A Trans History of Conversion Therapy

Conversion therapy has been the norm for trans youth and it hasn't gone away.

Of all the morally depraved lies and vicious agendas peddled by transphobic grifters, one of the most unforgivably fallacious and reprehensible—though there’s surely a hot contest there—is the idea that transition related healthcare for children is a form of conversion therapy.

None other than Graham Linehan suggested as much in an April 17th Substack post (I won’t link to it because the man is a grifter, clearly not a writer who deserves revenue or exposure from this or any platform; however, you can easily verify the quote if you feel the need):

“A conversion therapy that targets children who may turn out gay or lesbian. Homosexual. Fruity. Fabulous. Butch. Femme.

This conversion therapy isn’t really that different from the old conversion therapy. It involves torture, medical experiments, and outright quackery. Same shit, different day. It involves the off-label use of powerful cancer drugs, and no one knows the potential long term effects.

This new conversion therapy has a name. It’s supported by the left, criticized by the right. You’ve probably been told that unless these children receive the new conversion therapy, they might kill themselves.

That name of the new conversion therapy is ‘child transition’. ‘Transgender children’.”

What a tawdry (and badly written—“Fruity. Fabulous. Butch. Femme”? are we supposed to find that endearing from a straight dude?—heap of lies, almost line for line the opposite of the truth. But since his ilk are, we gather from their rhetoric, actions and beliefs, proudly and slavishly immune to truth, being bad faith artists in it for, we can only further presume, some sort of combination of money they can’t make otherwise, fame-through-humiliation as befitting their mediocrity, and a deep, venomous hatred towards trans people, I wouldn’t waste my time debunking the assertion. What’s more troubling to me is that this kind of easily falsifiable fiction further contributes to burying how central conversion therapy actually is in the lives of trans people and in trans history, especially for youth.

It’s just…not the kind of made-up conversion therapy Linehan’s peddling. 

We’ve seen so much political cannon fodder over what will happen if gender affirming care is banned or criminalized, cutting young people off from a type of care that is only just in its infancy as humane, ethical medicine. Trans healthcare is far from new, but gender affirming care as its principle is so new that almost no one has access to it and now we are witnessing the possibility of it being made illegal.

What happens when there’s no gender affirming care permitted by law in your state? Will conversion therapy swoop back in, no doubt to the pleasure of adults like Linehan who, let’s remind ourselves, apparently devote their full-time attention to trying to make the lives of a group of children so unlivable that they might cease to exist?

The truth is that conversion therapy never went away and it is so deeply built into medicine and psychiatry that banning gender affirming care won’t so much bring conversion therapy back as it will leave it newly untouched, the only game in town.

When I wrote Histories of the Transgender Child I didn’t devote a large amount of space to conversion therapy, honestly in part because the historical materials I encountered were so bone-chilling that I couldn’t stomach writing more about them. But the main reason was that conversion therapy was so widespread and proximate to transgender medicine and psychiatry in general that it would have taken an entire additional chapter in the book to contextualize it. Now, staring down this avalanche of anti-trans bills, and having talked with people who experienced conversion therapy first-hand as children, I’m convinced I need to tell this history. Consider this preliminary material for a larger future addendum to Histories of the Transgender Child, one in which I will fill out the story of so many trans kids who, instead of seeing a doctor, were institutionalized and/or held captive in carceral settings for their entire childhoods on the cruel principle that conversion therapy was all they deserved.

This, I gather, is the status quo that anti-trans legislators would like to see codified under the law.

Here is the real trans history of conversion therapy. And since this is a bit of a long read with a lot of historical receipts to come, here are the main points I will substantiate, followed by a summary of the five major types of gendered conversion therapy practiced in the United States from the early twentieth century to present.

Three principles of a trans history of conversion therapy:

1.     Conversion therapy is not (yet) the opposite of transgender medicine. The two were developed in tandem and originally meant to work together to gatekeep. In the mid twentieth century medical model of transsexuality a failed bout of conversion therapy was an actual prerequisite for transition.

2.     Conversion therapy was the norm and the main prescription for trans children when the first clinics in the US began to explicitly work with gay and trans youth. The interdisciplinary gender clinic at the University of California, Los Angeles, convened by psychiatrist Robert Stoller in 1962, had the explicit goal of trying to perfect conversion therapy on trans and gay youth, and would only let trans kids transition if all their coercive attempts at conversion failed (and they did fail, every single time).

3.     Conversion therapy was and still is the norm for youth who are medicalized without gender affirmation (for instance, intersex children) or criminalized and/or institutionalized (poor trans kids, trans kids of color, kids on the streets, and kids working in informal economies to survive).

