Same-Sex Attractions in Youth and their Right to Informed ConsentRICHARD FITZGIBBONS, M.D.
Youth have the right to be provided the accurate medical and psychological knowledge about homosexuality by pediatricians, mental health professionals, school counselors, educators and parents.
Notice to Reader: "The Boards of both CERC Canada and CERC USA are aware that the topic of homosexuality is a controversial one that deeply affects the personal lives of many North Americans. Both Boards strongly reiterate the Catechism's teaching that people who self-identify as gays and lesbians must be treated with 'respect, compassion, and sensitivity' (CCC #2358). The Boards also support the Church's right to speak to aspects of this issue in accordance with her own self-understanding. Articles in this section have been chosen to cast light on how the teachings of the Church intersect with the various social, moral, and legal developments in secular society. CERC will not publish articles which, in the opinion of the editor, expose gays and lesbians to hatred or intolerance."
One example of this activity is the American Psychological Association publication Just the Facts , that was sent to all the school superintendents in this country two years ago. It was sponsored by a coalition of 13 national organizations including the American School Counselors Association and the American Academy of Pediatrics. Just the Facts advised schools that all forms of sexual attraction are normal, warned against psychotherapy for homosexual attractions, encouraged on-campus gay clubs, and cautioned schools about the scientific literature, such as studies by the National Association for Research and Therapy of Homosexuality (NARTH), that presents heterosexuality as normative.
NARTH responded by sending a scientific statement on homosexuality that was pertinent to youth to the school superintendents and then later so did the American College of Pediatricians (ACOP) . Their statements presented issues related to the lack of genetic origins of same-sex attractions, the fluidity of such actions, the serious dangers to psychological and medical health from homosexual behaviors, the resolution of same-sex attractions, and the right to informed consent.
In response to the ACOP statement, Dr. Francis Collins, the director of the National Institutes of Health, on the NIH website dismissed the peer-reviewed articles cited by ACOP as being "misleading and incorrect." He went on to state, " . . . it is particularly troubling that they are distributing it in a way that will confuse children and their parents."
When ACOP asked Dr. Collins to identify the specific research that was misleading and incorrect, he failed to identify a single peer-reviewed article.
Another example of the impact of political correctness upon psychological science and youth was from a study in the November 2010 issue of the leading journal of child and adolescent psychiatry, the Journal of the American Academy of Child and Adolescent Psychiatry. In this study of the prevalence of mental disorders in US adolescents, the first table presented the socio-demographic characteristics. Three categories were listed in regard to parents: never married, previously married, and married/cohabiting.
Several years ago the failure to separate married and cohabiting households would have led the editors to return the article to the authors. They would have requested that, given the numerous research studies on the emotional and physical harm to children in cohabitating households, the authors separate the research findings under two different headings.
Seven months before the publication of this study of adolescent psychiatric illness a report on child abuse by the Department of Health and Human Services that found that children living with two married biological parents had the lowest rates of harm – 6.8 per 1,000 children – while children living with one parent who had an unmarried partner in the house had the highest incidence, at 57.2 per 1,000 children. Children living in cohabiting households are 8 times more likely to be harmed than children living with married biological parents.
Another research study on the dangers to children in cohabiting households published Pediatrics demonstrated that children residing in households with unrelated adults were nearly 50 times as likely to die of injuries than children residing with two biological parents. Children in households with a single parent and no other adult in residence had no increased risk of inflicted-injury death.
Another study that revealed that the cohabitation experience for adolescents is associated with poor outcomes and that moving into a cohabiting stepfamily from a single- mother family decreased adolescent well-being.
The author of the adolescent research study and the editors of the Journal of the American Academy of Child and Adolescent Psychiatry chose to ignore the overwhelming research that demonstrates the danger to children from living in cohabiting households. Also, the author has failed to respond to the requests of professionals who have requested the data in the study in order to analyze the differences between married and cohabiting households. A more in-depth analysis of the first study of the prevalence of mental health disorders in adolescents could be helpful in the efforts to protect children and marriage.
Contrary to the view of Judge von Walker, when he ruled against the California vote on proposition 8 to defend marriage, that "it is beyond any reasonable doubt that parents' genders are irrelevant to children's developmental outcomes," the mental health literature demonstrates that the nature of the household is critical to the health of youth.
