The APA’S deceptive science


the Deceptive Science on Homosexuality:

A Comprehensive Review of the Evidence




The Report is a collection of peer-reviewed articles from professional journals regarding homosexuality from the year 2000 onward. Included are some papers prior to 2000 considered to be classic research. Included articles range from psychology, child development, mental and physical health studies. A majority of the articles the authors conducted the original research presented. In addition, several articles contain analyses of studies published by others. Papers that are largely critiques of other studies are noted in the summary. 

The purpose of The Report is to detail and document how the American Psychological Association ignores scientific evidence for its role in political advocacy.

The American Psychological Association’s released answers to questions regarding homosexuality for a better understanding of sexual orientation. The following quotes represent the APA’s view of homosexuality: “Both heterosexual behavior and homosexual behavior are normal aspects of human sexuality…these orientations represent normal forms of human experience” (APA, 2008, page 3). Psychotherapy to change sexual orientation: “To date, there has been no scientifically adequate research to show that therapy aimed at changing sexual orientation (sometimes called reparative or conversion therapy) is safe or effective” (APA, 2008, page 3). Same-sex couples: “…research shows that many lesbians and gay men form durable relationships” (APA, 2008, page 5). Child rearing by same-sex couples: “Overall, the research indicates that the children of lesbian and gay parents do not differ markedly from the children of heterosexual parents in their development, adjustment or overall well-being” (APA, 2008, page 5). Reference: American Psychological Association. (2008). Answers to your questions: For a better understanding of sexual orientation and homosexuality. Washington, DC: Author. [Retrieved from www.apa.org/topics/lgbt/orientation.pdf.]


The American Psychological Association has in its past compromised its commitment to objective scientific assessment for political purposes. One such recent example is the pentagon scandal. 

{APA-Pentagon Scandal 2015} The APA claimed to support and adhere to strict ethical guidelines for research and practice. But a recent scandal emerged regarding the APA’s evident collusion with the CIA and other government agencies to support torture policies following the 9/11 attack on U.S. soil. Independent investigator David Hoffman published a paper titled the “Hoffman Report” documenting years of improper behavior by the APA. Not only did the APA support torture tactics, they denied and disregarded any claims of wrong doing. In addition, Hoffman documents how the entire APA organizational structure colluded to sustain the lies. The scandal has prompted severe criticism and many psychologists have suffered the consequences of a tarnished profession. Many top APA officials were forced to resign including CEO Dr. Norman Anderson, deputy CEO Dr. Michael Honaker and communications director Rhea Farberman. 


The problem with the American Psychological Association is clearly expressed by Lesbian feminist and university professor Camille Paglia was a guest on the Dennis Prager show, {Camilla Paglia}. Her analysis on the current trend of psychology, which she says is being destroyed by politics. She states:
Every single gay person I know has some sort of drama going on, back in childhood. Something was happening that we’re not allowed to ask about anymore . . . I can see patterns that are similar in my background to that of other women I know who are lesbians, but the biggest patterns are in gay men. Every single gay man I know had a particular pattern where for whatever reason, he was closer to his mother than to his father, and there was some sort of distance between the mother and the father, so that she looked to her son as her real equal or friend, as the real companion of her soul. Sometimes these women were discreet and dignified. Other times, they were very theatrical and in a sense they drafted their son into their own drama. But now, you are not allowed to ask any questions about the childhood of gay people anymore. It’s called ‘homophobic’. The entire psychology establishment has shut itself down, politically . . . and also, Freud was kicked out by early feminism in the late 60s and early 70s. So all the sophistication of analysis that I knew in my college years when I went to the state university of New York – there were a group of radical young Jewish students from the New York area – they were so psychologically sophisticated in being able to analyze the family background. It’s all gone, that entire discourse is gone. Everything is political now. Families are bankrupting themselves, sending their kids to the elite schools to learn a political style of analysis (that says) ‘every single thing in the human person has been formed by some external force upon us, we are oppressed, it’s being inscribed on us’. It’s really sick. It’s a sick and stupid way of looking at human psychology . . . we are in a period now of psychological stupidity.”   


In this paper, {Sutton 1} extensively critiques the APA’s position on SOCE. He discusses the different passages from the APA Task Force Report that claim SOCE is harmful. However he points out that the Report also states “[T]here are no scientifically rigorous studies of recent SOCE that would enable us to make a definitive statement about whether recent SOCE is safe or harmful and for whom.” Sutton responds by saying, “Essentially, the APA accepts “reports” of harm but not of benefits.” Another area of concern Sutton discusses is the fact that the APA Task Force Report claims that SOCE is ineffective. Sutton responds, “That claim is based upon unfair and biased methodological criteria.” 


Dermot O’Callaghan examines the Royal College of Psychiatrists (RCP)’s LGB Special Interest Group’s contribution in 2007 to the Church of England Listening Exercise {Dermot O’Callaghan}. Comparing statements made in RCP contribution with quotations from the 17 studies they reference, O’Callaghan finds that the studies do not support their claims. The RCP cites a study by Mustanski et al (2005) implying that it supports a genetic causation. But that study, which looked for genetic linkages to homosexuality, found no linkage of statistical significance. A subsequent study by Rice failed to confirm even the ‘possible’ linkages suggested by Mustanski. RCP blames the fact that some LGB people “experience greater than expected mental health and substance abuse problems on discrimination in society and rejection.” The study which referenced (King 2003) says, “It may be that prejudice in society against gay men and lesbians leads to greater psychological distress … conversely, gay men and lesbians may have lifestyles that make them vulnerable to psychological disorder.” RCP claims that “considerable amount of the instability in gay and lesbian partnerships arises from lack of support within society, the church or the family for such relationships.” However the article referenced (Mays 2001) says “it is unclear whether the greater risk for discriminatory experiences, if it does exist, can account for the observed excess of psychiatric morbidity seen among lesbians and gay men.” 




In the article Sexual Orientation Change Efforts in the Ideological Lion’s Den, {Andre Van Mol} discusses California’s ban on conversion therapy for minors. He states that it’s against our human rights to ban such a therapy if an individual seeks change. He breaks down all the myths that gay-activists are intentively advocating in regards to the naturalness of homosexuality and why conversion therapy is harmful. Firstly, he goes through the popular misconception that gays are born this way and debunks that theory by stressing that “nature and nurture both play complex roles.” Next, he answers the question (is sexual orientation immutable) by citing many studies that indicate orientations do in fact change, meaning that it is not fixed but rather fluid. Lastly, Van Mol protests the use of the LGBT rallying cry of the word “identity.” He states that identity should not be focused on sexual orientation, but rather as identifying others as people “with due compassion and respect.”


In the keynote speech titled Beyond Dispute? Bias in Social Science Research, {Walter R. Schumm} criticizes the recent court case that deemed it was beyond dispute that same-sex parenting outcomes were no different than those of heterosexuals. He outlines all the types of bias in this type of research claiming that no scientific thought should be “beyond dispute” since it is always evolving and ambiguous. There is always the possibility that any scientific belief might be proven incorrect. Some of the methodological issues and biases he mentions include random samples vs. convenience samples,  sample sizes (not wanting too small or too large of a sample), social desirability bias among participants and complex family backgrounds (in which many times the child of the same-sex couple was conceived when one parent was in a heterosexual relationship). Furthermore, other issues include working parents (so others may be doing a portion of the parenting), delayed effects (in which the effects of father absence may not be evident until the child reaches adolescence) and that parent, teacher and child reports may differ. 


In this article Hope and Homosexuality,” Sutton, et.al. section on critique of APA  {Sutton et al.} discusses many aspects of homosexuality including the APA’s input on the subject. In the born-that-way debate, the APA originally concluded that”there is considerable recent evidence to suggest that biology, including genetic or inborn hormonal factors, play a significant role in a person’s sexuality” (3-4). A decade later after more research was done, they revised their view and concluded “that nature and nurture both play complex roles” (8). However, this statement seems to be overlooked by popular media possibly because they are more interested in being politically correct than understanding science. Furthermore, even if sexual orientation was genetically determined, it does not mean that the condition is normal, healthy or moral. But in 2009 the APA asserts that it is a “scientific fact” that “same-sex attractions, behavior, and orientations per se are normal and positive variants of human sexuality” (10).


In the article, “Is Social Science Politically Biased,” {Michael Shermer} discusses the implications of such an imbalance of political affiliation within the field of social science, and states that an increase in viewpoint diversity is necessary in order to eliminate the handicap of strong political biases from research conducted within the field. To further his point, Shermer references several examples of the effects of this disproportion, some of which being the overwhelming majority of liberal compared to just a fraction of conservative social scientists, which creates a bias that influences which subjects are studied and which are not, and the use of distortive language to incorrectly interpret research conducted by scientists holding opposing viewpoints. In this article, Shermer is not claiming that one affiliation is better than another, but simply that there needs to be more of a balance of varying viewpoints in order to accurately conduct and interpret research within the field of social science.


Chapter 2: Science v. Politics


In this paper, the authors {José L. Duarte et al, 2014} argue that academic psychology has lost nearly all of its political diversity in the last 50 years and this could undermine the validity of social psychological science. The lack of diversity leads to the presumption that liberal attitudes are right and those who disagree are in denial. The underrepresentation of non-liberals in social psychology may be due to discrimination. The problem may be increasing, because while the ratio of liberals to conservatives among social science faculty is now greater than 10:1, there are hardly any conservative students in the pipeline. This may be because conservative students report facing hostility and ridicule. The authors point out that in the past “differing perspectives and dissenting voices— often dismissed, denigrated, ignored, and relegated to second class positions in their day—were crucial for progress in psychology.” The conservative and other non-liberal perspectives being suppressed today may lead to future breakthroughs. The authors recommend encouraging people with different assumptions to collaborate, with the hope they can move toward a more complete science of human behavior.


{Thomas Coy} argues that the term homosexuality is of recent invention and has been used as a political strategy to misinform the public and advance the agenda of those who seek to normalize homosexuality. In 1905 Sigmund Freud introduced the technical terms “sexual object” and “sexual aim.” Heterosexuality, homosexuality, bisexuality, pederasty, pedophilia, bestiality, fetishism, and voyeurism were all described as choices of sexual object. Alfred Kinsey, a zoologist who specialized in insects, was a key player in the sexual revolution. In his quest to tear down traditional morality, he equated homosexuality and heterosexuality. In 1973 the American Psychiatric Association removed homosexuality from its list of disorders, and the term “sexual orientation” entered into regular usage. “Sexual orientation” was added to anti-discrimination laws and used to target religious institutions who didn’t believe homosexuality is equal to heterosexuality. Homosexuality is associated with higher suicide rates, higher risk of domestic violence, higher drug and alcohol abuse, higher numbers of sexual partners, extreme sexual practices, and among men higher rates of cancer and STDs, including HIV/AIDS


In the article, {Satinover} discusses how the mental health associations misrepresent science. He reviews the history of the DSM which removed homosexuality as a mental disorder in 1973. What originally replaced homosexuality in the DSM was sexual orientation disturbance, which stated that it is considered disorderly for individuals to be “disturbed by, in conflict with or wish to change their sexual orientation.” Furthermore, Satinover discusses two Supreme Court cases in which the psychiatric guilds misrepresented scientific data. He claims they ignored some studies, twisted the wordings of others and cited page numbers irrelevant to the statements they made. Lastly, he examines a section of the court briefs used to define homosexuality as a “class,” a claim which (under precedent jurisprudence) depends upon homosexuality being an innate and immutable trait.


In 1968, the American Psychological Association approved guidelines stating that public policy statements should be based on scientific evidence, Monitor Opinion, {Raymond D. Fowler}. “The essence of the Tyler Report (1969), which has often been used to guide the association, is that the association should focus its advocacy most prominently on areas where psychology has solid supporting research data” (Fowler, Raymond, Ph.D. Chief Executive Officer, “Social Issues Stance: Why APA Takes Them,” APA Monitor, page 2, 1993).


{Leona Tyler} led an APA ad hoc committee which designed a system for detecting emerging issues and making and carrying out decisions regarding the APA’s role in public policy. The decision-making process has two elements: a graded series of action measuring the level of involvement in government, ranging from “do nothing” to “grass roots activism;” and a graded series of issues relevant to the APA.


