New Sexual Reorientation Study Off to a Shaky Start; Michael Bailey's Brain Scan Offer is Still Good

After the closing of Exodus International, the wind went out of the sexual reorientation sails. In June of last year, former ex-gay organization Exodus International leader Alan Chambers said the movement was “gasping for air.”
However, a quiet breeze may be blowing still as demonstrated by a study being conducted by one of the luminaries of reparative therapy, Joseph Nicolosi and relative newcomer Carolyn Pela.  Nicolosi and Pela summarized their preliminary findings at a meeting of the Christian Association for Psychological Studies a year ago. Nicolosi described the study on his website:

Dr. Pela described the study as being longitudinal with a within-group repeated-measures design.  Their dependent variable was psychotherapy as conducted at Dr. Nicolosi’s Thomas Aquinas Psychological Clinic.  The independent variables were (1) well-being as operationalized by the Outcome Questionnaire 45 (OQ-45.2), a highly respected measure of psychotherapy process and outcome, and (2) separately assessed dimensions of sexual orientation, namely, thoughts, desires, behavior, and identity.  Data collected to date involved 102 male psychotherapy clients who presented with ambivalence, discomfort, or distress regarding their SSA.  Eighty-one participants had been involved in the study long enough to have well-being assessed and data on change were available from 56 participants at the time of the CAPS presentation.

I am pretty sure the dependent and independent variables are reversed in his description. The independent variable is what is manipulated in an experiment and the dependent variable is a measure of results (see this brief explanation). That problem aside, what did they find?

Findings from preliminary data collected over a 12 month period indicated statistically significant reductions in distress and improvements in well-being, significant movement toward heterosexual identity, and significant increases in heterosexual thoughts and desires with accompanying significant decreases in homosexual thoughts and desires.  Effect sizes for these changes were generally in the moderate range, which suggests they are robust and not likely to be statistical artifacts.  The findings did not discover significant change in heterosexual or homosexual kissing or sexual activity.  These findings appear to have been the result of very low base rates in these behaviors among study participants leading to floor effects and a subsequent lack of change, as it is not possible to change a behavior in which participants are not engaging.

To summarize, the participants were thinking straighter but not doing anything about it.
To me, this result is understandable. If one is in treatment with the stated goal to think more about heterosexual outcomes, then there would be strong motivation to produce those experiences when asked. However, the test for any actual change will be when therapy is over and the regular rehearsal of such ideas isn’t happening. The difference between process changes (how a client feels during therapy) and outcome changes (what remains after therapy is over) is often great. Reorientation therapy studies are filled with people who said they had changed during the study but then felt differently months or years later. Thus, follow up must be a key component of any therapy study.
It should be pointed out that this study isn’t a true experiment since there is no control group. There isn’t a way to test for the effect of the passing of time. Spontaneous fluidity has been reported and it isn’t clear without a control group that psychotherapy is responsible for any change that is reported (or to what degree the therapy is responsible). Without a long term follow up and a control group, this study won’t provide much more information than we already have.
Finally, if Nicoloso and Pela truly want a potent and believable pre and post measurement, they should take Northwestern University professor Michael Bailey’s offer to conduct brain scans of the participants. Some years ago, Bailey informed Nicolosi that he could bring his patients to the lab to test their automatic responses to erotic cues. Nicolosi never took him up on the offer. I recently asked Bailey if the offer was still good. He answered in the affirmative. Pre (or even mid) treatment scans compared with post-treatment scans would help to offset the lack of a control group.
 

The Editor of The New Atlantis Responds to My Critique of the Mayer and McHugh Article

On August 25, Adam Keiper, editor of The New Atlantis emailed to give me his reaction to my initial critique of the new article by Lawrence Mayer and Paul McHugh on sexual orientation and gender. Please review that post before you read his remarks.
I appreciate Keiper’s professionalism in his remarks. I also appreciated a cordial phone call we had on Thursday. Keiper gave permission for me to publish his remarks. They are reproduced in full from the email. I plan to add my reactions over the next day or two within this post. I wanted to post his thoughts while the issue is current. My reactions to the part of the article on sexual orientation (I have yet to really examine the section on gender identity) are interspersed below.

In what follows, I would like to offer a few responses to some of the points you raise. I invite you to post this e-mail as an addendum to your piece on Patheos. I must note at the outset that I am not here writing on behalf of the authors of the report, nor as a scientist or physician (as I am neither), but rather as an interested reader of your piece and as the editor of The New Atlantis who worked closely with the authors on the report over the course of several months.
You begin by pointing out that “Sexuality and Gender: Findings from the Biological, Psychological, and Social Sciences” is not a study. You are correct. It is, as you rightly remark, a scientific review of the literature.
You are also correct in noting that The New Atlantis is not a peer-reviewed scientific publication. It is, rather, editorially reviewed — like many other journals and magazines intended for a wide public audience (such as Democracy Journal, National Affairs, The American Interest, The New Yorker, The Atlantic, etc.). When we publish essays and articles on technical subjects, our fact-checking process is especially rigorous, and in such cases we often ask experts to help our editorial team in its work. In the case of “Sexuality and Gender,” both our editorial team and the authors consulted with a range of experts in different fields. Peer review can be a very important part of the scientific publishing process. Our aim, however, was not to publish an original research study but rather to translate into accessible prose the scientific findings that were already published in peer-reviewed publications.
You next say:

Even calling the paper a new study isn’t accurate, there are no new studies in the paper. A bunch of old ones are missing as well.

