Sexual Orientation and Gender Identity Change Efforts: Are They the Same? Part 1

Sexual Orientation and Gender Identity Change Efforts: Are They the Same? Part 1
July 30, 2021

This blog series is drawing from the research paper: “The Problems with Correlating Sexual Orientation Change Efforts and Gender Identity Change Efforts,” available for free here. Written by Drs. Paul Eddy and Preston Sprinkle.

It has become commonplace to correlate Sexual Orientation Change Efforts (SOCE) with Gender Identity Change Efforts (GICE). But are they the same? Or even similar? My short answer is: not only do they share many more dissimilarities than similarities, but that the correlation between the two has the potential to harm many thousands, if not millions, of young people who are wrestling with their gender. But it’ll take us several blog posts to substantiate this rather provocative conclusion.


Let’s start by looking at how several respectable and influential organizations correlate SOCE with GICE. The American Psychological Association puts it plainly: 

“Conversion therapy” is a widely discredited form of psychosocial intervention (American Psychological Association, 2009) that seeks to change an individual’s sexual orientation or gender identity.[1] 


“Conversion therapy” is used as an umbrella term to describe both sexual orientation and gender identity change efforts. GLAAD follows in suit:

Conversion therapy is any attempt to change a person’s sexual orientation, gender identity, or gender expression.[2]


A statement by the U.S.-based Human Rights Campaign says virtually the same thing:

So-called “conversion therapy,” sometimes known as “reparative therapy,” is a range of dangerous and discredited practices that falsely claim to change a person’s sexual orientation or gender identity or expression.[3]


As does The American Medical Association:

So-called “conversion therapy” refers to any form of intervention, such as individual or group, behavioral, cognitive or milieu/environmental operations, that attempts to change an individual’s sexual orientation or sexual behaviors (sexual orientation change efforts [SOCE]) or an individual’s gender identity (gender identify change efforts [GICE]).[4] 

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According to Jack Drescher, the first explicit expression of this conflation was made by Simon D. Pickstone-Taylor in a 2003 Letter to the Editor of the Journal of the American Academy of Child & Adolescent Psychiatry.[5] Since then, this linkage has become an unquestioned cultural commonplace and has even trickled down to legislation around the globe. For instance, the Canadian Bill C-6, currently under consideration, would criminalize conversion therapy, defined as any

practice, treatment or service designed to change a person’s sexual orientation to heterosexual or gender identity to cisgender, or to repress or reduce non-heterosexual attraction or sexual behaviour.[6] 


In Australia, the Change or Suppression (Conversion) Practices Prohibition Bill 2020 was passed by the Victorian Parliament on February 4, 2021. This bill serves to ban

any practices directed at an individual that attempt to change or suppress a person's sexual orientation or gender identity.[7] 


One of the most interesting slights of hand that has gone virtually unnoticed in these correlations is the unsubstantiated assumption that the many studies that disprove the effectiveness of SOCE can be cited to discredit GICE, despite the fact that there is little to no evidence for correlating the two.


This was recently brought to light by leading sexologist Dr. James Cantor in his scathing critique of the American Academy of Pediatrics (AAP) 2018 statement on SOCE and GICE. The AAP reflects the language of other orgs cited above:

“[C]onversion” or “reparative” treatment models are used to prevent children and adolescents from identifying as transgender or to dissuade them from exhibiting gender-diverse expressions . . . . Reparative approaches have been proven to be not only unsuccessful‍ but also deleterious and are considered outside the mainstream of traditional medical practice.”[8] 


As with the other statements above, “reparative approaches” include both SOCE and a kind of GICE. (It’s worth noting that many people accused of practicing GICE would never try to persuade someone of “gender-diverse expressions”.) The problem here, as Cantor notes, is that there are no studies of conversion therapy for gender identity. Studies of conversion therapy have been limited to sexual orientation, and, moreover, to the sexual orientation of adults, not to gender identity and not of children in any case.”[9] Cantor, who also identifies as gay, goes on to point out: “Although AAP emphasized to the reader that “gender identity is not synonymous with ‘sexual orientation’…they went ahead and treated them as such nonetheless.”[10] 


How has this happened? How have so many highly revered and influential organizations spoken about sexual orientation and gender identity as if they’re the same thing, even while admitting that they’re not the same thing? And how has it taken this long for someone to “fact check” the assumption that there are many studies discrediting GICE, when those studies are focused on SOCE and not GICE?


We’re going to spend several blog posts addressing these and other questions. Before we close, we should point out some similarities between sexual orientation and gender identity.


First, it’s possible that the equation of SOCE and GICE is at least partly influenced by the prior conflation of sexual orientation and gender identity themselves. For instance, early sexologists like Richard von Krafft-Ebing (1840-1902) virtually equated homosexuality with transsexuality. Similarly, Karl Ulrichs, a 19th century pioneer of both sexology and gay rights, wrote several treatises on homosexuality which he referred to as “psychic hermaphroditism” and described as a woman’s soul is encased in a male body.[11] 


Even though it was common to equate the two well into the 20th century, sexologists and psychologists today now know that sexual orientation and gender identity are two distinct phenomena, which makes it a little odd that the differences between SOCE and GICE aren’t explored more often.