 In this article Editorial NARTH response to WMA statement {Christopher H. Rosik} responds to the World Medical Association (WMA) which attempted to discredit all professionals who work with clients wishing to modify unwanted same-sex attractions. Rosik claims that WMA’s statement lacks scientific integrity, fails to support claims with scholarly research and relies heavily on speculation. He discusses WMA’s claims and presents his viewpoint, backing it up with research done by professionals. For example, “WMA states without equivocation that homosexuality is “without any intrinsically harmful health effects.” This contention is exceedingly difficult to reconcile, for example, with a recent comprehensive review that found and overall 1.4 percent per-act probability of HIV transmission for anal sex and a 40.4 percent per-partner probability (Beyer et al. 2012).” Furthermore, “WMA implies that professional psychological care to assist a client in modifying unwanted same-sex attractions and behaviors is a form of harm-inducing stigmatization and discrimination” (112). But in reality the “rates of success and harm for change-oriented psychological care are currently unknown” (112). Finally, “WMA creates straw arguments by claiming practitioners…view their work as attempting to “cure” homosexuality, when in fact most recognize that change usually takes place on a continuum of change, as is the case for nearly every other psychological and behavioral condition for which people seek professional care” (112).


In this article, {Linda Ames Nicolosi} talks about a speaker at the NARTH conference who claimed psychology is losing its credibility. Former APA president Nicholas Cummings stated that social science is in a state of decline with social-activist groups now dominating the profession. Dr. Cummings admits that the APA takes positions in areas where they have no conclusive evidence. For example, the APA favored gay marriage in 2004 claiming that it “promotes mental health.” The evidence used to support this was, as a general matter “loving relationships are healthy.” Dr. Cummings explains, ”When we speak in the name of psychology we are to speak only from facts and clinical expertise.” If psychology speaks out on every social issue, “…very soon the public will see us as a discredited organization–just another opinionated voice shouting and shouting.”


{Christopher Rosik} The APA’s 2012 aspirational Guidelines for Psychological Practice with Lesbian, Gay, and Bisexual Clients demonstrates an exclusively gay-affirming bias.  To clients with discordant same-sex attraction due to superseding religious values, the APA only recommends clients modifying their religious beliefs or shift to a gay-affirming denomination.  The Guidelines dismiss any reason other than internalized homophobia for why clients with SSA may wish to resist or modify their desires.  The authors reject positive studies on SOCE, claiming they are too methodologically flawed to be considered scientific, and then uses this lack of evidence to conclude that SOCE is ineffective.  The APA unequivocally touts gay-affirmative therapy, even though the 2009 APA Task Force stated that gay-affirmative therapy lacks empirical support.  The Guidelines also seem to validate the common trend of non-monogamous relationships among the LGB community.  And despite the current dearth of sound research, the APA gives a strong endorsement of gay parenting.  The authors of the Guidelines routinely show bias in interpretation and use of data, such as citing Hooker’s and Shidlo and Schroeder’s studies, which have the same types of methodological errors they attribute to the SOCE research.


{Christopher Rosik 2} Though Robert Spitzer might wish he could retract his findings from his 2003 study of the experiences of 200 individuals who have underwent SOCE and experienced reduction or modification in SSA, all he has done and has been able to do is reassess his own interpretation of the data.  His reassessment hinges on his new opinion that the self-reports of his participants were not credible, asserting without evidence that they must have been lying or self-deceived.  Nevertheless, the quality of findings from his study—though inherently limited by the method of retrospective self-report—still suggests, even with response bias, that SOCE may be effective, or—at the very least—that more research should be funded and performed.  Interestingly, studies based on memory recall have clear limitations, and yet opponents of SOCE continue to use the Bell et al and Shidlo and Schroeder studies, which relied on memory recall.


{Regnerus 2016} Regnerus (2016) replicated a study done by Hatzenbueler et al., (2014) on the effect of structural stigma on mortality. The previous study indicated that , on average, those gay individuals who lived in communities thought to exhibit high rates of anti-gay prejudice, named structural stigma, experienced a life expectancy that was twelve-years lower than those who did not. Thus, mortality rates are impacted by structural stigma towards sexual minorities. In the replication, no statistically significant findings were found, despite utilizing ten different approaches to multiple imputations of missing data. Original data was taken from the General Social Survey (GSS) of 1988-2002, linked to mortality outcome data in 2008. The replication of the data, utilizing publicly-accessible datasets, did not indicate the same findings. This seems to be due to the imputation of missing data points from the dataset over the course of 1988-2002. Each of the four measures in the original dataset indicated that, within each variable, about 40% were missing values. Due to a lack of information regarding the imputation model for the data, the study was difficult to replicate. The replication failed to indicate the strong and statistically significant effect of structural stigma on mortality. Regnerus (2016) calls for greater rigor in science and transparency with regard to the findings and the conclusions drawn from them.


{Reisman 2002} This publication highlights the role of the press in subtly promoting the gay agenda. The positive portrayal of the gay lifestyle (and the lack of reporting about gay-related crimes) has led to the gradual shift over the past few decades from the gay/lesbian/bisexual/transgender population being viewed as abnormal or as a documented mental illness to being more widely accepted and upheld as a normal lifestyle. The topic of sexual orientation is discussed more frequently in schools and youth are being recruited to “come out” and join gay support youth groups. This movement has also given rise to the normalization of crimes such as child sexual abuse and pederasty.


{Clevenger 2002} Clevenger (2001) highlights the systemic bias involved in the publication of articles surrounding homosexuality. He asserts that there is a bias that keeps any articles from being published which do not promote certain political and ideological understandings of homosexuality. Spitzer’s findings that change could be experienced for some of those who underwent reorientation therapy were largely criticized, as well as his personal character, although he was the same researcher who advocated for homosexuality to be removed from the DSM in 1973. Peer reviewers are often biased, and anonymous which can also limit the opportunities for articles to be published based on the content or conclusions made. He concludes that APA, like other organizations structured to offer oversight within a field have become increasingly politicized, making their perspectives less credible and guided by honest research, even while their research is still highly regarded and utilized in legal settings. Competing points of view are silenced, in this perspective, and make for a one-sided science.


{Poljakovic & Dodig 2015} Poljakovic & Dodig (2015) explores gender theory, which is the notion that sex, which is biologically determined, does not have a major influence on one’s gender. This theory proposes that socialization and culturation have more significant roles in gender, and that gender is a social construct, rather than a biological reality. It identifies early influences in the development of gender theory, including Kinsey and Money, who proposed that we are sexually neutral at birth, but then assigned a gender which is then reinforced by socialization and culture. A case study of a biological male who was assigned as female after birth due to physical abnormalities was utilized to evidence this. The case was presented as if the child developed a healthy female identity, although it became clear later that the individual who was assigned a female gender at birth did not actually adopt a female identity and struggled with gender identity throughout his life.  Feminist psychologists, including Millet and Beauvoir then reinforced the idea that gender is constructed by culture and that the male-female binary is responsible for the unjust treatment of women over history. Butler (1990) is then presented, who advocated for a deconstruction of traditional thought around gender, for the sake of equality between men and women. She saw gender as a fluid and/or changeable construct, which contrasts conventional theory, which proposes that our sex determines our gender (masculine or feminine). Some research indicating that boys and girls may have differences which are not decidedly due to socialization, was presented, in which girls appear to have preferences for human faces, while boys take greater interest in non-animate objects. Studies worldwide do not appear to indicate differential treatment between boys and girls by parents, although differences are apparent, which challenges gender theory assumptions. The article closes with an exploration of the course which led to the removal of homosexuality from the DSM, and proposed that sociopolitical factors, as opposed to science, drove the decision to do so, pointing to the increase in mental health and physical health concerns among same-sex attracted persons, the research regarding infidelity in same-sex couples, etc. It also challenged the notion that reorientation therapy is more dangerous or less effective than other types of therapy for other experiences. Several studies indicating that homosexuality is biologically caused were presented, and the conclusions drawn by these studies were challenged as far-reaching.


{Rosik 2015} Rosik’s article explores the literature on sexual orientation change by reviewing Diamond & Rosky (2016). They indicate the complexity around sexual orientation, such as its multiple origins, factors, and highlights the unscientific nature of sexual orientation immutability claims. It notes the epigenetic component in understanding sexual orientation, then discusses heritability estimates of homosexuality, which indicate that 32% of variability in sexual orientation is due to genetic factors, which is less than several other traits not considered immutable, including divorce, smoking, low back pain, and body dissatisfaction, pointing that there are likely environmental contributions as well. Neuroendocrine contributions, namely exposure to sex-atypical levels of androgens or estrogens in utero could shape later sexual orientation, are possible, although much of the research on this is on animals, and the evidence is mixed. It is more likely that prenatal hormones contribute, but do not determine same-sex sexuality. In the research on change, they indicate that spontaneous change in sexual orientation is a regular occurrence, with data showing that 26-45% of men and 46-54% of women report experiencing change in attractions over 3-10 years of time. Some individuals perceive some level of choice in their sexual orientation, although the degree to which this is the case is unclear. The review asserts that the belief of sexual orientation immutability is not grounded in research, although advocacy which incorporates it as a principle keeps it from being disregarded. In reviewing legal use of the immutability of sexual orientation, the authors conclude that the evidence for immutability was negligible in leading to legal changes around homosexuality. Finally, the Diamond & Rosky article  states that immutability arguments marginalize bisexual persons and those sexual minorities who indicate choice, or those who dis-idenify with their sexual orientation or value another identity label over that one. Rosik then critiques the review for its dismissal of SOCE and the underlying worldview which may impact its thorough review of the literature in this area, while lauding its acknowledgment of the over-emphasis on immutability in sexual orientation discussions.


Chapter 3: The 1973 Decision

In a {NARTH} paper, objections are made to three claims made by the APA, namely that “there is no conclusive or convincing evidence that such therapeutic attempts offer actual change,” that “efforts to change sexual orientation are shown to be harmful,” and that “there is no greater pathology in the homosexual population than the general population.” The main limitation of this report is that while it presented a narrative chronological review of the literature, it did not provide much in the way of a discussion of the studies’ weaknesses and strengths. As with any intervention, there are complete failure rates, relapses and potentials for perceived harm. Client-determined motivation in compliance to treatment foretells the greatest positive response in most therapeutic endeavors. As one gay-identified scholar has put it, “We should defend the homosexual client’s right to choose professional support and assistance toward fulfilling his/her goals in therapy according to the client’s own values and tradition.  We should be committed to protecting our homosexual client’s right to autonomy and self-determination in therapy” (Monachello, 2006, p. 57). NARTH offers a comprehensive compilation of studies that report change in sexual orientation and that a number of therapist report a success rate of 30% or more. 


{Ronald Bayer} lays out the history of the battle between the Gay Liberation movement and the American Psychiatric Association over the inclusion of homosexuality in its Diagnostic and Statistical Manual. According to Bayer’s review of the history, homosexual acts were originally considered a sin, liable to God’s judgement. With the rise of the secular state, homosexual acts were ruled illegal and homosexuals were harassed or jailed. With the emergence of psychology as the definer of mental health, therapists viewed homosexuality as a psychological disorder that could be treated. In the 20th century support for a revolution against prevailing social order, led to demand that restrictions on sexual pleasure, perversions, and non-procreative sex be lifted. In 1973 the APA caved in to the gay activists’ intimidation and removed homosexuality from the DSM. However, the debate continues. A 1977 survey with responses from 2,500 psychiatrists found that “69% believed that homosexuality usually represented a pathological adaptation (and)… 70 % supported the view that the problems experienced by homosexuals were more often the result of ‘personal conflicts’ than of stigmatization.”


In the section titled 1973: The Watershed, {Gregory Rogers} discusses the decision that removed homosexuality from the list of psychological disorders. He believes that “intimidation, not science, had been the key motivating factor” (176). Rogers goes through a list of quotes regarding reactions to the decision: “Politically we said homosexuality is not a disorder, but privately most of us felt it is.” “Some psychiatrists still dispute whether this decision was based upon science or politics.” Charles Socarides called the 1973 decision “the medical hoax of the century.” He went on to say that “The removal of homosexuality from the DSM II was all the more remarkable when one considers that it involved the out-of-hand and peremptory disregard and dismissal not only of hundreds of psychiatric and psychoanalytic research papers and reports, but also of a number of other serious studies by groups of psychologists, psychiatrists, and educators over the past seventy years (the Group for the Advancement of Psychiatry Report, 1955; the New York Academy of Medicine Report, 1964; the Task Force Report of the New York County District Branch A.P.A. 1970-72). It was a disheartening attack upon psychiatric research and a blow to many homosexuals who looked to psychiatry for more help, not less.”