I disagree with your characterization; there are some recent studies and papers that are mentioned in the report, including a handful that were published in 2015 and 2016. All told, I believe the report is quite up-to-date. I also would not say that old papers are “missing” per se; that seems to imply cherry-picking, which is an unsupported charge. Of course the authors of the report could not have discussed every paper in the vast scientific literature, but they selected the papers that they discussed on the grounds of their quality and scientific significance — emphasizing literature reviews and meta-analyses, pointing out when other significant papers contradict or criticize the literature reviews and meta-analyses, and then discussing more recent papers and studies that fill in gaps or further advance knowledge. Some older papers in the literature were deemed to be neither sufficiently important nor sufficiently rigorous to warrant discussion.

While The New Atlantis article was thorough, I still don’t think Mayer and McHugh captured everything necessary to make the claims they make. More on that below.

We are gratified to learn that Professor Bailey agrees with some (even if not all) of the report’s major findings; namely, that the social stress model does not alone account for all of the mental health difficulties experienced by LGBT people, that the empirical evidence does not support the idea that gender identity is innate and fixed, and that all of these issues should be studied more openly and rigorously by scientists. (Professor Bailey also mentions that “Sexuality and Gender” does not discuss his review of the literature on sexual orientation. Professor Bailey’s paper is very recent, and so our authors were unable to include a discussion of it before “Sexuality and Gender” went to press.)

Bailey’s paper was published online on April 25, 2016. Given the quality of Bailey et al’s work, I think the paper should have been included in their review or they should have waited to publish until they were able to include it.

Moving on to some of the topics that you suggest ought to have been included in the report but were not:

Mayer and McHugh’s paper is missing any serious discussion of epigenetics.

It is true that, other than a passing reference, this report does not discuss epigenetics. There is a good reason for that: the literature on epigenetics and sexual orientation remains inconclusive with regard to the question of whether homosexuality is innate and fixed. It is in the nature of epigenetic markers that they are (for the most part) acquired rather than inherited, and so, without a well-supported theory about why (for instance) gay men have distinctive patterns of DNA methylation, the fact that they have such markers does little to explain the origins of homosexual attractions, behaviors, or identity. (For what it’s worth, the Bailey paper only dedicates a single short paragraph to epigenetics [on page 77], and that paragraph basically says that the evidence doesn’t amount to much.)

This is exactly why the recent work on epigenetics should have been included in both papers. One would not need to go into it much in order to say that the line of research is intriguing and may yield answers after more studies are done. Mayer and McHugh’s paper needed to do this because they made a very definite claim: “The understanding of sexual orientation as an innate, biologically fixed property of human beings — the idea that people are “born that way” — is not supported by scientific evidence.”
Since epigenetic research may indeed be relevant to that claim, I believe it was an oversight not to discuss the where that research program could lead. Keiper’s statement, ” without a well-supported theory about why (for instance) gay men have distinctive patterns of DNA methylation, the fact that they have such markers does little to explain the origins of homosexual attractions, behaviors, or identity.” I agree that such a theory doesn’t exist. However, I am not making strong claims against innateness. Given the state of research at present, I don’t think making such a strong claim is warranted. More on this point at the end of the post.

You go on to claim that

[Mayer and McHugh] overlook the new genetic linkage paper involving gay brothers

I believe you are incorrect. “Sexuality and Gender” does mention the 2015 genetic linkage paper involving gay brothers (Sanders, et al., including Bailey). If this is not the paper to which you are referring, please let me know.

You are correct. I am sorry for that oversight and have corrected that error in my original post.
Having said that, I believe Bailey et al’s discussion is more thorough. They note the need for very large samples in genome studies and tell us that findings approaching significance were found in the large 23andMe study (see Bailey on page 77 and Mayer and McHugh on page 32). While 23,000 sounds like a large sample, there were only a few over 1,000 exclusively gay males in the study. We learn that from Bailey et al, not Mayer and McHugh. In other words, the methods we have available at present may not be sensitive enough to find the very fine biological differences which may move one individual toward same sex attraction and another toward opposite attraction unless very large numbers of people are involved.

You also note that the report ignores “work on ‘gay rams.’” It is true that “Sexuality and Gender” does not discuss homosexuality in non-human animals. While there is evidence of apparently exclusive homosexuality among domestic rams, this is not very convincing evidence that homosexuality is innate and fixed in human beings. And as Bailey and his colleagues note in their review (pages 68–69), although homosexual behaviors are frequently observed among wild animals, exclusive homosexuality has never been documented for animals in the wild. (It is worth acknowledging that documenting exclusive homosexuality among wild animals would be a difficult task, and so it is possible that there are exclusively homosexual animals that have not been discovered — but this only shows the need for more research on these questions.)

