A major new report, published today 
challenges the leading narratives
 that the media has pushed regarding
 sexual orientation and gender identity.
Co-authored by two of the nation’s
 leading scholars on mental health 
and sexuality, the 143-page report 
discusses over 200 peer-reviewed 
studies in the biological, psychological, 
and social sciences, painstakingly 
documenting what scientific research
 shows and does not show about
 sexuality and gender.
The major takeaway, as the editor 
of the journal explains, is that “some 
of the most frequently heard claims 
about sexuality and gender are not
 supported by scientific evidence.”
Here are four of the report’s most
 important conclusions:
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The belief

that sexual orientation is an innate,

biologically fixed human property—

that people are ‘born that way’—

is not supported by scientific

evidence.
Likewise, the belief that gender

identity is an innate, fixed human

property independent of biological

sex—so that a person might be

a ‘man trapped in a woman’s

body’ or ‘a woman trapped in a

man’s body’—is not supported by

scientific evidence.
Only a minority of children who

express gender-atypical thoughts

or behavior will continue to do so

into adolescence or adulthood.

There is no evidence that all such

children should be encouraged to

become transgender, much less

subjected to hormone treatments

or surgery.
Non-heterosexual and transgender

people have higher rates of mental

health problems (anxiety,

depression, suicide), as well as

behavioral and social problems

(substance abuse, intimate

partner violence), than the general

population. Discrimination alone

 does not account for the entire

disparity.
The report, “Sexuality and Gender: 
 is co-authored by Dr. Lawrence Mayer
 and Dr. Paul McHugh. Mayer is a 
scholar-in-residence in the Department
 of Psychiatry at Johns Hopkins 
University and a professor of statistics 
and biostatistics at Arizona State
 University.
McHugh, whom the editor of The New 
Atlantis describes as “arguably the 
most important American psychiatrist
 of the last half-century,” is a professor 
of psychiatry and behavioral sciences
 at the Johns Hopkins University School
 of Medicine and was for 25 years the
 psychiatrist-in-chief at the Johns
 Hopkins Hospital. It was during his 
tenure as psychiatrist-in-chief at Johns 
reassignment surgery there, after a
 study launched at Hopkins revealed
 that it didn’t have the benefits for 
which doctors and patients had long
 hoped.
Implications for Policy
The report focuses exclusively on
 what scientific research shows and 
does not show. But this science can 
have implications for public policy.
The report reviews rigorous

research showing that ‘only a

minority of children who

experience cross-gender

identification will continue to

do so into adolescence or

adulthood.’
Take, for example, our nation’s
 recent debates over transgender 
policies in schools. One of the
 consistent themes of the report is 
that science does not support the 
claim that “gender identity” is a fixed 
property independent of biological
 sex, but rather that a combination
 of biological, environmental, and 
experiential factors likely shape how 
individuals experience and express 
themselves when it comes to sex and 
gender.
The report also discusses the reality
 of neuroplasticity: that all of our brains
 can and do change throughout our 
lives (especially, but not only, in
 childhood) in response to our behavior
 and experiences. These changes in
 the brain can, in turn, influence future
 behavior.
This provides more reason for concern
 over the Obama administration’s 
recent transgender school policies.
 Beyond the privacy and safety 
concerns, there is thus also the
 potential that such policies will 
result in prolonged identification as
 transgender for students who
 otherwise would have naturally grown out of it.
The report reviews rigorous research
 showing that “only a minority of 
children who experience cross-gender
 identification will continue to do so into
 adolescence or adulthood.”
 Policymakers should be concerned 
with how misguided school policies
 might encourage students to identify
 as girls when they are boys, and
 vice versa, and might result in 
prolonged difficulties. As the report
 notes, “There is no evidence that
 all children who express gender-
atypical thoughts or behavior should
 be encouraged to become
 transgender.”
Beyond school policies, the report 
raises concerns about proposed 
medical intervention in children.
 Mayer and McHugh write: “We are 
disturbed and alarmed by the severity
 and irreversibility of some interventions
 being publicly discussed and
 employed for children.”

They continue: “We are concerned
 by the increasing tendency toward 
encouraging children with gender
 identity issues to transition to their
 preferred gender through medical
 and then surgical procedures.” But
 as they note, “There is little scientific 
evidence for the therapeutic value of
 interventions that delay puberty or 
modify the secondary sex
 characteristics of adolescents.”
Findings on Transgender Issues
The same goes for social or surgical
 gender transitions in general. Mayer 
and McHugh note that the “scientific
 evidence summarized suggests we 
take a skeptical view toward the claim
 that sex reassignment procedures
 provide the hoped for benefits or
 resolve the underlying issues that 
contribute to elevated mental health
 risks among the transgender
 population.” Even after sex reassignment surgery, patients with gender dysphoria still experience poor outcomes:
Compared to the general population,

adults who have undergone sex

reassignment surgery continue to

have a higher risk of experiencing

poor mental health outcomes.