{Kaufman 2002} In this article Kaufman (2002) summarizes the reasons for the existence of the National Association for Research and Therapy of Homosexuality (NARTH). Benjamin Kaufman, Charles Socarides, and Joseph Nicolosi founded NARTH in 1992 in response to the politicization of homosexuality in the mental health field. In attempts to diminish discrimination against gay and lesbian individuals treatment options in the mental health field became increasingly gay affirmative and in 1993 the APA concluded that reparative therapy for clients who wished to eliminate or decrease same sex attraction and behaviors was unethical and an abuse of therapeutic practices. The author concludes that this politicization of homosexuality is itself unethical and harmful to any individuals who struggle with this because the client has the right to choose their goal for therapy and the appropriate treatment and the therapist is obligated to inform clients of all valid treatment options and outcomes regardless of personal or political views.


{Rondeau 2002} Rondeau (2001) explores how rhetoric, psychological and sociological ideas, and media portrayals can be used to impact the forum and discussion around homosexuality. It also discusses the events and circumstances which precipitated the removal of homosexuality as a diagnosable disorder by the APA. It highlights that, even into 1970, 84% if Americans believed that homosexuality was “a social corruption.” Early scientists who called for the normalization of homosexuality as an alternative lifestyle, sought to label those who disagreed as homophobes, desensitize the public, “jamming” which is meant to silence dissenting opinions, and conversion of the public by displaying former dissenters as those who have changed their perspective. The article discusses how rhetoric is evident and how persuasion, namely by way of the Elaboration Likelihood Model, and cognitive-dissonance allow advocates of a movement to shift and influence attitudes. Attitude change tends to follow behavior change, which indicates how a belief or attitude could shift if behavioral conformity is expected and required. The strategies used in this debate are related to marketing strategies, by way of education, media, government influence on business, and other avenues to shape the discussion and the concepts in more appealing ways for constituents.


Chapter 4: The APA Task Force Report

According to {Joseph Nicolosi}, Task Force Report — a Mockery of Science the APA “Task Force Report on Appropriate Therapeutic Responses to Sexual Orientation” (2009) is politically motivated and not scientifically objective. Evidence for this claim is based on the fact that the APA rejected highly qualified applicants with experience in sexual reorientation therapy, or even those neutral on the subject. On the other hand, the APA accepted “psychologists and one psychiatrist who were all activists in gay causes.” According to Nicolosi, the Task Force members reviewed several hundred studies, which had found subjects who changed their sexual orientation from homosexual to heterosexual. However, they dismissed the majority of these published and peer-reviewed studies (some from highly prestigious professionals) as flawed. They then concluded, that there was “insufficient evidence” of the possibility of change and advised psychologists are advised to avoid telling their clients they can change their feelings.


 {James Phelan} offers an analysis of the 2009 APA Task Force report. In general, the task force has stated, and the APA has voted on a resolution that sexual orientation change efforts (SOCE) is not likely to change sexual orientation, and that the continued use of SOCE is inappropriate and cautions its use in the marketplace. They justify their conclusions based on the task force’s review of an incomplete body literature, which the Task Force authors claimed was poorly designed. Phelan  points out that while the authors are critical of the design of articles supporting SOCE, they cite two pieces (American Psychiatric Assoc. 1973, and Gonsiorek, 1991) as evidence for the claim that “same-sex sexual attractions, behavior, and orientations per se are normal and positive variants of human sexuality and are not indicators of either mental or developmental disorders”. Neither of these are the product of a scientific peer reviewed study. The former is a statement. The latter was taken from a chapter in a book. The chapter’s author admitted the research was taken from faulty samples and poor designs. In the report Phelan also finds bias against religious values. In particular, the authors of the report stated that, “…although many religious individuals’ desire to live their lives consistently with the values, primarily their religious values, we concluded that…was unlikely to result in psychological well-being.”


In this article   “A Scientific, Conceptual, and Ethical Critique of the Report of the APA Task Force on Sexual Orientation”{Stanton Jones et al, 2010} discuss the shortcomings of the APA Task Force. While acknowledging some positive aspects of the report (eg: the APA recognizing the possibility of change – “although sexual orientation is unlikely to change, some individuals [have] modified their sexual orientation identity and other aspects of sexuality.”), there are problems and concerns that compromise scientific merit. For example, the APA vacillates its conclusions regarding SOCE. At one point they say, “there are no studies of adequate scientific rigor to conclude whether or not recent SOCE do or do not work to change a person’s sexual orientation.” But at another point they claim, “the results of scientifically valid research indicate that it is unlikely that individuals will be able to reduce same-sex attractions or increase other-sex sexual attractions through SOCE.” The APA contradicts their own statements and appears to be indecisive. As Jones et al notice “the [APA] Report quite notably uses the absence of evidence to argue that SOCE is unlikely to produce change and thus to strongly argue against the validity of SOCE, but shows no parallel reticence in its treatment of affirmative therapy.”


As {Phelan et al.} demonstrate in their critical evaluation, the APA’s report on Appropriate Therapeutic Responses to Sexual Orientation was fraught with methodological errors. In addressing the question about the safety and efficacy of sexual orientation change efforts (SOCE), the Task Force chose to do a literature review rather than an experiment. And though they ultimately reported that the existing evidence is inadequate to prove arguments on either side of the debate, they still chose to definitively conclude that orientation is unlikely to change and use this unsubstantiated conclusion to advocate exclusively for gay-affirmative therapy and for legislation against SOCE. In the Task Force’s selection process of articles for their review, they applied inconsistent standards and rigor, such as by excluding case studies if they supported SOCE but including case studies and anecdotal evidence of stigma and rejection that LGB people face in society and the harm of SOCE. They dismissed 34 psychoanalytic reports of orientation change. The Task Force claimed to exclude articles not published in peer-reviewed journals, yet did not follow this rule when including articles that supported arguments against SOCE or for gay-affirmative counseling. They accused studies supporting SOCE as having enough methodological flaws to warrant exclusion but used research by Kinsey, Ford and Beach, Hooker, and others—all with the same methodological flaws—to support gay-affirmative psychology. The few works they cited to justify the assertion that homosexual attractions and behaviors are normal and positive variants of human sexuality were not scientific works (one was a critique of previous research and not new evidence). They also failed to give a full accounting of all of the articles they supposedly used, stating that they reviewed 83 studies but referencing only 55. 



{Mayer & McHugh: see part 3} In Part 3 of this study it was concluded that gender identity being independent from biological sex, in which a man feels trapped in a woman’s body or vice versa, is not supported by scientific evidence. For children, a majority of those who identify as transgender do not identify as such in adulthood. In a recent study, only 0.6% of adults in the U.S. identify as transgender. In addition, adults who have undergone a sex change operation have an increased risk of mental health issues, including 5 times more likely to attempt suicide and 19 times more likely to commit suicide. 


The authors of this report {Judith A. Reisman et al, 2012} accuse United Nations Education, Scientific, and Cultural Organization (UNESC), the International Planned Parenthood Federation, (IPPF) and Planned Parenthood Federation of America (PPFA) of supporting activities and policies which undermine laws and traditions that protect children’s psychological, physical and social well-being by encouraging youthful rejection of religion and family, advocating child sexual activity, prioritizing sexual pleasure over HIV/AIDS prevention and expanding the global ‘sex-industrial complex.’ The authors present statistical and linguistic analyses to support their charge and call for criminal investigations. The authors argue based on common sense, tradition, statistical data, and neuroscience that exposing children to early, frequent and explicit sex education will trigger emotionally driven sexual beliefs, drives and, inevitably, conduct. The UNESCO and IPPF promote explicit sex education claiming it will prevent teenage pregnancy and sexually transmitted diseases. However, the authors conclude that the programs actually increase sexual activity at younger ages and therefore increase negative outcomes for children. In addition, explicit sex education does not protect children, but is instead “harmful to children by encouraging their sexualization and desensitizing society from the terrors of pedophilia.”


In the 2012 Gallup study of Percentage of Gays by {Gary J. Gates et al, 2012} it was discovered that 3.4% of US adults identify as LGBT. The survey method of a telephone interview included the use of a random sample of 121,290 adults, aged 18 and older, living in all 50 U.S. states and the District of Columbia, selected using random-digit-dial sampling. Across different subgroups in the US, the results indicated that nonwhites, women, younger Americans, those with lower levels of education and income, those in a domestic partnership or never-married singles and those living in the east and west regions are all more likely to identify as LGBT. 


In this experiment, {Helen W. Wilson et al, 2008} and Widom studied the question, Does Physical abuse, sexual abuse or neglect in childhood increase the likelihood of same-sex relationships and cohabitation?. The sample was made up of cases of childhood physical and sexual abuse and neglect from the county juvenile and adult criminal courts from 1967-1971. Wilson and Widom found the victims (now adults) and interviewed them. The results found that “childhood physical abuse and neglect were not significantly associated with increased likelihood of same-sex cohabitation or sexual partnerships. [However], individuals with documented histories of childhood sexual abuse were more likely than controls to report ever having had same-sex sexual partners” (7). Thus, “findings from this investigation provide tentative support for a relationship between childhood sexual abuse and same-sex sexual relationships” (9).


{Dale O’Leary}  Therapists who work with men with same-sex attraction have found a pattern of disturbed father/son relationships. This includes therapists who see SSA as a disorder and those who believe gay men were born that way. In a study of 106 male homosexuals patients and 100 heterosexuals controls by Bieber and associates (1968) found: “Profound interpersonal disturbance is unremitting in the homosexual father-son relationship…We have come to the conclusion that a constructive, supportive, warmly related father precludes the possibility of a homosexual son; he acts as a neutralizing protective agent should the mother make seductive or close-binding attempts. Irving and Toby Bieber (1979) reported that in their evaluations of over 1,000 male homosexuals, they did not find one “whose father openly loved and respected him.” These conclusions were confirmed in studies with non-patient homosexuals.According to Fisher and Greenberg (1996, p. 136): “There is not a single even moderately well controlled study that we have been able to locate in which male homosexuals refer to father positively or affectionately. On the contrary, the consistently regard him as an antagonist.” Richard Isay (1989), a gay therapist, reported that: “The majority of gay men, unlike heterosexual men who come for treatment, report that their fathers were distant during their childhood and that they lacked any attachment to them.”


In this study of 2 million Danes, {Frisch, Morten et al, 2005examined the various childhood factors that are important determinants of heterosexual or homosexual marriages. The results indicated that “…men with unknown fathers were 18% more likely to marry a same-sex partner” than men with known fathers (page 5). In regards to the mother’s age, “…men with 35 + year-old mothers had significantly (34%) higher homosexual marriage rates than men with <20 year-old mothers (page 5).” Divorce also was found to have an impact. “Homosexual marriage rates were 36 and 26% higher among men and women, respectively, who experienced parental divorce after less than six years of marriage than among peers whose parents remained married for all 18 years of childhood and adolescence (page 8).” And lastly with regard to siblings, “…both men and women who grew up as the youngest child in a sibship were significantly more likely to marry homosexually than peers with younger siblings (page 8).” In short, “for men, homosexual marriage was associated with having older mothers, divorced parents, absent fathers, and being the youngest child (page 1).” 


{Roberts, Andrea et al, 2011} A study of 34,653 participants in a national epidemiology survey showed that childhood sexual abuse predicts adulthood same-sex attraction by 2%, lifetime same-sex sexual partnering by 1.4%, and homosexual or bisexual identity by 0.7%, which if applied to the general population would estimate 9% of same-sex attraction, 21% lifetime same-sex partnering, and 23% same-sex identity are caused by sexual abuse.  To rule out the likelihood of gender nonconformity or nascent homosexuality influencing the abuse, the researchers used an instrumental variable model based on family characteristics that predict maltreatment independent of sexual orientation: childhood presence of a stepparent, poverty, parental alcohol abuse, and parental mental illness.  If participants with high predictability for maltreatment reported abuse, plus later adult same-sex sexuality, there was evidence of causation.


In this article {Rothman, Emily et al, 2011} systematically review 75 studies that show the prevalence of sexual victimization in the LGBT population in the US. The median percentage of the prevalence of child sexual assault in males in the LGBT population is 22.7%. The median percentage of the prevalence of adult sexual assault in males in the LGBT population is 14.7%. The median percentage of the prevalence of intimate partner sexual assault in males in the LGBT population is 12.1%. And the prevalence of hate crime related sexual assault in males in the LGBT population is a median percentage of 14. Compared to population-based data that showed 2-3% of men experience sexual assault in their lifetime, this data “…suggests that GLB individuals may be at increased risk for sexual violence victimization as compared to their heterosexual counterparts (page 3).”