The gay ram research is important because of the parallels with research in humans. One would not posit weak fathers or child abuse to explain rams who prefer other rams. Apparently, something in the biology of the rams is involved. We are not rams but there are similar brain structures involved, some of which show up in studies of human brains.

You claim that

[t]he TNA authors minimize the neural differences between gays and straights, calling them ‘minor differences in brain structures.’ How do these authors know what differences are minor and which are not? In fact, the differences in symmetry and brain activity are quite provocative and have not been accounted for by any environmental theory.

The neurological differences between homosexuals and heterosexuals represent some interesting correlations, but they cannot be used to accurately predict whether a person is heterosexual or homosexual. (Moreover, as anyone familiar with the fMRI literature can tell you, it is very easy to find brain differences in brain-scan studies; e.g. this study found that when people were aware that they were drinking Pepsi or Coke, this “brand knowledge for one of the drinks had a dramatic influence … on the measured brain responses.”) I don’t see much distance between the ending of your last sentence quoted above and what the report says, as in the executive summary: “… [S]uch neurobiological findings do not demonstrate whether these differences are innate or are the result of environmental and psychological factors.”

Continue reading “The Editor of The New Atlantis Responds to My Critique of the Mayer and McHugh Article”

The New Atlantis Study on Sexual Orientation and Gender Identity That's Not a Study

UPDATE: In a post out on 8/27/16, Adam Keiper, editor at The New Atlantis magazine responds to this post with a rebuttal to my points below. I urge you to go read it. I in turn respond to him. I also make a correction in my original post below based on his communication to me.
————————————————- (original post below)
Over the past year, hot discussions of sexual orientation have been pushed aside by controversies over gender identity and bathrooms. A new article from The New Atlantis shows that both topics have plenty of life. Yesterday, social media was buzzing about a new “study” of sexual orientation and gender identity by Lawrence Mayer and Paul McHugh. Actually, the article was not a study but a review and summary of empirical studies. As far as I can tell, it is being touted most by conservative leaning and anti-gay organizations.
The New Atlantis describes itself as a “Journal of Technology and Society.” However, the article did not receive peer review and it shows. Lawrence Mayer, the first author, is not well known in sexuality research circles but the second author is. Paul McHugh is retired from Johns Hopkins and was responsible for discontinuing the sex reassignment program there. He also was an advisor to the Repressed Memory Foundation in the 1990s.
Quickly, the National Organization for Marriage touted the paper as “Groundbreaking New Research.” Even calling the paper a new study isn’t accurate, there are no new studies in the paper. A bunch of old ones are missing as well.
In this post, I want to include some initial reactions and then some notes from Michael Bailey, professor at Northwestern, who was cited several times in TNA paper. I am going to focus on their points about sexual orientation and leave the gender identity points for a future post.
Here is their summary of research regarding sexual orientation:

● The understanding of sexual orientation as an innate, biologically fixed property of human beings — the idea that people are “born that way” — is not supported by scientific evidence.
● While there is evidence that biological factors such as genes and hormones are associated with sexual behaviors and attractions, there are no compelling causal biological explanations for human sexual orientation. While minor differences in the brain structures and brain activity between homosexual and heterosexual individuals have been identified by researchers, such neurobiological findings do not demonstrate whether these differences are innate or are the result of environmental and psychological factors.
● 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% of male adolescents who report same-sex attractions no longer do so as adults (although the extent to which this figure reflects actual changes in same-sex attractions and not just artifacts of the survey process has been contested by some researchers).
● Compared to heterosexuals, non-heterosexuals are about two to three times as likely to have experienced childhood sexual abuse.
● Compared to the general population, non-heterosexual subpopulations are at an elevated risk for a variety of adverse health and mental health outcomes.
● 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%, compared to under 5% in the overall U.S. population.
● There is evidence, albeit limited, that social stressors such as discrimination and stigma contribute to the elevated risk of poor mental health outcomes for non-heterosexual and transgender populations. More high-quality longitudinal studies are necessary for the “social stress model” to be a useful tool for understanding public health concerns.

First, here is Michael Bailey’s quick reaction:

1. Their review of sexual orientation is not up to date (A major omission is that it neglects to cite our recent magnum opus on this topic: http://psi.sagepub.com/content/17/2/45.full.pdf+htmlf). The idea that sexual orientation is fluid has some plausibility for women, but not for men.
2. I agree with the authors that discrimination alone is unlikely to completely explain differences between heterosexual and homosexual people in mental health profiles, although it may contribute.
3. They are right on that the idea of innate, fixed gender identity is not consistent with empirical evidence. I differ from them, however, in believing that sex reassignment is still the best option for some individuals.
4. Most importantly, I agree that all of these issues should be openly discussed and researched. There is little government support for open-minded investigation for these controversial issues. That is unfortunate and exactly backwards. Support should be directed to resolve the most contentious issues.

