Written Testimony of the Texas Medical Association
House Public Health Committee
House Bill 517 Rep. Celia Israel
May 1, 2019
Submitted on behalf of:
- Texas Medical Association
- Texas Pediatric Society
Chair Thompson and members of the Public Health Committee, the Texas Medical Association and Texas Pediatric Society appreciate the opportunity to provide written testimony in support of House Bill 517 by Representative Israel. Representing nearly 53,000 physicians and medical students, our testimony addresses our responsibility to provide evidence-based care and support for all children including those who do not identify with the sex they were assigned at birth or as heterosexual.
House Bill 517 clarifies that mental health providers who attempt to change the sexual orientation of a child as engaging in unprofessional conduct. Such attempts may include a variety of practices such as psychotherapy or other treatment aimed at changing a person’s sexual orientation, gender identity, or expression. In 2015, an expert panel made up of representatives of the American Psychology Association and the U.S. Substance Abuse and Mental Health Services Administration reviewed the literature and provided guidance on therapies related to children’s sexual orientation and gender identity. The summary report of this expert panel affirms the following:
- Same-gender sexual orientation and variations in gender identity and expression are a part of the normal spectrum of human diversity. These variations are not mental disorders.
- Research does not support the notion that mental or behavioral health interventions can alter gender identity or sexual orientation.
- Interventions aimed at changing gender identity or expression, or sexual orientation should not be considered behavioral health treatment but are considered coercive and can be harmful.
We are still in the early stages of assessing the population, specifically the health needs, of those who do not identify as being the sex they were assigned at birth or who do not identify as heterosexual. Much more rigorous study and research is indicated to support children who question or may identify their sexual orientation or identity as lesbian, gay, bisexual, transgender, or questioning (LGBTQ). Youth and adolescents face unique health barriers and risks and discrimination and stigmatization, as well as legal and social bias that contributes to health disparities among our LGBTQ patients. LGBTQ youth are at higher risk for suicide, sexually transmitted infections, and substance use. Medical associations such as the American Academy of Pediatrics recommend that health care for sexually minority youth be rooted in acceptance and support of the individual’s identity, and the provision of accurate information on the development of sexual orientation and gender identity.
The frequency of use of conversion therapies in Texas or the United States is not well understood, but we are aware that therapists advertise services in Texas. While Medicaid appears to currently have no specific prohibition against these services, Medicaid can only provide payment for services that are considered to be medically necessary. Because evidence does not support conversion therapy, it is not clear how the state or Medicaid managed care organizations handle claims for these services. A number of other states and the District of Columbia already prohibit mental health practitioners from engaging in conversion therapy with a minor patient.
LGBTQ youth are especially vulnerable – they are more likely to be homeless and are at increased risk of substance use disorders and suicide attempts than other youth. Pubertal manifestation of secondary sexual characteristics not matching one’s gender identity can cause extreme stress to transgender adolescents. In caring for LGBTQ youth, physicians must balance the need for the patient’s privacy with the need to educate parents and caregivers on how to care for and support these vulnerable children. But our responsibility to provide quality care to our patients also must acknowledge that some unproven therapies are being offered to change the sexual orientation of a child.
The care for each of our minor patients must be built in an environment that supports an open, safe, and confidential patient-physician relationship – but also upon evidence-based care that supports the child’s development. We believe House Bill 517 sets a clear standard that families must be aware that practices to change sexual orientation that are not evidence-based can be harmful. We encourage your support for this important legislation.
86th Texas Legislature Letters and Testimonies
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