The five major forms of conversion therapy, 1920s-present:

1.     Conversion as a step in trans medicine: the originary requirement by gatekeeping clinicians beginning in the 1950s and 1960s that any candidate for hormones and surgery have exhaustively proven that no conversion psychotherapy or medical conversion therapy had already stopped them from being trans. Only then would they be allowed to transition. For kids, the requirement that psychotherapy and behavioral therapy try to stop them from being trans was the norm and is the norm outside of pediatric gender clinics, of which they are very few—and soon, none in many states.

2.     Intersex conversion therapies force the same medical procedures withheld from trans children onto intersex children without any empirical explanation for the difference. (Many of the bills banning pediatric healthcare for trans kids right now include exceptions so that the so-called “experimental” or “irreversible” procedures that are, apparently, too dangerous for trans kids, can continue to be wantonly practiced on intersex kids who haven’t asked for them.)

3.     Hormonal conversion therapy: the forced administration of hormones to try to “correct” a trans child’s gender presentation. In trans girls, that would mean being given high doses of testosterone (on top of their endogenous testosterone); in trans boys, it would mean high doses of estrogens (on top of their endogenous estrogen).

4.     Psychiatric misdiagnosis and institutionalization: where a child’s transness is refused and instead treated as a fabricated mental illness, or in which a child’s gender expression is read as “defiant,” “oppositional,” or even as a cognitive disability, enabling captivity in psychiatric institutions, events often indissociable from arrest and incarceration. This is also where many parents are the reason their children are being subject to conversion therapies: they drag their children to psychiatrists or therapists, anxious over their gender.

5.     Violent forms of conversion therapy that aim to eradicate transness through extreme punishment and pain, including physical, psychological, and sexual abuse at the hands of adult therapists. Examples include electroshock, electro-convulsive therapies, abusive behavioral therapy employing physical and psychological punishment, and lobotomy. These practices were more prominent from the 1920s-1950s, but have hardly been eradicated since bans on conversion therapy are recent and only partial.

Now, let’s dig into the historical evidence for these claims to unpack just how central conversion therapy actually is as an arm of transphobia and eugenic medicine, which has the aim of trying to erase gay and trans children from existing.

Content warning: the historical materials discussed in the next section include graphic and disturbing accounts of conversion therapy. As a scholar, I write history from a principle of deep concern for what it means to circulate real people’s experiences of pain and suffering. I have, for instance, chosen not to write about the most violent materials I have encountered in my research (like lobotomy or electro shock therapy), but part of my ethics also includes not covering up the horror of the historical record, so I will not censor what I do discuss below.

Three Stories of Conversion Therapy

I. Hormonal conversion.

The idea that gay and trans people could be converted to straight and non-trans through high doses of hormones was an explicitly eugenic practice of medicine developed in large part through experiments on prisoners in the 1920s and 1930s. Intersex children formed the second captive population on whom such experiments were carried out. For example, in the mid 1930s, doctors at the Johns Hopkins Hospital had so badly mistreated an African American intersex child that they had forced the teenager to socially transition to male, then to female, then to male again, and then again to female, all in the span of a few years. Each time they dosed the child with high quantities of hormones meant to—unsuccessfully—force the body to grow in one sexed direction. They clinicians never asked this teenager what gender their felt themselves to be.[1]

The fact that hormonal conversion therapy never once worked to make children cisgender, binary, or heterosexual did not dissuade clinicians from continuing to think of it as something like their first-line approach. We can see this in a letter written to a doctor by a grandmother, who noted that her trans granddaughter had expressed that she was a girl since a very young age, but her family doctor administered “massive hypodermic injections of hormones” and later suggested two separate operations on her gonads to try and force them to masculinize her—all with no effect except creating pain and anguish.[2]

Many, many other children were forced to endure what can only be a horrifying, not to mention medical dangerous, buildup of extremely high levels of the wrong hormones in their body. This practice was so ubiquitous that there is hardly a trans child I came accross in my research except the most wealthy and privileged, or those who could either hide their transness from their families and schools, who escaped the reach of this conversion therapy.


II. UCLA’s conversion psychotherapy on gay and trans kids:

In a letter to a fellow doctor in 1971, the endocrinologist Harry Benjamin remarked that “According to Stoller and Green of U.C.L.A., young transsexual children may indeed be helped by psychotherapy. As you say, it is useless in the true transsexual adult.”[3] When clinicians started to realize they couldn’t successfully convert trans adults, they switched their focus to children.