As I reviewed the sexual orientations sections, I agree with Bailey. I especially agree that readers should read this major review of research on sexual orientation published earlier this year. Mayer and McHugh’s paper is missing any serious discussion of epigenetics, they overlook the new genetic linkage paper involving gay brothers, (they do address it, see the follow up post) as well as work on “gay rams.” The TNA authors minimize the neural differences between gays and straights, calling them “minor differences in brain structures.” How do these authors know what differences are minor and which are not? In fact, the differences in symmetry and brain activity are quite provocative and have not been accounted for by any environmental theory. Of course, we need more research with larger sample sizes but Mayer and McHugh just shrug these studies off as inconsequential.
Regarding sexual abuse, the authors review several studies which demonstrate higher rates of sexual abuse among GLB people as opposed to heterosexuals. For the most part, they report the relevant details but they failed to catch the mistakes in the Tomeo study and report it incorrectly (see this post for the problems with using Tomeo). Even though some who are touting the study miss this, the authors provide caution for those wanting to see homosexuality as the result of sexual abuse:

In short, while this study suggests that sexual abuse may sometimes be a causal contributor to having a non-heterosexual orientation, more research is needed to elucidate the biological or psychological mechanisms. Without such research, the idea that sexual abuse may be a causal factor in sexual orientation remains speculative.

They say “sometimes.” I would say infrequently or rarely and would add that we really don’t know. What we do know is that most people who are GLB were not abused. The TNA paper affirms that observation.
On the “born that way” claim, I find it contradictory that the authors express uncertainty about the causes of orientation but then say with great certainty that the “born that way” theory isn’t supported by scientific evidence. This line is apparently meant to hook the social conservatives which indeed it has. I mentioned the misleading “Groundbreaking New Research” headline from NOM, and then I just saw Liberty Counsel’s email which leads: “Scientific Research Debunks LGBT Propaganda.”
For readers wanting a more thorough review of the literature, please see the paper from Bailey and colleagues linked here.
 

What Kind of Woman is Caitlyn Jenner? Part Two of a Q&A on Autogynephilia with Michael Bailey

Yesterday, I posted part one of my interview with Michael Bailey on the topic of Caitlyn Jenner and autogynephilia. In that segment, Bailey covered the basics about autogynephilia and why he thinks Jenner manifests autogynephilic characteristics. In this segment, Bailey tackles what is known about outcomes for autogynephilic individuals, issues relating to minors with gender dysphoria and addresses critics of the concept. He also mentions one case where autogynephilia disappeared with the administration of leuprolide.
I also wrote GLAAD three times and asked for comment on autogynephilia generally and yesterday’s interview specifically with no response. GLAAD produces a tip sheet for journalists that doesn’t mention autogynephilia. Bailey addresses the media silence at the end of the interview.
I want to thank Michael for sharing his time and knowledge.

WT: What are the long term trajectories for autogynephilic individuals? What is the proper therapeutic response?
MB: Persons with autogynephilia often struggle, because of shame, lack of understanding, and the disapproval of others. Also, there is a real tension between achieving autogynephilic goals and maintaining conventional romantic relationships. Autogynephilic males who cross dress often go through binge-purge cycles, in which their cross dressing increases periodically, they get fed up and throw away their female clothing, and then later begin the cycle again. Some are fortunate to find partners (generally women) who accept their autogynephilia-driven behavior–some women even cooperate and participate. Some autogynephilic individuals never acquire partners, and they avoid the aforementioned struggle.
Some persons with autogynephilia are content to remain male. Those who get their gratification primarily from cross dressing are less likely to want to progress than those whose fantasies involve having female bodies, especially genitalia. Those, of course, can acquire female genitalia via surgery. Those who go that route generally undergo electrolysis and hormonal therapy prior to genital surgery.
As for “proper therapeutic response,” this is surely best considered at the individual level. But gender dysphoria due to autogynephilia doesn’t merely go away. Again, autogynephilia is like a sexual orientation, and that doesn’t change. I suspect that if there were more honesty about autogynephilia, then those who have it would understand themselves sooner, be less likely to commit to romantic interpersonal relationships, and would be more likely to pursue earlier sex reassignment. Evidence suggests they would be happier doing so, and there would be fewer wrecked families; quite parallel with the case of men hiding their homosexuality and getting heterosexually married.
WT: In your answer about proper therapeutic response, you said autogynephilia doesn’t change. Is this based on research or on the classification of autogynephilia as a sexual orientation? 
MB: Many men with autogynephilia would like not to have it. But I have never met a man who said his autogynephilia went away. Some transwomen say that it diminishes or vanishes after a sex change. Remember, the sex change also removes testosterone, which fuels male sex drive.
I should mention one other therapeutic approach that has not been widely used, to my knowledge. Still, I know one autogynephilic man who was on the verge of changing sex. He was, however, conflicted because he would have lost everything: his family fortune, his job, and his family. He was put on a course of leuprolide, a powerful drug that removes testosterone from the body. His desire to change sex virtually vanished. He’s happy and somehow able to have sex with his wife (viagra helps).
WT: I assume you are talking about adults. In other words, do you have different advice for minors? 
MB: The controversy over how and whether to treat preadolescent children experiencing gender dysphoria is irrelevant to controversies concerning autogynephilia. These preadolescent children are not autogynephilic. Autogynephilia almost never manifests in an obvious way before adolescence.
Lots of autogynephilic transsexuals wish they’d transitioned earlier. I can imagine this would have been better for them. If only people were more open about autogynephilia and people were more honest about it–and here I include journalists along with people with autogynephilia among those who have conspired to keep it secret–we could collect better data and ideally learn the optimal treatment for autogynephilic individuals of various subtypes.
I worry when autogynephilic transsexual activists (this includes all who were born male who have not always been exclusively attracted to men) advise families of preadolescent gender dysphoric children. The older activists have completely distinct conditions from the children, and the activists’ experiences are not an accurate guide to what the youngsters feel or how they will turn out. As we have argued, most preadolescent gender dysphoria does go away, and it is at least questionable whether it is in preadolescent children’s interests to change sex, socially (because this may lead to persistence requiring serious medical treatment).
WT: Why is there so little media coverage of the autogynephilia angle? 
MB: I think it’s a mixture of ignorance, political correctness, and fear. Most journalists know what they know from the media and from transgender activists — who do not mention autogynephilia. In fact, a few activists have managed to convince a lot of people that autogynephilia theory has been disproved (when in fact, it has substantial scientific support) and that anyone who agrees with it is anti-transgender (when in fact its major proponents, including me, have been quite supportive of transgender rights). As for fear, transgender activists (especially Lynn Conway, Andrea James, and Deirdre McCloskey) were so enraged by my writing about these ideas in my book that they tried to ruin my life. They were unsuccessful–their major success was to help Alice Dreger write a terrific article (and recently, a book) about the controversy–but I’m sure few people want to risk that. We will have made progress when Conway et al. are more ashamed of what they did to me than of autogynephilia.
WT: Is there anything else you would like to mention?
MB: I’ve noticed disapproval among some journalists–even Jon Stewart on the Daily Show went there–of the focus on Caitlyn Jenner’s attractive photographs in Vanity Fair. I can assure you (and Stewart): Caitlyn’s thrilled with that attention. It’s an autogynephilic fantasy.

