Sex Differences in Reported Effectiveness and Psychosocial Effects of Therapy-Assisted Sexual Orientation Change

Background  Sexual reorientation therapy (SRT) refers to voluntary therapeutic interventions for sexual orientation change, which may or may not include a goal of changing same-sex attraction (SSA), behavior, or identification. Research on the contested question of whether SRT is effective or safe consists almost exclusively of clinical studies of males. This study presents two improvements to the evidence: it includes a control group of non-therapy participants and distinguishes outcomes by sex. Methods This study was conducted at Ruth Institute, Lake Charles, LA, USA. It examined a cross-sectional nonprobability sample of persons reporting same-sex orientation change (n = 183) for the retrospectively reported extent of reduction in SSA and same-sex behavior (SSB), for exposure to SRT and other forms of therapy, and for positive and negative changes in six psychosocial problem domains: depression, suicidality, self-harm, self-esteem, social function, and alcohol or substance abuse. Reported values were compared by sex (129 men (70.5%) and 54 women (29.5%)) and by SRT exposure (98 (58.7%) were exposed, 69 (41.3%) not exposed, with 16 item nonrespondents). The mean change was assessed by a t-test for continuous variables and Fisher's exact test for categorical variables.  Results  Thirty-nine (38.6%) of 101 men and 44 (88.0%) of 50 women reported high SSA before changing sexual orientation and then reported low SSA after the change, thereby making a low same-sex attraction (LSSA) shift. SRT exposure increased the percentage of an LSSA shift for women (from three of five (60%) without SRT to 24 of 25 (96%) with SRT, p = 0.06, d = +1.3) but reduced it for men (from 12 of 22 (55%) without SRT to 17 of 44 (39%) with SRT, p = 0.167, d = -0.32). Therapy with a goal of SSA change weakened men's prospects of an LSSA shift the most (to eight of 26 (31%), p = 0.099, d = -0.49). For both men and women, therapy not directly related to sexual orientation change was most strongly associated with an LSSA shift (17 of 40 men, 30 of 30 women, overall p = 0.029, d = 0.51). Despite the sex difference in reducing SSA, 100% of both men and women reported slight or no SSB after the change (LSSB shift). Psychological problems improved overall, somewhat higher for women (2.84 on a five-point scale) than men (2.50) (p = 0.01, d = 0.38). SRT exposure enhanced overall psychological improvement moderately, by +0.26 (d = 0.34) for women and +0.20 (d = 0.21) for men, but strongly improved outcomes for depression for women (+0.80, p = 0.009, d = 0.69) and self-harm for men (+0.45, p = 0.021, d = 0.39). Previously suicidal persons reported a much stronger benefit from SRT than non-suicidal persons (+0.70, p = 0.002, d = 0.67). Conclusion For sexual orientation change, SRT helped women but not men to reduce SSA, which women did to a much greater degree than men. High psychological benefit from change was improved slightly by SRT, more for women than men. Research that excludes women is likely to substantially understate the effectiveness and psychological benefit of SRT. Theoretical, legal, and clinical implications are discussed.