UCLA’s gender clinic for youth never officially offered medical transition and especially not surgery. It was, on the contrary, a clinic established primarily for conversion therapy in young people that reluctantly would allow some patients to transition after they had been subjected to brutal behavioral therapies and psychoanalysis to try to root out and erase, or at least suppress, gender nonconforming behavior. Both gay and trans feminine children were brought to UCLA by their parents, which is one way we can loudly object to the baseless lie that trans medicine takes children who would otherwise grow up to be gay and make them transition. Nothing could be further from the truth; they were both targeted by the same clinicians.

The typical conversion therapies for children at UCLA worked on two axes: trying to use punishment to stop children from behaving in was deemed non-normative (for instance, picking “masculine” toys over “feminine toys,” speaking with a low voice, not crossing the legs, and acting as aggressively and angrily as possible to avoid femininity, all which would be reinforced and punished by the therapist) and by trying to force effeminate gay boys and trans girls to fear and accept adult men as their role models.  None of it worked, of course, but the damage was done nonetheless. You can read the contempt and hatred that served as the basis of this therapy in Stoller’s notes from a therapy session with a five year old child. He concludes his initial impressions by saying of this young kid: “I would not want him for my son.”[4] (I write much more about this clinic in chapter 4 of Histories of the Transgender Child, too.)


III. Psychiatric conversion therapy of institutionalized children:

The growth in scientific studies of human sexuality through so called “deviant” populations made extensive use of incarcerated and institutionalized people as experimental subjects. In the 1930s, the Committee for Research in Problems of Sex, an interdisciplinary group headed by psychiatrists at Johns Hopkins, funded a wide range of research, including “A Project for the Study of Homosexual Practices Among Delinquent Boys,” which aimed to examine gender non-normativity (the word “homosexual” here means a variety of things, including what we today consider to be, separately, transness) in children incarcerated at the Training School for Boys at Warwick in upstate New York.[5]

This early research, which never turned up much in the way of useful data, gave way in the postwar era to a general predisposition to institutionalize trans children on the assumption that they must be, like the children studies in the 1930, somehow delinquent. A trans girl in the Baltimore area was committed to Crowns-Ville State Hospital by her mother after she “started slipping to dressing as a girl.” This seventeen year old was also arrested under cross-dressing laws several times, leading to a vicious cycle of jailtime feeding into psychiatric institutionalization.[6] Remarkably, this girl wrote her own letter to Harry Benjamin, who was consulting on the case. As she explains it in her own words, there was nothing wrong with her, but the adults in her life were keeping her from being happy by being allowed to live a trans life:

“I was in a mental hospital 3 times. I was very mixed up and very unhappy until last month. I was in a bar and talking to another female impersonator, she told me she was a transvestite. I asked her what it meant, she said it meant she didn’t want sex with men or women until after she’d had a sex change. I gave this matter a lot of thought and it seemed to have put a whole new light on my life.”[7]

Many trans children were committed after their suffering in a transphobic environment took a toll on them, but this pretense was used to institute conversion therapy. Val, a trans woman whose childhood I have written a lot about, including in the New York Times, was committed when she was a teenager “due to a break down” in the words of a psychologist. While on the psych ward she was given heavy doses of sodium amytal to induce a heavily drugged state to see if the psychologists could forcibly pull a masculine identity out of her—they failed. As a result of these conversion therapies, Val’s adult psychologist was able to argue in favor of her transitioning as an adult, explaining in 1948 that “no form of psychotherapy or any other medical approach, can convince this individual that he must assume the role of a male and live out his life as one of masculine character.”[8] Here we see just how important conversion therapy was to trans medicine, where it served as a prerequisite and a kind of suffering trans people like Val had to survive in childhood in order to transition decades later. (A psychiatrist in Milwaukee had also suggested hormonal conversion therapy for Val at age thirteen, but her father had refused, saying “I’m not going to do anything like that to [Val]. The family doctor had tried hormones on himself without any results.”[9])

A typical misdiagnosis leading to conversion therapy was schizophrenia. A seventeen year old trans girl told her mother at age fourteen that she was a girl, which prompted the mother to take her to a psychiatrist that diagnosed her as schizophrenic in the late 1960s, institutionalizing her twice for a total of six months. When her mother read an article in a magazine about transsexuality in 1971, she apparently realized she might have been wrong to institutionalize her daughter.[10]

Many other trans kids found themselves in court-ordered conversion therapy, where the legal imperative was to make them “normal” to satisfy their sentence, as with a fourteen year old Puerto Rican trans girl in New York City whose therapist at a halfway house wrote other doctors for advice after feeling unsure how to pull that off, being so impressed by how much a girl she was.[11] 