Again, thanks to Michael for this information. Readers can leave follow up questions in the comments section which may form the basis for a return to the issue at a later time.

What Kind of Woman is Caitlyn Jenner? Part One of a Q&A on Autogynephilia with Michael Bailey

The transition of Bruce Jenner to Caitlyn Jenner has raised many questions about transgender issues. One that has not been widely discussed is autogynephilia as a trajectory for males who experience gender dysphoria. My impression of Jenner’s story is that she manifests aspects which are often associated with autogynephilia so it seems odd to me that the topic has not come up.
Michael Bailey is professor of psychology at Northwestern University and one of the more prolific sex researchers in the world. He kindly accepted my invitation to discuss autogynephilia in light of Caitlyn Jenner’s transition.

Throckmorton: What is autogynephilia? And how do autogynephilic individuals differ from androphilic men who become women?
Bailey: Before explaining what autogynephilia is, let me begin by explaining what it looks like. It occurs in natal males (those born male, regardless of whether they switch gender later), and it generally first manifests in adolescence, with the onset of puberty and sexual feelings. In the large majority of cases, it begins with erotic crossdressing. Generally, a boy discovers it’s sexually exciting to put in female clothing, especially lingerie, in private, look at himself in a mirror, and masturbate. People who know these boys don’t usually see them as feminine. Males like this usually are attracted to females, though some are not attracted to other people. A subset will discover other, related erotic fantasies, sometimes including the idea of having female anatomy (such as breasts and a vulva). If the anatomical fantasies predominate, then gender dysphoria is most likely to be intense. Males who eroticize the fantasy of having women’s bodies are most likely to get sex changes, for obvious reasons.
The phenomena I’ve talked about so far don’t make much sense if we take the conventional approach that these males have women’s brains. They make much more sense explained via autogynephilia. Autogynephilia might best be thought of as an unusual sexual orientation that occurs in natal males (those born male, no matter what they become). It’s very similar to male heterosexuality, because the erotic target is a woman. The difference is that in autogynephilia, the target is a self-constructed internal image–it’s like inwardly-turned heterosexuality. These males eroticize and fall in love with a woman they create within themselves
WT: Do you believe that Caitlyn Jenner is autogynephilic? If so, why?
MB: I believe it is very likely that Caitlyn Jenner’s transition was motivated by intense autogynephilia. I believe this because the best science suggests there are two completely different reasons why natal males become women: because they are feminine androphiles (lovers of men) or because they are autogynephilic. Jenner’s history shows none of the former and is very consistent with the latter. I refer specifically to his previous heterosexual marriages and secretive crossdressing.
WT. She says she always had gender dysphoria and that there was no erotic component. Would she say this if she were autogynephilic? Why?
MB: Autogynephilic individuals experience gender dysphoria, typically beginning in adolescence, when their intense erotic longing for female characteristics almost always begins. There is evidence (John Bancroft published an article long ago) showing that after changing sex, some show memory distortion. They begin to assert that their gender dysphoria began in early childhood and was far more overt than they had alleged before. They also deemphasize the erotic component, even if they admitted it before. I think they do this for at least two reasons: shame (because: sex is involved) and the desire to believe they really have the brains of women (as Jenner suggests she does–um, how does she know that?). I think also that Jenner (and others in the spotlight) likely enjoys the media spotlight, and the mainstream media loves the “was always a woman trapped in a man’s body” story and can’t deal with the “experienced intense sexual arousal when crossdressing or imagining I had a woman’s body” story.
WT: If Jenner doesn’t want people to think her transition was due to autogynephilia, why shouldn’t we just go along? 
MB: This inaccurate denial of autogynephilia is not for the good, because being honest could help lots of males struggling with their autogynephilia. (And there are lots who are.) It might help them understand themselves. It might help them accept themselves. It would at least say “Autogynephilia is nothing to be ashamed of.” I would say that people who admit and deal with their autogynephilia are even admirable.
Falsely misrepresenting one’s gender issues is also bad for science. It’s not good for people to believe false things merely because journalists don’t want to go certain places. Even among scientists, too many don’t bother to learn about the relevant literature and just listen to transgender people’s explanations (“I have the brain of a woman.”). This leads to bad scientific studies and ideas.