For example, the extensive research on children in homes without fathers shows the harm done to the mental health of such children, to families and to the entire culture..
A large and growing body of research indicates that mothers and fathers bring distinctive talents to parenting and that the children are most likely to thrive when they are raised by their own mother and father. Children long to know and to be known by the man and woman who brought them into this world.
Just the Facts violates the right to informed consent in youth in regard to the positions taken by the American Psychological Association, the American Academy of Pediatrics and the American School Counselors Association in regard to diagnosis, proposed treatment, the risks and benefits of not receiving treatment and the health risks associated with the homosexual lifestyle. It fails to present the diagnosis of gender identity disorder, the fluidity of sexual attractions in youth, the absence of a biological basis for SSA and the serious emotional conflicts in youth with same-sex inclinations, such as a lack of secure attachment relationships with a parent or same-sex peers. Also, it does not identify the serious high-risk behaviors, compulsive masturbatory and sexual behaviors, depression, and excessive anger in those with homosexual inclinations. These numerous conflicts should not be ignored, are not caused by the culture, and should be addressed rather than denied.
The next area in which the criteria for informed consent are violated is the nature and purpose of proposed treatment and youth. There is a failure to recommend treatment in spite of serious emotional, behavioral and sexual problems. Even worse, strong advice is given against treatment except that which affirms a homosexual identity. Also, the risks of not receiving treatment are not identified.
One benefit of treatment of same-sex inclinations that Columbia University psychiatrist, Dr. Robert Spitzer, found in his 2003 study of men and women out of the homosexual lifestyle for at least five years was that 87% found therapy to be helpful in terms of feeling more masculine or more feminine. Also, 93% found therapy helpful in developing more intimate nonsexual relationships with those of the same sex.
Today, there is a consensus that there is not a genetic or hormonal origin of homosexuality. A 2008 American Psychological Association publication stated, "although much research has examined the possible genetic, or model, and develop developmental, social and cultural influences on sexual orientation no findings have emerged that permit scientists to conclude that sexual orientation is determined by any particular factor or factors. Many think that nature and nurture both play complex roles. . . ."
Also, if homosexuality were genetically determined, identical male twins would be 100% concordant for this condition. A study from the Australian twin registry found that only 11% of identical twins with SSA had a twin brother who also experienced SSA.
In addition, Dr. Francis S. Collins, M.D, Ph.D, former director of The Human Genome Project, who wrote, "There is an inescapable component of heritability to many human behavioral traits. For virtually none of them is heredity ever close to predictive...An area of particularly strong public interest is the genetic basis of homosexuality. Evidence [indicates] that sexual orientation is genetically influenced but not hardwired by DNA, and that whatever genes are involved represent predispositions, not predeterminations.
In our clinical work over the past 34 years with perhaps three to four hundred men and women with same-sex attractions, we have found that the most common cause of same-sex attractions in males is an intense weakness in masculine confidence that is associated with strong feelings of loneliness and sadness. This insecurity arises from a number of factors, including same-sex peer rejection in early childhood as a result of a lack of eye–hand coordination. This challenge in boys interferes with male bonding in sports and with secure same-sex attachments. Other origins of male insecurity and sadness are an emotionally distant father relationship, a poor body image and, finally, sexual abuse victimization.
Several major research studies of adult and adolescent males with SSA have also demonstrated low self-esteem as being a major conflict in their lives. The first study from the Netherlands of 7,076 adults demonstrated that lesser quality of life in men was predominantly explained by low self-esteem. The authors recommended the importance of finding out how lower sense of self-esteem comes about in homosexual men.
In a 2010 Israeli study of ninety homosexual and 109 heterosexual men with mean age of 26 and with no significant differences with respect to country of birth, ethnic origin, education level, military service, or participation in psychotherapy, homosexual young adults scored lower on the self-esteem measure and higher on narcissism compared to their heterosexual counterparts.
A 2011 UK study of 10,000 adolescents was notable for boys with some same-sex experience reporting less self-esteem and more experiences of forced sex.
Other causes of male same sex attractions are a mistrust of women arising from conflicts with a controlling, angry, and overly dependent mother or from significant rejection by females. Finally, selfishness and sexual narcissism are factors in some males.