This study by {Beard, Keith et al, 2013} examined the effects of brother-brother incest (BBI) and child sexual abuse by an adult male (CSA-AM). Compared to the control group, victims of BBI were 7.1 times more likely to have experienced psychological injury, 9.9 times more likely to have cheated on their spouse or long-term partner by having sex with men, 7.1 times more likely to have masturbated to images of adult men, 11 times more likely to have engaged in sexual relations to an adult male and 6 times more likely to endorse having a gay, bisexual or questioning sexual orientation. “Both the victims of BBI and the victims of CSA-AM were significantly more likely than controls to self-identify as gay, bisexual, or questioning.”


In this article {Rosik, Christopher} responds to two research papers (O’Keefe et al., 2014; Beard et al., 2013) regarding the topic of child sexual abuse and its relationship to adult sexual orientation. While Rosik applauds these studies for “questioning the presumed dominant role of biological and genetic factor in the development of non-heterosexuality,” he also expresses concerns and limitations with the studies. O’Keefe et al explain that based on their data “same-sex and heterosexual conditioning experiences during the critical period for learning sexual preferences appear to explain a major portion of the development of adult sexual orientations and also the immutability of those sexual preferences once adulthood has been reached.” Rosik notes the downplayed potential for change in adolescence and adulthood. The other limitation Rosik mentions is that “they [the researchers of the study] appear to assume that same-sex and opposite-sex orientations are equally malleable and subject to conditioning and imprinting.” They don’t mention anything about a normal developmental pathway consisting of proper gender identity formation which should favor an opposite-sex orientation. 


{Lester Pretlow} From a physiological perspective, Dr. Lester Pretlow discusses how same-sex attractions (SSA) are developed and unintentionally maintained. Pretlow explains how the reinforcement of certain behaviors and emotions, even at a very young age, can influence one’s nervous systems, which in turn contributes to the development and maintenance of SSA and gender identity confusion. The aim of this article was to help those who have unwanted SSA better understand their homosexual tendencies and attractions as being a result of a disconnection between their central and autonomic nervous system so they can mitigate their homosexual behaviors through maintaining and restoring steady-state regulation of the nervous systems.


{Neil Whitehead} argues that the famous path analysis study by Bell, Weinberg, and Hammersmith (1981) was misinterpreted.  In their quest to find or rule out a single predominant cause for SSA, Bell, Weinberg, and Hammersmith dismissed a number of social factors, even though they ultimately arrived at 15 clusters, which were already identified by clinicians and theorists, and these social factors accounted for 76% of the variance in adult sexual orientation.  Nevertheless, because a single cause was not indicated, they defaulted to a biological explanation.  The authors conclude that it must been the phenomenon of tracking a pre-existent biological factor that caused the occurrence of the social factor clusters.  However, the study shows that only 59% of the adult homosexual men reported homosexual feelings in childhood; and only 44% for women.  And research has historically shown that homosexuality in teenagers is at least 25% more unstable than heterosexuality in teenagers.  Path analysis truly is most effective when studying a small number of factors, and not so effective at studying something so multi-factorial as homosexuality.  The Van Wyk and Geist follow-up study (1984) shows that most social contributors to SSA were indirect and dependent on the presence of other factors.


{Seutter & Rovers} Seutter & Rovers (2004) evaluate the impact of self-report of emotionally distant or intimidating relationships with mothers and fathers on homosexuality. They consider the “weak father” theory and “family of origin” theory, hoping to understand how these may impact intimacy and love over time. A sample of 455 Roman Catholic Canadian seminarians were asked to rate intimacy with each parent and intimidation from one’s parent. 84% of the sample identified as heterosexual and 16% of the sample identified as homosexual. Significant differences were found on the scale which evaluated intimacy with father, in that homosexual priests endorsed significantly less intimate relationships with their father than heterosexual priests. No significant differences were found on any other scales. The researchers endorsed an interactionist hypothesis regarding the cause of homosexuality, in that it is likely that biological, environmental, family-of-origin, and choice all factor in to the development of homosexuality in men. Further, it is difficult to identify whether emotional absence was present in childhood or is a function of the disclosure of same-sex attraction to one’s parent later in life.


{Lapinski & McKirnan} In a 2013 study Lapinski and McKernan examine how much a Christian upbringing negatively impacts lesbian, gay and bisexual (LGB) individuals’ acceptance of their LGB identity. Participants were recruited from ads online and in homophile organizations and those interested in participating were directed to an anonymous, self-completed online questionnaire that used various measures to collect data on religious upbringing, current religious affiliation, and sexual history and identity. While research from other studies seems to indicate a negative association LGB identity acceptance and religious upbringing, this study shows no significant difference between current or former Christians’ positive or negative gay identity. Lapinski and McKernan also noted two subgroups within the sample of 84 participants, one in which Christians were able to reconcile their homosexual identity with their religious identity and the other in which former Christians had not been able to integrate these two identities and rejected the religious identity in favor of their homosexual identity. The authors conclude that further research in this area is required to investigate the complex interplay between religious and sexual identity.


{Nicolosi 2015} Dr. Nicolosi’s paper summarizes Freud’s theories of homosexuality based on his Oedipus Complex theory. Though at times his views seemed ambiguous, he nevertheless established principles that have become fundamental to psychodynamic schools of thought regarding homosexuality, namely: the likelihood that homosexual desires originally spawned from a childhood over-identification with the mother and a weak father figure; that narcissism is a common characteristic of homosexual development, and that homosexual attractions are a way to compensate for the before mentioned factors.


{Sutton 2014} Sutton identifies and explores the multiple factors which appear to impact the development of same-sex attraction. The ones attended to in the article include disaffirmation from familial and social influences, All of these factors may predispose, but do not predetermine same-sex attraction. Others include unmet needs, unrealized growth and maturation, unresolved feelings, unhealed hurts, and unreconciled relationships, unrealistic hopes and expectations of self and others, and unfulfilling or inauthentic self images, unmanaged co-occurring compulsions such as addictions to drugs, alcohol and food, and mood and personality disorders. The article concludes that homosexual orientation is not an unchangeable and biologically predetermined trait, but rather appears to be a result of complex interactions between nature and nurture. The article points out shifts in American perceptions of the causes of same-sex attraction, as favoring nature over nurture influences. However, the dominant conclusions among the APA is that there is no consensus regarding the reasons a person develops their orientation in the way that they do. The article points out the uniqueness of each person, and how one factor can impact several individuals to varying degrees, resulting in impacts on attractions for some and not for others. There does not appear to be one cause for same-sex sexuality, or one blue-print for the development of same-sex sexuality. It would seem that biological factors, including temperament, abilities, sensitivity and interests may be factors to consider. Perceived and internalized experiences of one’s gender identity and gender nonconformity also seem to be important, as well as early experiences of affirmation, or lack thereof. Parental involvement and intimacy with parents are also highlighted as theories of causal factors in same-sex attraction, as are lack of acceptance and support within one’s faith community, which can lead to condemnation and subsequent shame. Psychoanalytic principles, including psychosexual development arrest are also implicated, in the context of one’s identity development and need for affirmation and relational needs to be met by important individuals. The article asserts that, while change of sexual orientation is possible for some, it is more helpful to think of same-sex sexuality and orientation on a continuum, in which not all will experience the same level of change in orientation as a result of therapy.


In a large study of 557 LGB adults and a control group of 525 heterosexuals comprised of the LGB group’s siblings, {Balsam, Rothblum, and Beauchaine (2005)} found that the LGB group was significantly more likely to indicate childhood psychological and physical abuse parents or caretakers, more childhood sexual abuse, more domestic abuse in adulthood, and more sexual assault in adulthood.  Bisexual men and women were more likely to report a history of rape than gays and lesbians.  Gay men reported the highest percentage of a male childhood sexual abuse perpetrator, and heterosexual men reported the least.  Even within the same family, LGB siblings were at greater risk of victimization by parents than their heterosexual siblings.


{Fields, Malebranche, and Feist-Price (2008)}, in a combined analysis of three small-size qualitative studies, found a 32% prevalence of childhood sexual abuse among black MSM.  In two studies, respondents (50% in one study) attributed their present-day same-sex attraction and behavior to the childhood sexual abuse.  In all of the studies, common traits of the CSA included an older male relative perpetrator, nonverbal communication with the perpetrator, nondisclosure to other family members, and the abuse was prolonged and repetitive over years.  Survivors described tendencies to attempt to “block out” the experience, feelings of isolation, depression, social withdrawal, social anxiety, suicidal ideation, contempt and engaging in fights when peers would call them “sissy,” and deficiencies in self-confidence and verbal communication.  Despite their practice of homosexual behavior, many of the participants identified as heterosexual.


In an ethnically diverse study of 669 LGB adults, {Balsam, Lehavot, Beadnell, and Circo (2010)} found that childhood emotional abuse was the strongest predictor of psychopathology for all participants, of which all races had similar incidence.  Latino and Asian LGB individuals reported the highest levels of physical abuse.  Latinos and blacks reported the highest levels of sexual abuse.  Compared to whites, black LGBs showed a stronger correlation between emotional abuse and PTSD and anxiety symptoms, and Latinos showed physical abuse correlates stronger to PTSD and anxiety.  Across all races of LGB individuals, the prevalence of emotional abuse was high (50.2% of men, 60.8% of women) and the rates of sexual abuse (32% of men, 42.4% of women) and physical abuse (35.3% of men, 37.5% of women) were significant.

{Gender Identity Disorder} List of articles and summaries regarding gender identity disorder. 

{Childhood Experiences of Female Homosexuals} List of articles and summaries regarding childhood experiences of female homosexuals. 



Chapter 6: The myth of the “Gay Gene” and the Idea of Biological Predetermination of Homosexuality

{Mayer & McHugh: see Part 1} This exhaustive scientific study conducted by two Johns Hopkins University scientists reveals that scientific evidence does not support the “born that way” claim regarding homosexuality or the transgender claim of one being “trapped in the body”. Written by Dr. Lawrence S. Mayer and Dr. Paul R. McHugh, this study evaluates data from over 200 peer-reviewed studies regarding sexual orientation and gender identity. The study also reveals that there is no biological factor that is associated with or can explain homosexuality. In addition, it was concluded that sexual orientation is fluid over a person’s lifetime. In one study as many as 80% of male adolescents who experienced same-sex attractions no longer had these attractions as adults. 


In this article (Hope and Homosexuality,” Sutton, et.al. section on change) {Sutton et al.} discuss both sides of the “born that way” debate. On one side there are those wishing to normalize SSA and thus claim people are born that way (meaning SSA would not be considered a psychological disorder). Supporters of this theory often cite a study by Dean Hamer who claimed to have found a “gay gene.” But this study has failed to duplicate its findings. On the other side of the debate are those who understand science and the empirical research that has been done. Sutton et al cite an identical twin study by Neil Whitehead which found that “if an identical twin has same-sex attraction, the chances that the co-twin has it too are only about 11% for men and 14% for women.” This would mean that genes more mostly not responsible. 


{Neil Whitehead 2} (2014) discussed why first same sex attraction (SSA) is not technically a developmental milestone as it was operationally defined by occurring at a certain age/ time and with standard deviations far from 50 percent.  For first SSA, the standard deviation was around 40 percent indicating that a person’s first SSA may not be an end all be all determination of sexual orientation.  In fact, there was no evidence found to support first SSA as an innate developmental milestone meaning that there is low genetic influence yet predominant other factors (such as social factors) that may explain more justifiably a person’s first SSA.


{Douglas Abbott} 2009 conducted a literature review to explain the causes of homosexuality. In his research, Abbott found that homosexuality is not the result of one single gene, or even a group of genes. Other theories propose that prenatal hormone imbalances could cause homosexuality, as well as heritability, but the researcher found that the environment also has an effect on a person’s sexual orientation, thus conflicting biological theories. Therefore, nature vs. nurture becomes a huge discussion in which a selection of either or is unidentifiable. In accordance with new statements released by the American Psychological Association (APA), the researcher concluded that although there may be some genetic influence in homosexuality, other factors such as environment can also have an effect, therefore genetics cannot be labeled the sole cause of homosexuality.