I think that Jenner’s brain has nothing more in common with the brain of a natal woman than mine does. She’s not that kind of woman. Her gender dysphoria was much more akin to times in my life when I had erotic and romantic longings for someone I couldn’t have.
WT: Do autogynephilic individuals have attraction to other people? 
MB: Usually, they are also attracted to women in the world (i.e., women besides their inner creation) as well. Some of these individuals marry–some tell their wives and some don’t. Wives who know often feel like they are married both to their husband and to the other woman. And the men (many–probably most–never become women) sometimes struggle between their love for their families and their desire to become women. This desire is like a typical man’s midlife crisis.
A subset of autogynephilic males report that they are bisexual, but knowledgeable scientists think this is not true bisexuality. Rather than attraction to men’s bodies, these individuals enjoy the fantasy of being courted by, desired by, or even engaging in sex with men, as women. This makes them feel quite feminine, and is thus exciting. Another subset identifies as asexual. These have plenty of sexual fantasies–it’s just that the sexual fantasies are all about the internal woman, and there’s nothing left for women in the world.
WT: What research support does this phenomenon have? 
MB: There is a great deal of support originating in Toronto in the important clinic formerly run by Ray Blanchard, the scientist most responsible for the study of autogynephilia. Blanchard observed that erotic arousal at the idea of having a female body was uncommon among natal male gender patients who said they were exclusively attracted to men (he referred to these as “homosexual” because with respect to their birth sex, that is their sexual orientation). In contrast, it was very common among natal male gender patients attracted to women, those who identified as bisexual, and those who identified as asexual–he referred to these three subtypes as “non homosexual” because they were not exclusively attracted to men. Homosexual natal male gender patients tended to have been extremely feminine since childhood. Nonhomosexual patients, not so much. (In follow up studies of preadolescent boys so feminine they wanted to be girls, not a single one was attracted to women as an adult.) Non homosexual natal male gender patients’ gender dysphoria is rarely evident in childhood but begins in adolescence. Homosexual patients request sex reassignment surgery much younger than non homosexual patients do–at least they have in the past. This partly reflects the fact that many non homosexual patients form families that delay them from pursuing such surgery.
A good resource summarizing this science (up to 2003) is the third section of my book (free pdf). A more scholarly and updated treatment is Anne Lawrence’s book.

Tomorrow, I will post the second part of my Q&A with Michael Bailey. In that part of the interview, Bailey opines about the proper therapeutic response to autogynephilic individuals, minors and transgender issues, media reporting about autogynephilia and his critics.
Part two of this Q&A is here.

New Study of Gay Brothers Renews Interest in Genetic Factors in Homosexuality

Papers in Australia and the UK published stories late yesterday about a study recently described at the 2013 International Association for Sex Research by Alan Sanders and then yesterday by Michael Bailey at the American Association for the Advancement of Science on genetics and homosexuality. According to an abstract of a 2012 presentation of the study, the researchers conducted a genome-wide linkage study involving over 400 pairs of gay brothers. The team identified two regions of interest: the pericentromeric region of chromosome 8 and Xq28, the region previously reported by Dean Hamer in 1993. According to the 2012 abstract, the findings “suggest that genetic variation in each of these regions contributes to development of the important psychological trait of male sexual orientation.”
The study has not been published but will surely renew interest in genetic factors involved in homosexuality. According to Bailey, as reported in the Guardian, sexual orientation is not a choice. However, this does not mean that sexual orientation is completely determined by genes. It appears that the regions identified in this study contribute in some manner to variation in the trait of sexual orientation. The linkages identified in the study do not eliminate the role of other factors in sexual orientation, including the balance of hormones during fetal development.
The new study is consistent with our statement in the recent letter to Uganda’s president Yoweri Museveni:

From a scientific perspective, the causes of homosexuality are only partially understood. While it is unlikely that there is one simple biological or genetic cause for homosexuality in all people, there are neural, cognitive and personality differences between homosexuals and heterosexuals which appear to have at least some basis in biology.