In our clinical experience the most common origin of SSA in females is a mistrust of males originating primarily from conflicts with fathers who are excessively angry, alcoholic, abusive, or highly narcissistic. The next conflict present in women is a weak feminine identity that can arise from a lack of secure attachment in the mother relationship, peer rejection and loneliness or from a poor body image. Also, struggles with loneliness and inability to establish a loving relationship with a man can lead to intense loneliness and an attempt to escape this sadness through a homosexual relationship.
A 2010 study of 7,643 women between the ages of 14 and 44, drawn from the National Survey of Family Growth conducted by the Centers for Disease Control and Prevention (CDC), found that women who grew up in households where their biological fathers were absent were three times more likely to have had homosexual partners in the year prior to the survey than were women who grew up with their biological fathers.
Dr. Laumann's research at the University of Chicago has shown that "sexual orientation has found to be unstable over time in both males and females." In another study Kinnish demonstrated that sexual attraction/orientation is inherently flexible, evolving continuously over the life span and that women demonstrate greater fluidity than men.
Well-designed research studies published in leading peer-reviewed journals have shown a number of psychiatric disorders to be far more prevalent in teenagers and adults with SSA. These include major depression, anxiety disorders, substance abuse, suicidal ideation, suicide attempts and sexual abuse victimization. Many of these studies were done in countries where homosexuality is widely accepted, such as in New Zealand and the Netherlands.
Youth have the right to know the recent research that demonstrates the serious health risk of acquiring cancer in the homosexual life style. A major study published in the journal Cancer in May 2011 revealed that men with SSA in California are twice as likely to report a cancer as heterosexual men. Most troubling was the median age of onset of cancer in the men with SSA - 41 years old.
GLB youth who self-identified during high school report disproportionate risk for a variety of health risks and problem behaviors , including suicide sexual risk behaviors, multiple substance abuse use, victimization. In addition these youth are more likely to report engaging in multiple risk behaviors and initiating risk behaviors at an earlier age than their peers.
Young men who have sex with men (MSM) are at extremely high risk for contracting a sexually transmitted infection. According to the CDC , the number of MSMs ages 13 to 24 with newly diagnosed HIV is increasing each year and almost doubled since 2000. The number infected increased by 11% in 2001 and by 18% in 2006.
A 2008 study found the HIV new-infection rate in the US 40% higher than estimated. Boys who begin to engage in sexual activity with males at an early age are more likely to become HIV positive or contract an STD. Intensive condom education has failed to prevent infections. According to Dr. Philip Alcabes, an epidemiologist at Hunter College, "It looks like prevention campaigns make even less difference than anyone thought."
A study of young men aged 17–22 who have sex with men found that 22% reported beginning anal sex with men when aged 3 to 14; of these, 15.2% were HIV positive. Of those who began sex when they were 15 to 19, 11.6% were HIV positive. While of those who began sex with men when they were 20 to 22, only 3.8% were HIV positive. It is clear that every year that a male with SSA delays sexual involvement reduces his risk of HIV.
In a study of 137 young males with SSA aged 17 to 21, 30% admitted to at least one suicide attempt. Forty-four percent attributed this attempt to family problems including marital discord, divorce and alcoholism. Other factors included a history of sexual abuse in 61%, substance abuse in 85%, illegal activities in 51%, effeminacy in 36%, and prostitution in 29%.
The data on the 10,587 youths from the national longitudinal study of adolescent health revealed that 1% reported same-sex attraction only, whereas 5% reported attraction to both sexes. Those with SSA were twice as likely to perpetrate violence and also at greater risk for experiencing and witnessing violence.
In March 2010 the CDC reported that the rate of new HIV diagnoses among men who have sex with men (MSM) is more than 44 times that among other men and more than 40 times that among women. The rate of primary and secondary syphilis among MSM is more than 46 times that of other men and more than 71 times that of women. The factors that were listed as causing higher HIV prevalence included greater risk of HIV transmission to receptive anal sex and other sexual activities, complacency about HIV risk particularly among young MSM, difficulty consistently maintaining safe sexual behaviors over the course of a lifetime, and homophobia.