{Camperio Ciani et al, 2012} conducted a questionnaire to assess factors associated with fertility in female maternal relatives of homosexual men. The rearchers collected data from 161 female Europeans (100 were mothers or aunts of heterosexual males, 61 were mothers or aunts of homosexual males). Female participants responded to the Big Five Questionnaire to develop a personality profile and the 10-point Likert Scale to assess their behaviors (i.e. sexual behaviors such as condom use). Participants male relatives completed the Kinsey scale to determine if they were homosexual or heterosexual. It was found that mothers or aunts of a homosexual male have significantly higher fertility, more offspring, fewer complications during pregnancy, a more relaxed attitude toward family values, and are more extroverted than mothers or aunts of a heterosexual male. The researchers concluded that there is a possible connection between homosexuality and a maternal gene on the X-chromosome.


{Blanchard, Ray} (2011) conducted a study to assess the connection between fertility in maternal females and homosexuality in their firstborn son. The study involved a decently large sample size of 40,197 firstborn heterosexual males and 4,784 firstborn homosexual males. Researchers were hoping to find support for the fraternal birth order effect which basically states that a mother’s ability to produce the proper gens for a male dwindles the more sons she has. Contrary to predictions and previous research however, homosexuals had fewer siblings than their heterosexual counterparts.


{Camperio Ciani and Pellizzari} (2012) conducted a study using 3 theories to assess the possible connection between maternal female fertility and homosexuality in their relatives. The first theory was sexual antagonistic selection which states that male homosexuality is a result of a genetic factor responsible for increasing fertility in females. The second theory was overdominance which claims there is a genetic factor that promotes both gayness and fertility. Finally, the third theory was fraternal birth order which suggested that the presence of older male siblings can influence homosexuality in younger male siblings. The researchers examined 2100 female Europeans (mothers, aunts, and grandmas of either homosexual or heterosexual males). In accordance with predictions, maternal females of homosexual males showed significantly higher fertility rates than maternal females of heterosexual males. The researchers concluded that the theory of sexual antagonistic selection was supported.


{Iemmola, Francesca} Iemmola and Ciani (2008) conducted a study to test if females with homosexual offspring have higher fertility rates.  In this study, 250 Italian male probands (98 heterosexual, 152 homosexual) were given a self-administered questionnaire about their biological and sexual information.  The Kinsey Scale was used to determine sexual orientation.  In confirmation with the hypothesis, as homosexuality increased in the maternal line, fertility in the females also increased.  This finding is not significant for the paternal line.  Also, homosexual males had significantly more older brothers.  The researchers concluded that if these findings can be replicated, it may provide more evidence for a genetic factor influencing homosexuality, though it is not the only factor.


{Camperio Ciani et al, 2009} conducted a questionnaire to further expand prior research on the correlation between homosexuality and fecundity of their female relatives of the maternal line to now include bisexual men.  The questionnaire involved 239 Italian men who classified as heterosexual (88), homosexual (65), or bisexual (86).  In accordance with the hypothesis, female relatives of heterosexuals were significantly less fecund than females related to homosexuals and bisexuals alike.  In addition, though only homosexuals have significantly more older brothers as compared to heterosexuals, bisexuals do have more older siblings than heterosexuals.  The researchers concluded that this study provides more evidence that there is an X-chromosomal factor related to male homosexuality and female fecundity.


{Camperio Ciani et al, 2004} conducted a survey to expand the theory of the X-chromosomal genetic factor linkage of homosexuality and maternal line female fecundity. Most prior studies involved the homosexual’s mother while this one also included the homosexual’s grandmother. Conducted in Italy, 98 homosexuals and 100 heterosexuals completed a questionnaire to assess the variables. As predicted, fecundity in the maternal grandmothers of homosexuals was significantly higher than that of grandmothers of heterosexuals. The researcher’s discussed however that 79% of the variance in homosexuality is still unexplained; therefore other factors should also be considered.


{Jean and David Zeh} composed an article to discuss what they believe could be an alternative genetic explanation for male homosexuality: cytoplasmic genetic elements (CGE). The researchers discussed that there could be mitochondrial effects that cause the killing or feminizing of cells in males. In accordance with other research, this effect is one genetically found as a maternal inheritance. The researchers concluded that CGE’s are becoming a more influential topic in the understanding of sexual conflict. (opinion article)


{J. Michael Bailey} conducted a questionnaire between homosexuals and their mothers to test the neurohormonal theory which states that when a mother experiences a stressful pregnancy, the male fetus is exposed to insufficient amounts of testosterone, leading to homosexuality. Homosexual participants responded to questions about their behavior and existence of homosexuality in relatives. Their mothers responded to questions about the stress level of their pregnancy and their proneness to stress. Inconsistent with the researcher’s hypothesis, mothers of male homosexuals did not have a significantly more stressful pregnancy than mothers of male heterosexuals. On the contrary, mothers of female homosexuals did have a significantly more stressful pregnancy than mothers of female heterosexuals. From the results however, the researchers concluded that prenatal stress is not a determining factor of sexual orientation.


{Dawood et al, 2000} conducted a questionnaire on 29 pairs of gay men with at least one gay brother to determine if male homosexuality could be familial. The questionnaire involved 5 parts: the Kinsey scale (to assess participant’s level of homosexuality), childhood gender nonconformity (to assess gay tendencies as a child), the continuous gender identity (similar to Kinsey scale), a family relationship assessment, and a self-acceptance assessment. Contrary to predictions, 83% of the participants discovered their brother’s homosexual orientation after they had already discovered their own, thus supporting the idea that homosexuality is not familial.


{Carlos Valenzuela} Valenzuela (2010) conducted research to disconnect the linkage between homosexuality and non-right handedness in the fraternal birth order (FBO) theory. He found that many families with homosexuals contradicted the sex ratio that FBO maternal anti-male immune factors imply. In other words, FBO claims maternal anti-male factors lower masculinity the more sons a mother has (which would naturally lessen multiple male offspring), yet families with boys were increasingly more likely to have another boy. The researcher concluded that although FBO could have an effect of homosexuality, it does not determine it.


{Cantor et al, 2002}  Cantor, Blanchard, Paterson, and Bogaert (2002) conducted correlational to assess the prevalence and probability of the fraternal birth order effect in homosexuals. The researchers found, on average, men with 2.5 or more older brothers are twice as likely to identify as homosexual; thus making the fraternal birth order effect a highly attributable factor to their homosexuality. In addition, it was also found that 1 out of 7 gay men become homosexual as a result of the fraternal birth order effect.


{Hatfield} (2005), attempted to solve Amar Klar’s theory of a single gene responsible for multiple alternative phenotypes, such as hair whorl (the direction it spins on the back of the head), handedness, speech laterality, bipolar disorder, schizophrenia, and sexual orientation.  Hatfield proposed that the mystery gene is RHD, and he further speculated that maternal immunization (MI) could be a key factor in determining sexual orientation since RHD exhibits MI.  “It is hypothesized that the ‘gay’ gene, if it exists, might display MI because homosexual men are significantly more likely to have an older brother than the general population, suggesting that production of maternal antibodies to the gay gene of an older sibling might somehow make younger brothers more likely to become [non-heterosexual] . . .” (emphasis added; p. 709).  Hatfield had hoped research into RHD that was just beginning in 2005 would provide supporting evidence.


{Bailey et al} Bailey, Dunne, & Martin (2000) explore the sexual orientation, recalled childhood gender nonconformity, and continuous gender identity in Australian twins (n = 4901). Gender differences were found in the endorsement of sexual orientations, in that more women more frequently endorsed slight to moderate homosexual feelings, while men more frequently endorsed exclusively homosexual feelings. The article found that only childhood gender nonconformity was significantly heritable for men and women both. Family of origin appears to be an important factor involved in sexual orientation, gender nonconformity and continuous gender identity, as well as genetic factors therein. It continues to be a challenge to tease out the genetic and shared environmental contributions that impact the heritability of gender nonconformity in both sexes. Another challenge is finding a large enough sample of homosexual participants to have high statistical power and allow for detecting heritability of various traits. 


{Kirk et al} An Australian survey of 4901 adult twins measured sexual orientation by the components of behavior, feeling/attraction, and attitudes/identity (Kirk, Bailey, Dunne, & Martin, 2000).  This sample was recruited from a voluntary twin registry, which represents 10-20% of all living twins in Australia.  Out of this registry, the researchers used a base of participants from a large, semi-longitudinal twin-family study of alcohol use and abuse from 1991 to 1992, with a 70% response rate. Estimates of the heritability of homosexuality in this sample ranged between 50 and 60% in females, but only about 30% in males.  For females, correlations were higher between identical twins and homosexual feelings, attitudes, and partners than for non-identical twins.  The researchers concluded that additive genetic effects were of greater importance in women than in men.


{Chivers and Bailey} In a survey of 35 to 39 (not all fully completed the surveys) female-to-male (FTM) transsexuals, Chivers and Bailey (2000) contrasted homosexual and nonhomosexual FTMs’ sexual interests. Homosexual FTMs were defined as genetic females sexually oriented toward women even after sex-reassignment.  They hoped to replicate findings from Bailey’s 1999 study comparing lesbian and heterosexual genetic women.  The homosexual FTMs reported greater gender nonconformity in childhood, preference for more feminine partners, greater sexual (rather than emotional) jealousy, more sexual assertiveness, more lifetime partners, increased desire for phalloplasty, and more interest in visual sexual stimuli.  Researchers chose to measure sexual fantasy rather than behavior, which can be based more on opportunity than preference.  Both groups reported equal levels of feeling masculine in childhood, but homosexual FTMs reported greater masculine behaviors.  Chivers and Bailey considered the results to be parallel to the heterosexual and lesbian genetic female population.


{Burri et al, 2015} This study hypothesizes that common genetic factors can explain the association between sex typicality, mating success, and homosexuality in a British sample of female twins, by way of quantitative genetic analysis. It also considers whether the covariance between traits is explained by a single underlying genetic factor or by single random factor. Both a questionnaire evaluating sexual attraction (Kinsey-type Scale) and a retrospective questionnaire of childhood gender nonconformity were administered to volunteer female twins. Of the 8,418 questionnaires sent, 4,322 were included in the final data analysis. However, number of sexual partners was only available for 996 female twins (498 twin pairs) with 242 full dizygotic pairs and 256 full monozygotic pairs), and were based on self-report.  Findings identified that sex a-typicality was associated with female homosexuality, that those identified as more masculine heterosexual women had greater numbers of lifetime sexual partners, and that these relationships may be impacted by a single shared latent phenotype (heritability of 40%). This phenotype accounted for 22% of the variation for sexual attraction, 15% for childhood gender nonconformity, and 13% for number of partners. Thus, this fitness-reducing trait may be maintained over time by way of the potential reproductive benefits to heterosexual individuals. Several limitations include small sample size, recall biases, social desirability bias, limited statistical power, environmental and cultural impacts on phenotype, mediating variables, a small non-heterosexual sample, and difficulty in quantifying reproductive success.


{Dewar} Dewar (2002) provides a theoretical explanation for homosexuality as beneficial for male reproductive success. Previous conceptualizations see homosexuality as problematic for evolutionary theory. In this article, Dewar (2002) evaluates how bisexuality could be adaptive over time, known as the Alliance Theory. It states that sexual behavior functions to form alliances as it broadens expressions of affection, possibility of friendships, social status and resources. The article also explores how historical shifts from hunter-gatherer males to agricultural environments could have led to pressures on men that explain the reproductive benefit of interpersonal skills in males, impulse-control, and the subsequent feminization of the male brain. Finally, the article identifies various traits that may have adaptively emerged in varying degrees in heterosexual and homosexual males as a result, including qualities such as advanced empathy and fine motor skills. This theory fails to explain exclusive homosexuality in males, however.


{Santtila et al, 2007A Finnish study of 6001 female and 31524 male twins and their siblings sought to determine the prevalence and heritability of potential for homosexual response (PHR) by asking if one would accept a homosexual advance from someone one found attractive and liked, assuming the act would remain secret and inconsequential (Santtila et al, 2007). Researchers found a greater incidence of overt homosexual behavior among men (3.1%) than women (1.2%) but that women showed reported greater PHR (65.4%) than men (32.8%). The majority of individuals who reported PHR had not engaged in over homosexual behavior in the past year. Regarding heritability, the researchers declared the existence of genetic effects upon PHR and overt homosexual behavior with no shared environmental effects. *Personal note: This study showed no raw data and I found it incredibly difficult to follow how they arrived at their conclusion regarding genetic effects.