In the worst of circumstances, trans kids would spend their entire childhoods in and out of different carceral and psychiatric settings, as with a young trans girl from Oregon who, her parole officer explained, had “an extended history of institutionalization commencing at age 8 when he [sic] was placed in the Perry Center for emotional disturbed children where he remained for six years. After numerous runaways from the center, [child’s name redacted] was committed on [date redacted, 19]71 to McLaren School for Boys, the Oregon State reform school. Runaway has been [child’s name] recorded offense.” Despite this girl running away, presumably, from unsafe environments, the parole officer still claimed she “has been identified as a severely disturbed child who has exhibited much confusion over his sexual identity since early childhood ad when on a runaway status, he dresses as a female. This identity problem is coupled with a possible mildly retarded IQ range, and extremely low impulse control.”[12] 

This language is pervasive in records from this era.

There are hundreds of other children whose experiences with conversion therapy fill my archival research for Histories of the Transgender Child, but these few snapshots tell the general outline of the stories of these kids.

There is nothing flippant, then, about transphobes using the language of conversion therapy to describe gender affirming care. Not only is it a baseless lie, but it is frankly a disgusting denial of the real pain and impact of actual conversion therapy on trans youth over the past century. I don’t know a single trans person who hasn’t been touched, directly or indirectly, by conversion therapy’s ongoing presence in our lives. When I was seeking out care for a bad bout of PTSD this past year, one of my biggest fears was that if I sought out psychiatrists, even in an out-patient setting, they might not just exploit my vulnerability and try to convince me to detransition (my primary care doctor, you might remember, had already tried to get me to detransition for an antibiotic), but that just seeking mental health care like that would inevitably cause me to be even more harmed than trying to deal with it on my own because of institutional transphobia.

As we organize to defeat this latest round of anti-trans bills, we need to think beyond the status quo as our goal. Even if we defeat these bills and gender affirming care is not banned, conversion therapy remains far from a marginal practice. It forms part of the very fabric of trans medicine, especially for kids, and we owe it to these youth to do everything we can to stop these violent and barbaric practices. 

[1] HHY1005.2. [Note: HIPAA law prevents me from reproducing the private information contained in the document titles for these materials; a full explanation of this code and how to retrace the citation can be found in Histories of the Transgender Child, p214]

[2] C.C. to Harry Benjamin, June 30, 1965. Harry Benjamin Collection, Correspondence, Box 4, Kinsey Institute for Sexological Research, Bloomington, IN.

[3] Harry Benjamin to John P. Curran, M.D. January 5, 1971. Harry Benjamin Collection, Correspondence, Box 4, Kinsey Institute for Sexological Research, Bloomington, IN.

[4] Robert Stoller, typed notes November 19, 1963, Box 16, Robert Stoller Papers, Charles E. Young Library Special Collections, University of California, Los Angeles.

[5] Robert W. Laidlaw to Robert Yerkes, March 4, 1936. Adolf Meyer Collection, Series II 20, Alan Chesney Mason Medical Archives, Johns Hopkins Hospital, Baltimore, MD.

[6] H.D. to Harry Benjamin, November 26, 1969. Harry Benjamin Collection, Correspondence, Box 4, Kinsey Institute for Sexological Research, Bloomington, IN.

[7] L.D. to Harry Benjamin, November 28, 1969. Harry Benjamin Collection, Correspondence, Box 4, Kinsey Institute for Sexological Research, Bloomington, IN.

[8] H.M. Coon, report to W.B. Campbell, Department of Neuro-Psychiatry, University of Wisconsin, Madison, General Hospital July 19, 1948. Harry Benjamin Collection, Correspondence, Box 3, Kinsey Institute for Sexological Research, Bloomington, IN.

[9] Berdeen Frankel Mayer, Case History and Closing Note, October 2, 1950. Harry Benjamin Collection, Correspondence, Box 3, Kinsey Institute for Sexological Research, Bloomington, IN.

[10] Charles Ihlenfeld, “The Transexual,” manuscript with revisions for Sexuality, August 4, 1971. Harry Benjamin Collection, Correspondence, Box 7, Kinsey Institute for Sexological Research, Bloomington, IN.

[11] W.Pomeroy to Diane Robertson, February 2, 1976. Harry Benjamin Collection, Correspondence, Box 7, Kinsey Institute for Sexological Research, Bloomington, IN.

[12] Richard S. Peterson to John Money, September 10, 1974. John Money Collection, Correspondence, Box 8, Kinsey Institute for Sexological Research, Bloomington, IN.