A 2002 study a lifetime abuse victimization revealed that 7% of heterosexual males reported being abused whereas 39% of males with SSA reported being abused by other males with SSA. Other research demonstrates partner abuse reported by 35% to 55% of participants. Other research on homosexual relationships demonstrates similar findings.
One of the largest studies of same-sex couple revealed that only seven of the 156 couples had a totally exclusive sexual relationship. The majority of relationships lasted less than five years. Couples with a relationship lasting more than five years incorporated some provision for outside sexual activity in their relationship: "The single most important factor that keeps couples together past the 10-year mark is the lack of possessiveness. . . . Many couples learn very early in their relationship that ownership of each other sexually can be the greatest internal threat to their staying together."
Amsterdam research found that most new HIV infections there occurred among men with SSA who were in steady relationships. The researcher concluded, "Prevention measures should address risky behavior, especially with steady partners, and the promotion of HIV testing."
The Catholic Medical Association offers this medical opinion on same sex adoption in its publication, Homosexuality and Hope, "Research on same-sex unions demonstrates that they are markedly different from marriage in that exclusivity and permanency are not present or desired in the vast majority of these unions. Same-sex unions suffer a significantly higher prevalence of domestic abuse, depression, substance-abuse disorders, and sexually transmitted diseases. Physicians should caution their patients about the dangers of same-sex unions and advocate against children being placed in such unstable relationships. The overwhelming body of well-designed research demonstrates that the healthiest environment for child development is a home with a mother and father who are married."
The extensive research on the serious psychological, academic and social problems in youth raised in fatherless families demonstrates the importance of the presence of the father in the home for the healthy child development. Clinical experience would indicate that the deliberate deprivation of a mother to a child, motherlessness, while not studied as extensively, causes even more severe damage to a child because the role of the mother is so crucial in establishing the ability to trust and to feel safe in relationships.
Extensive research exists that demonstrates the importance of gender complementarity to the healthy development of children. This literature from peer-reviewed journals cites the importance of both mothering and fathering for the healthy development of a child.
Research published in 2010 by Marquardt, Glenn and Clark  demonstrated the following troubling negative factors in donor conceived individuals: on average, young adults conceived through artificial insemination were more confused, felt more isolated from their families, were experiencing more psychic pain, and fared worse than a matched group of children who were conceived naturally in areas such as depression, delinquency and substance abuse.
In a well designed study of 174 primary school children with 58 children in married families, 58 in heterosexual cohabitating and 58 in homosexual unions, married couples offer the best environment for a child’s social and education environment, followed by cohabiting couples and finally by homosexual couples.
Two major studies that claim no psychological damage to children who were deliberately deprived of the benefits of gender complementarity in a home with a father and a mother were published in 2010 by Gartrell and Bos  and Biblar and Stacey's .
In the Gartell and Bos article all data are self-reports by mother and child. Lesbian mothers well know the political agenda of the research. Also, there is no direct comparison group, only a normative group by Achenbach when he normed the CBCL, the Child Behavior Checklist, that was used in the study.
Again, in the Biblar and Stacey research in 31 of the 33 studies of two parent families, it was the parents who provided the data, which consisted of subjective judgments. As in the study published in Pediatrics, this created a social desirability bias in that the homosexual parents knew full well why the study was being done. They knew the political agenda. Also, of the 33 studies in two-person families, only 2 studies included men. This was an examination of published studies of women, not men, and the title implies both.
Pope Benedict has written that to deliberately deprive a child of a father or a mother is to do violence to a child.
The goals of therapy are to help the person identify the underlying causes of his or her SSA, which often includes low self-esteem, sadness, loneliness, anger and anxiety. Therapy that is initiated to treat these emotional conflicts often includes a spiritual component, as in the treatment of addictive disorders.
There have been numerous reports of successful therapy of SSA. Success depends on many factors, including the professional expertise of the mental health professional, the relationship between therapist and client, length of treatment, presence of significant support for treatment, and the presence of other psychological problems, particularly addictions.
Spitzer's study of 200 men and women who had sought professional help to deal with SSA and who were out of the lifestyle for five years found that 64% of the men and 43% of the women subsequently identified themselves as being heterosexual. Contrary to the claims made by the opponents of therapy, they did not experience an increase in psychological conflicts as a result of therapy.