{Bogaert} Anthony F. Bogaert (2004) used two previous surveys from research done by others to see if birth order (first, middle, or last child) had an effect on a child’s sexuality. These surveys were then compared to the current study that examined the sibling sex ratio (number of brothers compared to the number of sisters) of homosexual men and women in two national probability samples. The two samples were then combined, which together had 2800 male participants, and 3,501 female participants. The results showed that both homosexual men and women had a higher ratio of brothers than sisters. The present results supported the idea that the birth order of a child influences their sexuality more than the number of brothers compared to sisters.


{Sheldon et al, 2008} A small qualitative study (42 White and 44 Black adults) of a non-random sample among the general public showed a wide range in beliefs about the etiology of homosexuality and the possible ramifications of discovering a genetic origin (Sheldon, Pfeffer, Jayaratne, Feldnaum, &amp; Petty, 2007). Participants were selected from a separate survey of 1200 people, narrowed down by responses to questions about racism, acquiring small samples from all perspectives. Many respondents appreciated the complexity of etiology, expressing openness to some type of heredity that served an underlying predisposition that would be manifested after being influenced by other factors. Commonly, those who favored in the nature arguments believed discovery of a gay gene would translate to more tolerance and acceptance. However, others considered it support for eugenics.


{Davidson & Friedman} (1982) explores the impact of bias and perception on work with sexual minorities, particularly heterosexual bias that overemphasizes certain aspects of one’s experience of same-sex sexuality. The researchers’ concern is that a client’s life and presenting problems would be interpreted in terms of their sexuality only when this deviates from social norms. An experimental study was done with 235 undergraduate psychology students, who were presented with a case study of a male client with several mental health presenting concerns, who also indicated they were involved in extramarital affairs. Half of the participants were given a case study where the extramarital affairs were with women, while the other half were given a case study where the extramarital affairs were with men. Six questions where then asked to explore the presence of labeling bias. It was hypothesized that (1) those given the same-sex sex-affair case would be more likely to consider sexual deviation as a diagnostic label or a neurotic disorder based on the history of same-sex relationships, (2) encourage the prescription of medication, (3) be more interested in obtaining in formation on sexual or marital issues, (4) see the core problem as related to sexuality, (5) more often decide to focus therapy on the patient’s sex life, and (6) mention sexuality as a causal factor in the presenting complaints. Content analysis of participant responses was done by two independent raters and strong inter-rater reliability was indicated. Findings indicated that, in the case of hypotheses 1, 3, and 6, those who read a case study on homosexual affairs were significantly different in the hypothesized direction. Limits of the study include that these are undergraduate students, as opposed to trained clinicians in diagnosis, who may be more subject to bias and diagnostic inaccuracy. 


{Overby} Overby (2014) was interested in comparing people’s attitudes toward homosexuality in association with their political preference in the 2008 election. To test his hypothesis, he had participants complete a survey with questions about their feelings toward homosexual rights, political parties, as well as a personality test. Findings showed that 52% of participants think that homosexuality is caused by biology and only 32% felt it was a personal choice. Of those statistics, those who thought homosexuality was a biological happening were more likely to be liberals voting for Obama, and those who thought it was due to choice were more likely to be conservatives voting for McCain. Thus, the researcher concluded that personality has an influence on beliefs of public policy.


{Sanders et al, 2014} In a study of 409 pairs of homosexual brothers—the largest of its kind— Sanders et al (2014) claimed to demonstrate significant genetic linkage for male sexual orientation and replicate previous studies implicating Xq28. Participants were recruited through gay pride events and websites, and they submitted a questionnaire along with a DNA sample. For the item identifying one’s sexual orientation, only brothers who identified as homosexual were considered certain of their orientation. (Brothers who identified as heterosexual were listed as “unknown sexual orientation.”) The authors were careful to note that linkage can only indicate a region and not particular genes, and that genetic contributions are far from determinant (p. 9).


{Ngun & Vilain} (2014) conducted a review to examine the role of genes and epigenetics in sexual orientation. The researchers concluded that although genetics does have a role in sexual orientation, environmental factors such as the prenatal environment and a possible imbalance of hormones as well as birth order and a mother’s immunity also have an effect. An example of these prenatal environment effects can be seen in woman with Congenital Adrenal Hyperplasia (CAH), a condition which causes female testosterone levels to be escalated thus masculinizing the woman’s personality and sometimes physical attributes.


{Jannini et al, 2010} Jannini, Blanchard, Ciani, and Bancroft (2010) composed a compilation of expertise in their article to discuss homosexuality as being nature or culture. With concepts such as brain feminization (hormone imbalance), fecundity of the maternal line in families with homosexual offspring, and maternal immunization (influencing later male births being more susceptible to homosexuality), it is evident that there is some substantial biological evidence for homosexuality. However, taking into account gender nonconformity during gender identity development, an interaction of biological factors as well as environmental factors is displayed.


{Cameron & Cameron} This study draws from a sample of 5,182 American adults. It evaluates their report of incestuous relationships, which was disproportionally reported by male and female bisexuals and homosexuals. 7.7% of the male sample identified as bisexual or homosexual. Of the 22 male individuals who reported “physical sexual relations with at least one brother”, 12 (55%) identified as homosexual. Of the 5 males who reported sex with more than one sister, 5 (25%) identified as homosexual. Of the 5 males who reported sex with their father, 3 identified as homosexual. All three males who reported sex with their mother identified as homosexual. Of the 38 males who reported incestuous relationships with immediate biological family members, 15 (39%) identified as homosexual or bisexual: 13 (52%) of the 25 with same-sex encounters and six (29%) of the 21 reported opposite sex encounters. 3% of the sample was comprised of 88 women who identified as lesbian or bisexual and these comprised three (7.5%) of the 40 who had sex with a brother; none of three who had sex with a sister; one (9%) of 11 who reported sex with their father; one of two who reported sex with a step-mother; three (15%) of 20 who reported sex with their step-father, and one (11%) of nine who reported sex with a step-brother. Female bisexuals or homosexuals accounted for four (8%) of 52 who reported incestuous relationships with those in their immediate family, four (8%) of 49 with opposite-sex, and none of three with same-sex sexual encounters. From these findings, the article concludes that homosexuality could be learned and suggests incest as a potential cause for homosexuality.


{Kolb & Johnson} Kolb & Johnson (1955) provides case studies of four male homosexual persons who presented with emotional and behavioral concerns in addition to their experience of homosexuality. It argues that prolonged seduction by one’s mother and genital frustration caused by the importance placed on identifying self with the mother early in life, and continuing in this identification into adulthood. Further, three of the four cases indicate an absent father, or one who does protect the son from an overbearing mother. In therapy, clients were encouraged to stop same sex sexual behavior, face anxiety that results from hostility towards the hated parent. In addition, the case samples hypothesize that aspects of the parental relationships would lead to transference in the therapeutic relationship that allow for a corrective emotional experience.


{Poole} Poole (1972) hypothesized that adult sexual orientation stems from early childhood socialization, in which the child’s emotional needs and understanding of herself are met through the child’s interaction with her parents. The study collected data via a questionnaire on childhood socialization experiences from 50 self-identified homosexual women who were recruited from gay bars and clubs and 50 self-identified heterosexual women, roughly matched for age, who were recruited from college campuses. The results indicated that, compared to the heterosexual women, the homosexual women experienced less encouragement to play gender-specific role- play games, had mothers who were unhappy in their roles, and had parents who displayed little affection and understanding towards the subjects and also did not view the subject of sex in a favorable light. In the case of the homosexual women, Poole concluded that their childhood socialization distanced them from positive experiences in traditional heterosexual gender roles leading to a greater tendency to find emotional and sexual satisfaction from members of the same sex as they matured. Although the sample size of this study is small it provides some evidence for an association between adult sexual orientation and childhood experiences in the family, particularly in the parent-child interactions.


{Pattatucci & Hamer} This study evaluates familial rates of homosexuality and developmental differences in 358 heterosexual, bisexual, and lesbian women, in order to evaluate the role of heredity in variations in sexual orientation. Sexual orientation was identified using the 7-point Kinsey Scale. Pedigree analysis involved collecting family history and asking individuals to rate the sexual orientation of first, second and third degree relatives, in order to evaluate potential for genetic influences on sexual orientation. Follow-up interviews were conducted one year later (n = 175). These evaluated gender of sexual partners within the last 12 months, the persistence of self-identified sexual orientation, and updates to the family history information gathered in Time 1. The majority of women, (80.2%) did not change over the course of that year, indicating some stability in lesbian, heterosexual, and bisexual identity. When asking about sexual or romantic attraction to a female, 2/3 of the sample of heterosexual women endorsed this. Developmental timing of same-sex attraction differed within each group, namely that lesbians experienced first attraction first, then bisexual women, then heterosexual women. Half of lesbian women within the sample endorsed heterosexual attraction. In this case, developmental timing of awareness of opposite sex attraction was first in bisexual women, then heterosexual women, then in lesbian women. 


{Sanders & Ross-Field} Sanders and Ross-Field (1986) conducted 2 experiments to assess the cognitive ability of homosexual men in comparison with heterosexuals on visuo-spatial tasks. In Experiment 1 participants were asked to complete a water level task in which they were shown a 2D image of a bottle with a line marking the water level, and then had to draw the water level line on other images of a bottle tilted at different degrees. Experiment 2 was another version of the same task. The findings showed that heterosexual females and homosexual males did significantly worse on the task than heterosexual males, but not very different from each other. The researchers concluded that there is a similarity in cognitive ability with females and homosexual males different from heterosexual males that may be due to biological factors.


{Troiden} Troiden (1979) explores a proposed model of gay identity development, namely sensitization, dissociation and signification, coming out, and commitment. 150 Caucasian gay men were interviewed by way of a convenience sample in order to evaluate the accuracy of this stage model in understanding the development of a gay identity. Sensitization, identified by 72% of the sample, is feelings of being different from peers in important ways, including alienation and feelings of gender inadequacy. Dissociation and signification, the second stage, begins with dissociation, the suspicion that one may be gay, followed by subsequent attempts to separate one’s identity from the feelings or experiences that contribute to these suspicions, including sexual attraction or sexual behavior. This was endorsed by 148 of the study’s participants, who acknowledged that they felt the need to explain, ignore, excuse or justify these experiences so that they need not define their sexual identity immediately as gay. Coming out involves definitive labeling of sexual feelings as indicative that one is gay (Mean age = 19.7). It includes self-labeling as gay (51%), involvement in gay culture roughly around the same time or slightly after self-labeling (50%), and seeing this as a positive and livable lifestyle (87% within one year of self-labeling). Stage Four, commitment, is the adoption of “gay” as a way of life. 76% of the sample endorsed having a romantic lover, while 91% indicated they desire one. A distinguishing finding of this study is that 88% of the sample endorsed acceptance of their homosexuality, while 91% stated that, even if given the opportunity to change sexual orientation, they would remain gay. One final caution of the study is that not all those who experience one or more of these stages adopt a gay identity, and that those who do so accomplish this over the course of many years.  


{McCormick & Witelson} In this study McCormick and Witelson (1991) explored the possibility of a neurobiological origin for homosexuality by expanding upon research that indicates an association between prenatal exposure to atypical levels of sex hormones and sexual identity. McCormick and Witelson administered three tests of spatial ability and two tests of verbal ability to an experimental group of 38 homosexual men, and two control groups of 38 heterosexual men and 38 heterosexual women. Unlike previous research, this experiment did not show a significant difference in verbal fluency between the heterosexual men and women, which the authors hypothesize, may explain why there was also no significant difference between the homosexual and heterosexual men in verbal fluency. However, as expected, there was a significant difference between the heterosexual men and women in the area of spatial ability, in which the men scored higher than the women. The study also demonstrated a significant difference between the homosexual and heterosexual men on two of three spatial tests, with the homosexual men scoring lower than the heterosexual men. McCormick and Witelson concluded that the cognitive differences they noted in their study, typically associated with sex differences, indicates a neurobiological element in the development of same-sex attraction in men.