Truth Wins Out has an interview with Alan Sanders about the study and related issues in interpreting the role of genetics in homosexuality.
 
 
 

Ex-gay Therapist Says He Changes Gay Brains; Michael Bailey Says Prove It

Recently, on the Joni Show, ex-gay therapist Jerry Mungadze said his therapy helps rewire the brains of gay clients. Listen (see RWW for transcript):

If you want the full context, go to this segment on the Joni Show and hear the rest.
Mungadze did not say how he accomplished this or how he tested it. His website mentions neurotherapy but we are not given many specifics.
Being aware that Michael Bailey at Northwestern University has challenged ex-gay therapists to send clients to his lab for brain scans to assess change in sexual arousal patterns. I asked him if he was open to issuing the same challenge to Mungadze. As I expected he agreed enthusiastically. Essentially, the challenge requires that Mungadze send a client to his lab before and after therapy to see if sexual arousal patterns have changed. Mungadze can invite the press or any other observers if he wants to. Bailey and I have discussed this for several years and made these offers to others. Thus far, no one has taken him up on the offer. I wonder if Mungadze will.
 
 

Politifact rates Tim Pawlenty's views on sexual orientation

On the July 10 Meet the Press program, Tim Pawlenty was asked by David Gregory whether or not homosexuality is a choice and if it is genetically caused. Politifact rated Pawlenty’s answers and overall did a pretty good job of it.
They rated Pawlenty as mostly true on the genetics question but false on the question of choice. Go give it a read. Also, what do you think of this money quote from Michael Bailey?:

“If you can’t make a male attracted to other males by cutting off his penis, castrating him, and rearing him as a girl, how likely is any social explanation of male homosexuality?” Bailey asks.

J. Michael Bailey on twin research and sexual reorientation

Several new twin studies have been published over the past several months. A new one, just published on the Archives of Sexual Behavior website, deals with sexual orientation and neuroticism and psychoticism (more about that study in a future post). One of the co-authors of this new paper is J. Michael Bailey. Dr. Bailey is among the world’s top sexuality researchers and author of numerous publications involving twins and sexual orientation. Here he comments on the limitations of twin studies and sexual orientation change. This conversation was triggered in part by the recent NARTH report which stated that “homosexuality is not innate” without research supporting the statement.

In an email, I asked Michael to discuss how both the right and left misunderstand twin studies and their relationship to questions of innateness. His answers are indented and presented in full with some comments from me.

Both the left and the right conflate “genetic” with “inborn.” The debate over sexual orientation (and other traits) is more about inborn than genetic. As an example of the difference, it is common for identical twins to be discordant for homosexuality (i.e., given a gay identical twin, his twin is usually straight). It is a terrible mistake, though, to assume that this reflects the kind of social environment that can be manipulated. As you know, childhood gender nonconformity is very highly predictive of adult homosexual outcome. I’ve spoken to several mothers of identical twins discordant for

extreme childhood gender nonconformity (where one male twin wants to be a girl and the other is a typical boy). In each and every case, the mothers insist they did nothing–nothing–to differentiate the twins until well after the behavioral/emotional differences emerged. I

believe them.

On this point, some observers might not be quite as believing as Dr. Bailey. However, I lean in his direction on this, especially with extreme gender nonconformity. On this blog, we had an extensive conversation with a mother of twins, one quite non-conforming and the other not. In this context, it might be good to review those posts. (part 1, part 2). At the same time, I am aware of some parents who do indeed raise kids to prefer gender nonconformity. Extremes in childrearing may in some cases influence the trait of gender nonconformity in kids, but one does not need such parenting to get the same result.

The left often assumes some genetic influence means that social environment plays no role at the individual level. If some genetic factors operate for some, then they must operate for all. However, this cannot be assumed from twin studies. Neither can it be assumed that the differences between twins all relate to environmental factors which are alterable. On this point, Bailey says:

The main issue is nature-nurture. Heritability (which can be estimated from twin studies) generally is consistent with nature. But environmentality (the complement of heritability) DOES NOT MEAN nurture as it is typically assumed (i.e., social and reversible causation). MZ twins [monozygotic or identical] can differ (and I expect usually do) for biological reasons. At this point neither hypothesis (biological or social causation of MZ twin differences) has strong evidence to for it.

Note the last statement. We simply don’t know as yet. This is another reason why I think why I believe the NARTH paper is misleading. The paper uses weak therapy research to make a statement about innateness and immutability of sexual orientation. First we do not know whether twin differences occur for social or biological reasons. And then we do not know if any of the factors in any given case are alterable. Francis Collins made this same point when reacting to how Dean Byrd at NARTH quoted his book The Language of God:

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.

The recent NARTH paper implies that studies demonstrating some shifts in sexual behavior disconfirm the view that homosexuality is innate. As Bailey notes above, we do not know. However, Bailey indicates a situation which provides a problem for environmental hypotheses.