Dr. Spitzer commented on his study, "Depression has been reported to be a common side effect of unsuccessful attempts to change orientation. This was not the case for our participants, who often reported that they were 'markedly' or 'extremely' depressed [prior to treatment] (males 43%, females 47%), but rarely that depressed [after treatment] (males 1%, females 4%.). To the contrary, [after treatment] the vast majority reported that they were 'not at all' or 'only slightly' depressed (males 91%, females 88%)."
In addition participants in Spitzer's study were presented with a list of several ways that therapy might have been "very helpful" (apart from change in sexual orientation). Notable were feeling more masculine (males) or more feminine (females) (87%) and developing more intimate nonsexual relations with the same sex (93%).
Dr. Jay Wade at Fordham University published a 2010 research study that showed that men with unwanted SSA can experience healing by developing healthy non-sexual relationships, i.e., friendships, with other men. They also reported a decrease in homosexual feelings and behavior, an increase in heterosexual feelings and behavior, and a positive change in psychological functioning.
A 2009 doctoral dissertation on Courage demonstrated that an increased rate of chastity is negatively correlated with psychopathology: an increased rate of chastity is positively correlated with happiness; the time in Courage is positively correlated with a history of increased religious participation, and extended participation in Courage is positively correlated with chastity.
Gender identity disorder is a childhood psychiatric disorder in which there is a strong and persistent cross-gender identification with at least four of the following: repeated stated desire to be of the opposite sex; in boys a preference for cross-dressing or simulating female attire and, in girls, wearing stereotypical masculine clothing with a rejection of feminine clothing such as skirts; strong and persistent preferences for cross-sex role in play; strong preference for playmates of the opposite sex, and intense desire to participate in games and pastimes of the opposite sex.
Boys who exhibit such symptoms before they enter school are more likely to be unhappy, lonely, and isolated in elementary school. They often suffer from separation anxiety, depression, and behavioral problems and become targets to be victimized by bullies and even pedophiles. Often they experience same- sex attraction in adolescence, and if they engage in homosexual activity, they are more likely than boys who do not to be involved in drug and alcohol abuse or prostitution. They are also at greater risk to attempt suicide, to contract a sexually transmitted disease, or to develop a serious psychological disorder as an adult. A small number of these boys will become transvestites or transsexuals.
A loving and compassionate approach to these troubled children is not to support their difficulty in accepting the goodness of their masculinity or femininity, which is being advocated in the media and by many health professionals who lack expertise in GID, but to offer them and their parents the highly effective treatment that is available.
The following interventions for boys with GID are helpful:
The following interventions for girls with GID are helpful:
Some medical centers are unfortunately going further and providing hormone treatments to GID children whom they label as transgender. A pediatric specialist at Children's Hospital Boston has recently begun a clinic for boys who feel like girls and girls who want to be boys. He offers his patients, some as young as 7 years, counseling about the "naturalness" of their feelings and hormones to delay the onset of puberty. These drugs stop the natural process of sexual development that would make it more surgically difficult to have a sex alteration later in life.
This approach theoretically allows the child and adolescent patients more time to decide whether they want to make the change. This physician alleges that those whom he labels as transgender children are deeply troubled by a lack of understanding of their feelings and have a high level of suicide attempts. He told the Boston Globe that he has never seen any patient make a suicide attempt after they've started hormonal treatment. 
While this physician is accurate in his interpretation of the literature that children with GID and transgender ideation are deeply troubled, his claims of a high level of suicide attempts in children with GID is not substantially supported by that same literature. What is supported is that most children who are treated for their feelings of being of the opposite sex improve remarkably and experience a resolution of their serious emotional and behavioral pain and conflicts. All children with cross-gender feelings should be evaluated for GID before any hormonal treatment is considered. This pediatrician also fails to consider the potentially serious side effects attributable to taking these hormones in childhood.
Paul McHugh, MD, University Distinguished Service Professor of Psychiatry and past Chair of Psychiatry at Johns Hopkins University, has a much different view of the attempt to change the sex of children. His studies of transgender surgery brought the procedures to an end at Johns Hopkins. He has stated that "treating these children with hormones does considerable harm and it compounds their confusion. Trying to delay puberty or change someone's gender is a rejection of the lawfulness of nature."