{Sigal}  At the time of Sigal’s (1978) study, a clear understanding of the cause of schizophrenia was unknown. This study examines the role of genetic, organic, and familial factors in the development of schizophrenia in 100 men who were hospitalized at least once and received follow up evaluations roughly 4 years after initial admission. Genetic factors were assessed by the presence of at least one first degree relative with schizophrenia; organic factors were assessed by the presence of head concussion, temporal lobe epilepsy, and minimal brain damage; and psychosocial factors were assessed by the presence of an over-protective parent and latent homosexuality. The three most influential factors correlated with schizophrenia were one first-degree relative with schizophrenia (27%), an over-protective parent (16%), and head concussion (11%) and these three factors frequently overlapped. Sigal (1978) concludes that the varying clinical presentation and course of schizophrenia indicate a complex interaction between genetic, organic and psychosocial factors, with the most significant factors being genetic and psychosocial.


{Dorner} The findings of studies on both castrated male rats and homosexual men conducted by G. Dörner and the Institute of Experimental Endocrinology at Humboldt University in the late 1960’s and 1970’s demonstrate that male homosexuality may be based on discrepancies between the genetic sex and a gender-specific sex-hormone levels during critical periods of prenatal brain differentiation. Methods were developed to determine the genetic sex and the proper sex hormone levels in amniotic fluid so as to attempt to detect and correct these discrepancies. It was found that changes in neurotransmitter concentrations, hormones, and certain psychosocial influences that occur during critical periods of the differentiation and maturation of the brain might permanently affect sexual orientation, behavior, and gender role behavior throughout life.


{Zastowney et al, 1987} The case study presented in Zastowny, Lehman, & Dickerson’s (1987) article offers insight into the influence of both genetic predisposition and early family relationships on sexual identity. The 19-year-old male in this study, who identified as homosexual, was born with Klinefelter’s Syndrome (47 XXY genotype), which has been linked to a range of psychological disturbances, including those related to sexual identity. This particular case study, however, presented with unusually severe symptoms of distress, leading the authors to consider the influence of chronic traumatic childhood experiences. The authors concluded that the combination of genetic factors (Klinefelter’s Syndrome and parents’ mental illness) as well as an unstable, abusive upbringing offer greater insight into understanding his sexual and emotional development compared to an etiology that stems from isolated genetic or psychosocial factors.


{Holtzen} This study tested Geshwind and Galaburda’s hypothesis (1985) of an association between cerebral lateralization and sexual orientation by comparing handedness distribution of heterosexuals and non-heterosexuals. Individuals were asked to self-report handedness, utilizing the Edinburgh Handedness Inventory. 141 completed questionnaires from GLB persons were received as well as 254 questionnaires from heterosexual family members of survey participants.  The sample was predominantly white, well-educated individuals, who have disclosed their same-sex sexuality to their family, impacting generalizability of the research. Findings of this study include that, for men and women in the study, sexual orientation predicted handedness, although the predictive power was small, accounting for only 2.6% and 1.3% of the variance, respectively. Compared to Heterosexual men and women, non-heterosexual men and women demonstrated a great degree of non-righthandedness.  Due to small sample size (n=401), comparisons among same-sex members of the same family could not be conducted. No age and gender differences were found in handedness distribution. Participants were selected using a convenience sample through organizations which provide support to GLB individuals and their families. 


{Gooren} L. Gooren (1986) conducted a study to determine whether the neuroendocrine response of the luteinizing hormone (LH) to a single dose of estrogen could distinguish homo-, trans-, and heterosexuals of both sexes. The study failed to find such differences among groups of female homo-, trans-, and heterosexual individuals – all demonstrated an initial decline in serum LH levels after the estrogen was administered, followed by a sharp rise. The similarity of LH responses to estrogen administration in the three groups of women studied does not support the theory that brain androgenization is a factor in the establishment of gender identity or sexual orientation. Among the groups of males studied, the response to the estrogen administration was varied. In some homo-, trans-, and heterosexual males, the serum LH levels remained below the pretreatment levels, while in others, the levels rose, similar to the response in the female groups. In those men whose LH levels rose, there was a sharp fall in testosterone levels after estrogen administration and hCG administration. It seems that the differences in the LH responses in the male groups can be explained by other endocrine factors not necessarily related to gender identity or sexual orientation.


{Blanchard & Bogaert} 302 white, single-birth heterosexual males were matched with 302 homosexual males of the same demographic within the same birth year or within one year of birth.  Participants were given an anonymous, self-administered questionnaire in which they recorded all siblings of their biological mother and paternity of each sibling. Results confirm a higher birth order for homosexual males, with a statistically significant difference between number of older siblings in homosexual and heterosexual males. Number of older brothers was shown to increase likelihood of homosexuality by 34% for each older brother. Parental age and number of older sisters was not shown to be statistically significant once number of older brothers was controlled for. It is unclear whether these findings are the result of a biological (immune hypothesis) or psychosocial reaction. 


{Schwartz et al, 2010} The study conducted by Gene Schwartz, Rachael Kim, Alana Kolundzija, Gerulf Rieger, and Alan Sanders (2008) was the first to attempt to better understand sexual orientation in men from an evolutionary perspective by concurrently investigating several factors related to sexual orientation, namely: family size, handedness, hair whorl rotation, family composition, and maternal lines. The method used was an anonymous questionnaire administered to 694 homosexual men and 894 heterosexual men. The results of this study corroborated the findings of several previous independent studies regarding family size and composition that showed that homosexual men have more relatives, more gay relatives, and older brothers than heterosexual men. These findings contribute to the understanding of sexual orientation in men and shed light on the evolutionary quandary of male homosexuality. However, little significance was found regarding the relationship of maternal lines, handedness, and hair whorl rotation patterns to homosexuality in men.


{VanderLaan & Vasey} In a 2011 study, VanderLaan and Vasey examined the effect of older brothers compared to older sisters on the development of male sexual orientation. The study collected data via questionnaire on age, birth order and sexual orientation from a sample of 341men from Independent Samoa. The results of this replication sample combined with VanderLaan and Vasey’s (2007) initial sample indicate that, compared to older sisters, older brothers were a significantly greater predictor of male same-sex attraction. Furthermore, the mothers of the men who identified with same-sex attraction in this study tended to have more children compared to the mothers of the men who identified as heterosexual. VanderLaan and Vasey’s (2011) results confirm findings, previously limited to Western cultures alone, that maternal fecundity and the presence of older biological brothers significantly contribute to the development of male same-sex attraction and that these two factors are independent of cultural influences.


{Rahman et al, 2008} The authors of this study used a comparative survey design, whereby the number of homosexual relatives among white and non-white homosexual men were compared to the number of homosexual relatives among white and non-white heterosexual men. Additionally, they tested whether or not the fecundity of female maternal relatives of homosexual men is higher than that of female maternal relatives of heterosexual men, or what is known as the “fertile female” hypothesis. The authors surveyed a total of 155 heterosexual men and 147 homosexual men from the student population of the of the University of East London and the Soho district of London, a recognized gay area of the city. The analysis showed that both white and non-white homosexual men had a significant excess of homosexual maternal line male relatives, with 9.8% of all white maternal line male relatives and 7. 4% of all non-white maternal line male relatives being homosexual. When testing the “fertile female” hypothesis, the authors found that, for whites, the maternal aunts of homosexual men had significantly higher fecundity than the maternal aunts of heterosexual men, but found all other variables among other relative classes to be insignificant. The data were non-normally distributed, so non-parametric Mann-Whitney U tests were used.


{Blanchard & Lippa}  Research has shown an association between the fraternal birth order effect and adult male homosexuality as well as an association between non right-handedness and homosexuality in adult men and women. In a 2007 study, Blanchard and Lippa examine how the interaction between the fraternal birth order effect and handedness influences sexual identity. The authors collected data on sexual orientation, birth order, and handedness from a sample of 255,114 (men and women) subjects who responded to an internet research survey advertised on the British Broadcasting Corporation (BBC) website. Among those men who had both older and younger siblings, results showed a significant correlation between the number of older brothers and right- handed homosexual men but not between the number of older brothers and non right-handed homosexual men. The authors further point out that although their results confirm previous findings on the fraternal birth-order effect, the evidence is weaker than in previous studies due to an unexpected higher ratio of older siblings to younger siblings among the survey respondents. They hypothesize that this may be due to the parental stopping rule of ceasing to have children once they have children of both sexes and that this finding should be addressed in future studies.


{Rahman et al, 2009} Rahman, Clarke, & Morera (2009) explores the hypothesis that hair whorl direction could be predictive of homosexuality. They studied 100 heterosexual and 100 homosexual men by way of a “target sampling” method. Counterclockwise direction has been linked previously to homosexual orientation in men. The Kinsey Scale was used to evaluate sexual orientation, number of biological siblings and birth order were listed, and handedness was evaluated. Hair whorl was identified by two independent raters who inspected the scalp region of each participant. The authors found that there was no significant difference in whorl direction between the two groups, thus it is not clear that direction of hair whorl is an important neurobiological marker of homosexuality. However, the fraternal birth order effect (having more older brothers for homosexual men) was found, namely that homosexual men had significantly more older brothers than heterosexual men. Number of older sisters was positively correlated with counterclockwise hair whorls in heterosexual men only. A logistic regression indicated that, with each older brother, the odds of homosexuality increased by 41% in this sample.


{DuPree et al, 2004}  Studies of animals in the mammalian class indicate evidence of an association between atypical prenatal hormone activity and sexual identity. Many of these studies have particularly targeted the aromatase enzyme, which is responsible for the masculinization of the brain through converting male sex hormones into female sex hormones. In this study DuPree et al. performed DNA analysis on homosexual brothers to establish whether the human aromatase gene CYP19 determines sexual orientation. Four hundred and thirty nine subjects who had two or more gay male siblings were recruited through local and national ads in homophile publications and sexual orientation was assessed via questionnaire through the Kinsey scales of sexual attraction. Results indicated that that naturally occurring variations in the CYP19 gene do not contribute significantly to differences in male sexual orientation even though aromatase itself may still play some role in the development of sexual orientation.


{Rice et al, 1999} The authors of this study sought to test the theory that homosexuality is genetic by further testing Hamer’s position that there is a link between male homosexuality to microsatellite markers on the X chromosome. The authors scrutinized this theory by surveying the sharing of alleles at position Xq28 in 52 gay male brothers from Canadian families, particularly investigating four markers at Xq28, those being: DXS1113, BGN, Factor 8, and DXS1108. Genotyping was performed on DNA samples from the brothers themselves without genotyping of parents. As controls, the authors used an additional 33 sibling pairs who were concordant for multiple-sclerosis, which were genotyped simultaneously with the gay siblings. All allele scoring was performed independently by two evaluators who were unaware to the siblingship. The authors found no excess sharing for any of the four markers tested, meaning the results were not consistent with an X-linked gene underlying sexual orientation in this particular region of the X chromosome. The authors were uncertain as to why their results differed from Hamer’s original study, but were confident in their results since their sample was larger than Hamer’s. 


{Purcell et al, 2000} This study investigates the fraternal birth order effect on a sample of 97 gay men recruited by letter, newspaper and radio ads and referrals from organizations “oriented” toward gay membership or readership. The fraternal birth order effect, thus far reliably and consistently correlated with sexual orientation in men, shows that compared to heterosexual men, gay men tend to be born later in birth order and also have a greater number of older brothers than expected based current demographic data. Purcell, Blanchard, and Zucker (2000) measured birth order according to Slater’s Index and results placed a significantly higher number of participants later in birth order Furthermore, the 37 participants with at least one brother and one sister tended to be born later among their brothers than among their sisters, confirming the correlation other studies have found between the fraternal birth order effect and male sexual identity. The authors of this study conclude with a brief summary of existing biological and psychosocial theories on causes of the fraternal birth-order effect and conclude that there is insufficient empirical data for either explanation and call for further research that offers a “comprehensive account” for the etiology of sexual orientation.


{Kendler et al, 2000} examine the effect of genetic and environmental influences on sexual orientation through studying twin and nontwin sibling pairs in large U.S. national sample. Sexual orientation was assessed via self-report as heterosexual, bisexual, or homosexual, in response to one question, “How would you describe your sexual orientation?” The authors then combined bisexual and homosexual responses into one category, “nonheterosexual”. Overall, monozygotic twins exhibited a higher rate of similar sexual orientation and nonheterosexual sexual orientation was significantly greater among monozygotic twins than among dizygotic twins and nontwin siblings. Results also indicated that impact of family environment on sexual orientation in all twin and nontwin groups was much lower than the genetic impact. The authors conclude that family environment does play a role the development of sexual identity but is not as influential as genetic factors.