Studies of the rare conditions of penile ablation and cloacal exstrophy (in which hormonally normal males are reassigned and reared as females from a very early age) show that such males grow up to be attracted to females, as per their biological, but not their social sex. To repeat something I’ve said many many times (and have never had a good answer), if you can’t make a male attracted to other males by cutting off his penis and rearing him as a female, how likely is any social hypothesis?

Bailey adds a bit of a challenge to his comments:

The folks who insist that (male) sexual orientation can be changed should put their money where their mouths are and fund you and me (and the researcher of their choice) to do a study with objective (i.e., penile and neural) pre-post measures.

We have discussed a study like this since 2006. I am aware of people who would participate but funding is an issue. Bailey and I both have sought such funding but no one has provided encouragement.

Anyone interested?

I will have more on the NARTH paper in future posts. Thanks to Michael for his comments and expertise.

Genetic effects of gender atypical behavior and sexual orientation: A study of Finnish twins

Due to time constraints, this post is less review than description of results. However, I wanted to post something on this study in advance of some commentary coming from Michael Bailey on the topic.
Here is the reference and abstract:

Abstract: The existence of genetic effects on gender atypical behavior in childhood and sexual orientation in adulthood and the overlap between these effects were studied in a population-based sample of 3,261 Finnish twins aged 33–43 years. The participants completed items on recalled childhood behavior and on same-sex sexual interest and behavior, which were combined into a childhood gender atypical behavior and a sexual orientation variable, respectively. The phenotypic association between the two variables was stronger for men than for women. Quantitative genetic analyses showed that variation in both childhood gender atypical behavior and adult sexual orientation was partly due to genetics, with the rest being explained by nonshared environmental effects. Bivariate analyses suggested that substantial common genetic and modest common nonshared environmental correlations underlie the co-occurrence of the two variables. The results were discussed in light of previous research and possible implications for theories of gender role
development and sexual orientation.
Common Genetic Effects of Gender Atypical Behavior in Childhood
and Sexual Orientation in Adulthood: A Study of Finnish Twins
K. Alanko, P. Santtila, N. Harlaar, K. Witting, M. Varjonen, P. Jern, A. Johansson, B. von der Pahlen, & N. K. Sandnabba. Arch Sex Behavior.

The sample was obtained via a registry maintained by the Central Population Registry of Finland which includes all twin pairs born in 1971 or earlier. The researchers requested information from the twins and received responses from 36% of those surveyed (3,604). For various reasons, the authors assume representativeness of their sample, although I think they might be open to some challenge on this point given the response rate.
The authors used Zucker’s Recalled Childhood Gender Identity/Gender Role Questionaire and Sell’s Assessment of Sexual Orientation. The SASO assesses both behavior and attractions via four items:

Item 1: During the past year, on average, how often were you sexually attracted to a man (woman for female participants)? The response alternatives were: never, less than 1 time per month, 1–3 times per month, 1 time per week, 2–3 times per week, 4–6 times per week, daily. Item 2: During the past year, on average, how often did you have sexual contact with a man (woman for female participants)? The response alternatives were the same as for Item 1 above. Item 3: How many different men (women for female participants) have you had sexual contact with during the past year? Item 4: During the past year, on average, how many different men (women for female participants) have you felt sexually attracted to? The response alternatives to Items 3 and 4 were: none, 1, 2, 3–5, 6–10, 11–49, 50–99, 100C. The participants were given numerical scores so that a response of ‘‘none’’/‘‘never’’ gave a score of 0 and a response of ‘‘100 or more’’/‘‘daily’’ gave a score of 7.

Here are the correlations of twins sharing traits of sexual orientation and gender atypical behavior.
Alanko et al, table 3
Correlations were higher for identical twins than fraternal twins for both traits, especially for women. About the genetic contribution to GAB and sexual orientation, the authors said:

Significant genetic effects were found for women and men for both GAB and sexual orientation, as was our second hypothesis. The heritability estimates for childhood GAB were 51% and 29%, and for sexual orientation 45% and 50%, for women and men, respectively.

These numbers are higher than past studies and may be related to the nature of the sampling although this is not clear.
The authors also found a relationship between GAB and sexual orientation.

Our first aim was to study the phenotypic correlations between childhood GAB and adult sexual orientation. Significant correlations of moderate sizes were found, indicating that the two phenomena were related. The strength of the phenotypic association was higher for male participants, implying that childhood GAB was a stronger predictor of adult sexual orientation for men.

The authors note that these data in conjunction with past studies lead them to propose the possibility of several pathways to homosexual attractions.

There might, in other words, be different genotypes for different kinds of homosexuality. It might also be possible that the relative importance of shared environment and genetic influences vary during development. It is plausible that parents influence their children directly only as long as they live at home (Knafo et al., 2005; Plomin et al., 2001). Bailey et al. (2000) found that GAB predicted about 30% of the variance in men’s sexual orientation. As neither the phenotypic nor the genetic correlations were unity in the present sample, GAB preceded a homosexual orientation for some participants, whereas gender typicality preceded a homosexual orientation for other participants.

What did not show up was any significant role of shared environment for men. A small amount of the effect could be attributed to shared environment for women. Another data point suggesting that the pathways to adult sexual orientation are different for men and women.
Stay tuned…