Dr. McHugh studied those who sought transsexual surgery at Johns Hopkins and also wrote, "I have witnessed a great deal of damage from sex-reassignment. The children transformed from their male constitution into female roles suffered prolonged distress and misery as they sensed their natural attitudes. Their parents usually lived with guilt over their decisions, second-guessing themselves and somewhat ashamed of the fabrication, both surgical and social, they had imposed on their sons. As for the adults who came to us claiming to have discovered their true sexual identity
and to have heard about sex-change operations, we psychiatrists have been distracted from studying the causes and natures of their mental misdirections by preparing them for surgery and for a life in the other sex. We have wasted scientific and technical resources and damaged our professional credibility by collaborating with madness rather than trying to study, cure, and ultimately prevent it."
A 2011 follow up of SRS (sexual reassignment surgery) from Sweden demonstrated that persons after sex reassignment, have considerably higher risks for mortality, suicidal behavior, and psychiatric morbidity than the general population.
Another review article on SRS concluded sexual reassignment surgery violates basic medical and ethical principles and is therefore not ethically or medically appropriate. (1) SRS mutilates a healthy, non-diseased body. To perform surgery on a healthy body involves unnecessary risks; therefore, SRS violates the principle primum non nocere, "first, do no harm." (2) Candidates for SRS may believe that they are trapped in the bodies of the wrong sex and therefore desire or, more accurately, demand SRS; however, this belief is generated by a disordered perception of self. Such a fixed, irrational belief is appropriately described as a delusion. SRS, therefore, is a "category mistake" – it offers a surgical solution for psychological problems such as a failure to accept the goodness of one's masculinity or femininity, lack of secure attachment relationships in childhood with same-sex peers or a parent, self-rejection, untreated gender identity disorder, addiction to masturbation and fantasy, poor body image, excessive anger, and severe psychopathology in a parent. (3) SRS does not accomplish what it claims to accomplish. It does not change a person's sex; therefore, it provides no true benefit. (4) SRS is a "permanent," effectively unchangeable, and often unsatisfying surgical attempt to change what may be only a temporary (i.e., psychotherapeutically changeable) psychological/psychiatric condition.
In our professional opinion the vast majority of children who express a wish to be of the opposite sex have GID and have the right to the highly effective treatment that is available for this disorder.
Pope Benedict communicated profound wisdom for youth and adults on homosexuality in his book Light of the World: "Sexuality has an intrinsic meaning and direction which is not homosexual. The meaning and direction of sexuality is to bring about the union of man and woman and in this way give humanity posterity, children, future. This is the determination internal to the essence of sexuality. Everything else is against sexuality's intrinsic meaning and direction. This is a point we need to hold firm, even if it is not pleasing to our age."
Youth have the right to be provided informed consent about the serious medical and psychiatric illnesses and risks of the homosexual lifestyle. Pediatricians, mental health professionals, physicians, nurses and school counselors have a legal responsibility to do so and parents, family members, educators and clergy a clear moral responsibility.
Richard Fitzgibbons, M.D. "Same-Sex Attractions in Youth and their Right to Informed Consent. " Twenty-third Workshop for Bishops in Dallas, Texas (February 16, 2011).
This paper was presented at the Twenty-third Workshop for Bishops in Dallas, Texas, on February 16, 2011 and was sponsored by The National Catholic Bioethics Center and the Knights of Columbus. It was revised September 30, 2011.
Reprinted with permission of Richard Fitzgibbons, M.D. All rights reserved.
Richard Fitzgibbons, M.D. is the director of the Institute for Marital Healing in West Conshohocken, Pa. He is the co-author with Robert Enright, of Helping Clients Forgive: An Empirical Guide: An Empirical Guide for Resolving Anger and Restoring Hope, 2000, American Psychological Association Books. He co-chaired the task force of the Catholic Medical Association that produced the document, "Homosexuality and Hope." His website is maritalhealing.com.
Copyright © 2011 Richard Fitzgibbons
Not all articles published on CERC are the objects of official Church teaching, but these are supplied to provide supplementary information.