One study found that, compared

to controls, sex-reassigned

individuals were about five times

more likely to attempt suicide

and about 19 times more likely

to die by suicide.
Mayer and McHugh urge researchers 
and physicians to work to better
 “understand whatever factors may 
contribute to the high rates of suicide
and other psychological and
 behavioral health problems among
the transgender population, and to
think more clearly about the treatment
 options that are available.” They
 continue:
In reviewing the scientific literature,


we find that almost nothing is well

understood when we seek

biological explanations for what

causes some individuals to state

that their gender does not match

their biological sex. … Better

research is needed, both to

identify ways by which we can

help to lower the rates of poor

mental health outcomes and

to make possible more informed

discussion about some of the

nuances present in this field.
Policymakers should take these
 findings very seriously. For example,
the Obama administration recently
 finalized a new Department of Health
 and Human Services mandate that
 requires all health insurance plans 
under Obamacare to cover sex 
reassignment treatments and all 
relevant physicians to perform them.
The regulations will force many
 physicians, hospitals, and other
health care providers to participate
 in sex reassignment surgeries and
 treatments, even if doing so violates
their moral and religious beliefs or
 their best medical judgment.
Rather than respect the diversity of
opinions on sensitive and controversial
 health care issues, the regulations
 endorse and enforce one highly
contested and scientifically
 unsupported view. As Mayer and
 McHugh urge, more research is
 needed, and physicians need to be
 free to practice the best medicine.
Stigma, Prejudice Don’t Explain
 Tragic Outcomes
The report also highlights that people
who identify as LGBT face higher risks
 of adverse physical and mental health
 outcomes, such as “depression,
anxiety, substance abuse, and most
alarmingly, suicide.” The report
summarizes some of those findings:
Members of the non-heterosexual population are estimated to have about 1.5 times higher risk of experiencing anxiety disorders than members of the heterosexual population, as well as roughly double the risk of depression, 1.5 times the risk of substance abuse, and nearly 2.5 times the risk of suicide.
Members of the transgender population are also at higher risk of a variety of mental health problems compared to members of the non-transgender population. Especially alarmingly, the rate of lifetime suicide attempts across all ages of transgender individuals is estimated at 41 percent, compared to under 5 percent in the overall U.S. population.
What accounts for these tragic outcomes? Mayer and McHugh investigate the leading theory—the “social stress model”—which proposes that “stressors like stigma and prejudice account for much of the additional suffering observed in these subpopulations.”
But they argue that the evidence suggests that this theory “does not seem to offer a complete explanation for the disparities in the outcomes.” It appears that social stigma and stress alone cannot account for the poor physical and mental health outcomes that LGBT-identified people face.

One study found that, compared to controls, sex-reassigned individuals were about five times more likely to attempt suicide and about 19 times more likely to die by suicide.
As a result, they conclude that “More research is needed to uncover the causes of the increased rates of mental health problems in the LGBT subpopulations.” And they call on all of us work to “alleviate suffering and promote human health and flourishing.”
Finally, the report notes that scientific evidence does not support the claim that people are “born that way” with respect to sexual orientation. The narrative pushed by Lady Gaga and others is not supported by the science. A combination of biological, environmental, and experiential factors likely account for an individual’s sexual attractions, desires, and identity, and “there are no compelling causal biological explanations for human sexual orientation.”
Furthermore, the scientific research shows that sexual orientation is more fluid than the media suggests. The report notes that “Longitudinal studies of adolescents suggest that sexual orientation may be quite fluid over the life course for some people, with one study estimating that as many as 80 percent of male adolescents who report same-sex attractions no longer do so as adults.”
Findings Contradict Claims in Supreme Court’s Gay Marriage Ruling
These findings—that scientific research does not support the claim that sexual orientation is innate and immutable—directly contradict claims made by Supreme Court Justice Anthony Kennedy in last year’s Obergefell ruling. Kennedy wrote, “their immutable nature dictates that same-sex marriage is their only real path to this profound commitment” and “in more recent years have psychiatrists and others recognized that sexual orientation is both a normal expression of human sexuality and immutable.”
But the science does not show this.
While the marriage debate was about the nature of what marriage is, incorrect scientific claims about sexual orientation were consistently used in the campaign to redefine marriage.
In the end, Mayer and McHugh observe that much about sexuality and gender remains unknown. They call for honest, rigorous, and dispassionate research to help better inform public discourse and, more importantly, sound medical practice.
As this research continues, it’s important that public policy not declare scientific debates over, or rush to legally enforce and impose contested scientific theories. As Mayer and McHugh note, “Everyone—scientists and physicians, parents and teachers, lawmakers and activists—deserves access to accurate information about sexual orientation and gender identity.”
We all must work to foster a culture where such information can be rigorously pursued and everyone—whatever their convictions, and whatever their personal situation—is treated with the civility, respect, and generosity that each of us deserves.