggests a somewhat different conclusion that I intended. I would urge anyone who is concerned about the meaning to refer back to the original text.

The evidence we have at present strongly supports the proposition that there are hereditary factors in male homosexuality — the observation that an identical twin of a male homosexual has approximately a 20% likelihood of also being gay points to this conclusion, since that is 10 times the population incidence. But the fact that the answer is not 100% also suggests that other factors besides DNA must be involved. That certainly doesn’t imply, however, that those other undefined factors are inherently alterable.

Your note indicated that your real interest is in the truth. And this is about all that we really know. No one has yet identified an actual gene that contributes to the hereditary component (the reports about a gene on the X chromosome from the 1990s have not held up), but it is likely that such genes will be found in the next few years.

Collins confirmed the accuracy of this statement to me in a separate email. Note that he says his words were juxtaposed to create a different meaning than he intended. Also, note that lack of genetic predetermination does not mean that orientation is generally alterable.