Second, many contemporary researchers say that childhood gender non-conformity is often a precursor to later same-sex orientation in adolescence and adulthood.[12] Likewise, many trans* identified people (especially females) also experience attractions to the same biological sex. This doesn’t mean that orientation and gender identity are the same; it simply means that at least some T people are also LGB, and some LGB people have similar gender-nonconforming experiences as T people.


Third, and similar to the previous point, much of 20th-century psychoanalytic theory viewed homosexuality as a condition stemming from a dysfunctional parent-child relationship. And a similar theory was also applied to gender identity disorders—specifically, to young boys who were believed to have had an overly-enmeshed mother and/or a passive or absent father.[13] In other words, the same kind of nature vs. nurture debates have been had over both same-sex attraction and gender dysphoria.


Lastly, there have been various historical and political connections between the LGB and trans* communities such that, by the end of the 1990s, it was increasingly common to find a “T” being added to “LGB” within a variety of organizations and public forums.[14] Researchers have pointed out that one unifying social force is the fact that “discrimination against both gay and transgender people stems from transgressing gender norms.”[15] Indeed, people who have gone through SOCE and so-called GICE both have a history of widespread ridicule, shame, opposition, and abuse, by virtue of having a minority experience. Both gender minorities (T) and sexual minorities (LGB) share similar minority experiences living in a majority context.


Despite these similarities—some of which we probably shouldn’t try to resurrect—there are many more differences between sexual orientation and gender identity, which should warn against conflating SOCE with GICE. We will unpack several of these, beginning with the problem of definitions—while the meaning of Sexual Orientation Change Efforts (SOCE) are readily understood (and rejected by most people in society), the meaning of Gender Identity Change Efforts is fraught by different words that mean different things to many different people with many different assumptions about human nature. One person’s “gender identity change” is another person’s “helping a teenager accept their (God given) bodies.” It all depends on one’s anthropological assumptions and the disparate meanings assigned, or assumed, in the words they are using. We’ll explore this further in the next blog post.

[1] APA, “Banning Sexual Orientation and Gener Identity Change Efforts,”

[3] Human Rights Campaign, “The Lies and Dangers of Efforts to Change Sexual Orientation or Gender Identity,”,

[4] AMA, “LGBTQ change efforts (so-called ‘conversion therapy’),”

[5] Jack Drescher, “Queer Diagnoses: Parallels and Contrasts in the History of Homosexuality, Gender Variance, and the Diagnostic and Statistical Manual,” Archives of Sexual Behavior 39/2 (2010), 427-60 (here p. 451). See Simon D. Pickstone-Taylor, “Children with Gender Nonconformity [Letter to the Editor],” Journal of the American Academy of Child & Adolescent Psychiatry 42/3 (2003), 266.

[6] “Bill C-6: An Act to amend the Criminal Code (conversion therapy),” Department of Justice – Government of Canada (October 27, 2020),

[7] “Change or Suppression (Conversion) Practices Prohibition Bill 2020,” Department of Justice and Community Safety – Victorian Government (February 4, 2021),

[8] Jason Rafferty, AAP Committee on Psychosocial Aspects of Child and Family Health, AAP Committee on Adolescents, AAP Section on Lesbian, Gay, Bisexual, and Transgender Health and Wellness, “Ensuring Comprehensive Care and Support for Transgender and Gender Diverse Children and Adolescents,” Pediatrics 142/4 (2018), e20182162 (p. 4). DOI:

[9] James Cantor, “Transgender and Gender Diverse Children and Adolescents: Fact-Checking of AAP Policy,” Journal of Sex and Marital Therapy 46/4 (2020), 307-13 (here p. 308; emphasis in text).

[10] Ibid., 308-09.

[11] On some of the ways in which gender norms and stereotypes influenced scientific conclusions on homosexuality in the first half of the 20th century, see Karen A. Martin, “Gender and Sexuality: Medical Opinion on Homosexuality, 1900 – 1950,” Gender & Society 7/2 (1993), 246-60. On Ulrich and his uranism theory, see Robert Beachy, Gay Berlin: Birthplace of a Modern Identity (New York: Knopf, 2014), 3-41.

[12] E.g., Harry Bakwin, “Deviant Gender-Role Behavior in Children: Relation to Homosexuality,” Pediatrics 41 (1968), 620-29; Bernard Zuger, “Early Effeminate Behavior in Boys: Outcome and Significance for Homosexuality,” Journal of Nervous and Mental Disease 172/2 (1984), 90-97; T. D. Steensma and P. T. Cohen-Kettenis, “More than Two Developmental Pathways in Children with Gender Dysphoria?,” Journal of the American Academy of Child and Adolescent Psychiatry 54/2 (2015), 147–48.

[13] A version of this approach was taken by Richard Green, the lead researcher in the single-most significant 20th-century study of gender-nonconforming children, which were eventually published in his 1987 book, The “Sissy Boy Syndrome” and the Development of Homosexuality.

[14] E.g., Parents, Families and Friends of Lesbians and Gays, “PFLAG Votes ‘Yes’ Overwhelmingly to Include Transgender in Mission” (September 23, 1998), releases/923b.html.

[15] Jami K. Taylor, Daniel C. Lewis, and Donald P. Haider-Markel, The Remarkable Rise of Transgender Rights (Ann Arbor, MI: University of Michigan Press, 2018), 41-42.