{Drabant et al, 2012} Drabant, Kieger, Eriksson, Mountain, Francke, Tung, Hinds & Do (2012) explores the possible role for certain genes on the x chromosome which may impact variations in sexual orientation. This was a web-based survey over 23,000 adults gathered through the 23andme database. It explored questions on one’s sexual identity, sexual identity milestones, family history of homosexuality, sibling gender, birth order, gender identity, and attitudes towards homosexuality. A custom Illumina array was used to genotype all survey respondents. Prevalence is hard to identify from this sample due to sampling bias and participant level of willingness to disclose their sexual orientation. 77% of participants identified as heterosexual only, 6% identified as homosexual only. Of the men surveyed, 9% identified as homosexual only. Of the women surveyed, 2% identified as homosexual only. Preliminary findings of phenotype associations, which were gathered from other aspects of the database, included a positive relationship between identifying as lesbian and alcoholism, as well as identifying as gay and several psychological concerns, including depression, anxiety, OCD, and panic. Other findings included that no genetic loci reaching genome-wide significance was found among men or women. There did not appear to be an association between sexual identity and SNPs on the X chromosomes of men or women in the sample. Still, findings are limited because while the sample itself was large, that of individuals who identified as homosexual only was still small. 


{Klintworth} In this study, the authors investigated the physical as well as psychological characteristics of twins to investigate differences in sexually discordant monozygotic twins. The authors examined one set of twins, one of whom (the homosexual one) had been admitted to the Johannesburg General Hospital after attempting suicide. The authors collected an abundance of physical and psychological data on both twins, including fingerprints and dental impressions, test results of color blindness, taste thresholds, early childhood development, family history, hobbies and interests, occupation, education, and much more to survey the significance of each trait. As per the physical data, a mutual red-green color-blindness was determined to be the most significant trait since it is a sex-linked characteristic. For the psychological data, a projective psychological test showed that the homosexual twin had a dependent attitude toward the mother and fear of an aggressive father, while a Thematic Apperception Test showed that the heterosexual twin had an ambivalent personality with occasional explosive outbursts. While several conclusions about particular traits were reached, no general or overarching conclusion was presented.  


{Rainer & Mesnikoff} In this study, the authors employ a twin study method to determine the etiology of homosexuality, since such studies have been established as a means of finding genetic mental disorders, while also utilizing a variation of co-twin control methods, which compares pairs of one-egg twins under different life conditions. After surveying a considerable number (not given in study) of twins to locate sets with differing sexual preferences, the authors located two pairs. They then observed the two pairs of twins, one male and one female, using a free association method to assess their patterns of interpersonal interaction. Their theory was that since genetic traits will remain a constant, the influence of life experiences would be more easily determined, and they could so further ##### the developmental process in homosexuality. The authors found that the twin with a homosexual role was rejected by his or her respective parents and determined that the parents had a preference for the heterosexual one. They also concluded that slight anatomical differences between twins resulted in a special attachment between the mother and the heterosexual twin.


{Kallmann} In 1947, Franz Kallman and the Department of Medical Genetics of the New York State Psychiatric Institute at Columbia University conducted a study of predominantly homosexual male twins and the genetic aspects of their homosexuality. A statistically representative sample of homosexual twin cases was established and a procedure was arranged to provide verified clinical, social, and cytological data for the sex ratings of the subjects as well as their co-twins, brothers, and fathers. An attempt was also made to find an adequately controlled determination of the sex ratio among the siblings and children of the index cases. All of the 85 monozygotic twin pairs demonstrated concordance as to the practice and rating of homosexual behavior after adolescence. Many of the twin partners claimed to have developed their sexual patterns independently of their twin and all of them denied any form of sexual activity with their co-twin. In the dizygotic group, more than 50% of the co-twins of distinctly homosexual subjects showed no evidence of overt homosexuality. Furthermore, the study also found that only two males who are similar in both the genetic constitution and the developmental aspects of sexual maturation and personality integration would also be apt to be alike in those specific vulnerabilities favoring a trend toward fixation or regression to immature levels of sexuality. The results of the total fertility quota of the subjects were small: 5 children (3 boys and 2 girls), while the data regarding the sex ratio of siblings was not found to be statistically significant.


{King & McDonald} Michael King and Elizabeth McDonald (1992) conducted a study of 46 homosexual men and women who were twins to analyze their sexuality and that of their co-twin.  Using a self-selective methodology, subjects responded to posted advertisements and answered a questionnaire.  Of the 46 respondents, only 9 (20%) claimed that their co-twin was also homosexual. 7 (15%) of 33 twins from same-sex pairs reported having a homosexual relationship with their co-twin.  The study found a high level of shared knowledge of sexual orientation between members of twin pairs and a relatively high likelihood of sexual relations occurring with same-sex co-twins (particularly monozygotic pairs) at some point. The discordance for sexual orientation in both monozygotic and dizygotic pairs confirms that genetic factors are an insufficient explanation of the development of sexual orientation in twins.


{Taylor} Alan Taylor, MA (1983) examines stereotypes of male and female homosexuals in the context of masculine-feminine traits using the Personality Attributes Questionnaire (PAQ). The 103 adult respondents, 64 female and 39 male, were asked to rate 4 groups: “men”, “women”, “male homosexuals”, and “lesbians”, on the PAQ according to which ratings they thought applied to most members of each group. “Male homosexuals” were rated significantly different than “men” and “lesbians” than “women” on the majority of items, confirming that homosexual stereotypes existed for this sample, and that male and female homosexuals were perceived differently. These results strongly support the view that participants’ definition of sex role is a highly important reference point for their perception of homosexuals. Based on participants’ ratings, the present study shows not only that stereotypes of male and female homosexuals exist, but also that they are predictable due to these sex role evaluations and the consequent attitudes towards homosexuals that are derived from these.


{Alanko et al, 2010} In Finland, a study of 3261 adult twins of mixed zygosity and genders recalling their childhoods, showed that childhood gender atypical behavior (GAB) predicted homosexuality in adulthood (Alanko et al, 2010). Males had a twice greater likelihood of homosexuality in adulthood if they had GAB in childhood, which the researchers attributed the GAB half to additive genetic effects and half to environmental effects. They concluded for women that nonadditive genetic effects contributed to half of the GAB and orientation. For both sexes, this correlation between GAB and homosexuality was consistently higher in monozygotic twins than dizygotic twins, suggesting to the researchers a genetic influence. However, the researchers also noted that the monozygotic correlations were not in unity. They posited that the socially accepted idea that girls may have GAB and still grow up into heterosexual women could provide a social influence on orientation, especially if GAB is less frequent in boys than girls, causing the traits to be more peculiar and inviting more shame and ostracism.


{Bearman & Bruckner} Bearman and Brückner performed a study of 5512 twins and siblings to test the validity of competing hypotheses of same-sex attraction etiology (2002). The socialization model predicts that parents and others interact with opposite-sex twins in ways less scripted in regards to gender socialization, treating both twins so similarly it leads to increased rates of SSA, especially in males. The genetic model predicts that concordance of SSA between sibling pairs increases with genetic similarity. The evolutionary model states that if a male with SSA has older biological brothers, the SSA was due to the mother carrying a “biological memory” of how many sons she has carried, causing changes in her intrauterine environment which activates prenatal feminization of the youngest son. The prenatal hormone model suggests that for opposite-sex twins in the womb, the female transfers excess hormones to the male. The study showed that males with female twins are more likely to report SSA than any other group (16.8%), more than twice as likely as males with a full sibling sister (7.3%) and more likely than same-sex twins (9.9%), which discredits the genetic model. Among male opposite-sex twins, SSA is twice as likely with those without older brother (18.7%) than those with older brothers (8.8%), contradicting the evolutionary model. According to the socialization model, the presence of an older sibling would affect the orientation of opposite-sex twins by locking in gender-socializing mechanisms in the family in advance and sanctioning gender nonconformity. Also, as the socialization model predicts, the presence of an older sibling has no effect on opposite-sex female twins.


{Bogaert 2006} A study of 944 men showed that the only predictor of adult homosexuality was the existence of a biological brother, regardless of whether or not they grew up together (Bogaert, 2006), suggesting that the fraternal birth-order effect has prenatal origins.


{Burri et al, 2011} The authors of this study sought to resolve a tension between the genetic and non-genetic components that contribute to the covariation between early sex-typed behavior (which the authors refer to as Childhood Gender Typicality, or CGT) and adult gender identity (AGI), or a person’s feelings of masculinity or femininity in adult life. After administering two separate questionnaires, the authors had final data relating to sexual orientation and its psychological correlates, CGT and AGI, for 4,426 female twin individuals. No males were included due to an unavailability of data. Zygosity was established using standardized questions about physical similarity and confirmed by DNA genotyping in cases of uncertainty, while sexual orientation was established with a scale similar to the 7-point Kinsey scale. The authors found that sexual attraction and CGT are influenced by genetic factors, but genetic contributions had a much weaker impact on AGI. Meanwhile, the effect of non-shared environmental factors on all traits was significant, but there was no effect of the shared family environment on all traits. In summary, AGI showed less variability compared with CGT.


{Langstrom et al, 2010} In this study, the authors conduct a true population-based survey of all adult twins ages 20-47 in Sweden between 2005-2006, according to the Swedish Twin Registry. 21,481 men and 21,607 women were eligible for the web-based survey, with response rates of 11,229 men and 14,096 women. The authors then surveyed respondents in a questionnaire assessing lifetime numbers of opposite-sex and same-sex partners, with zygosity of twins being established using standard physical similarity questions previously validated through genotyping. The authors tested the influence of genetic effects, shared environment, and individual specific environment on homosexuality in both sexes. Biometric modeling revealed that, in men, genetic effects explained .34–.39 of the variance, the shared environment .00, and the individual specific environment .61–.66 of the variance. Corresponding estimates among women were .18–.19 for genetic factors, .16–.17 for shared environmental, and 64–.66 for unique environmental factors. The authors concluded that their results support the notion that same-sex behavior arises not only from heritable but also from individual specific environmental sources. Additionally, the authors found that hereditary effects appeared weaker in women than men.


{Mustanski et al, 2005} The authors of this study intended to test previously published evidence supporting maternal loading of transmission of sexual orientation and its epigenetic effects on autosomal genes. The study’s participants were comprised of 456 individuals from 146 families with two or more gay brothers. Participants were predominantly white, college-educated, middle to upper socioeconomic status, and their mean age was 36.98 (8.64 SD). The authors used Lander and Kruglyak’s (1995) criteria to report regions with suggestive linkage and administered Kinsey scales of sexual attraction, fantasy, behavior, and self-identification in structured interviews or questionnaires to assess sexual orientation. The authors genotyped using PCR (polymerase chain reaction) with 403 microsatellite markers at 10-cM intervals of chromosome location. They calculated maximum likelihood estimations (mlod) scores, separated for maternal, paternal, and combined transmission. The authors built upon the body of research by finding three new regions of genetic interest: 7q36, 8p12, and 10q26. Genes mapped on 7q36 encode for neuroendocrine hormones essential for brain development in a region that has been found to be enlarged in homosexual men. The 8p12 region encodes certain prenatal hormones, and the 10q26 region results from excess sharing of maternal but not paternal alleles. The authors point out that these locations have been identified for further exploration and explain several limitations of their research.


{Whitam et al 1993} The authors of this study sought to test Kallmann’s theory that there is nearly a 100% concordance rate of sexual orientation in monozygotic twins by studying 61 pairs of twins and three sets of triplets regardless of type of twin, sex, or sexual orientation of the co-twin. Zygosity was measured by the Nichols and Bilbro instrument, and sexual orientation was established by use of the 7-point Kinsey scale, with all sets of twins marked as either concordant, partially concordant, or discordant. The authors found that, like a study from Bailey and Pillard, in monozygotic twins, concordance is the most common pattern but discordance for sexual orientation is not rare. For instance, among monozygotic male twins, 29.4% were discordant for sexual orientation. For female monozygotic twins, on the other hand, the concordance rate was 75%, but the authors admit their sample was relatively small. The concordance rate for male dizygotic twins with a female twin was 33.3% while the concordance rate for male dizygotic twins with a male twin was 28.6%. Among the triplets, two monozygotic pairs were found within the three sets, and if they were counted as monozygotic pairs the combined concordance rate for sexual orientation for monozygotic pairs would have risen from 64.7% to 67.6%. In summary, the authors concluded that their findings aligned with Bailey and Pillard, but differed from Kallmann, leaving them seriously questioning the sample he used. 


{Eckert et al, 1986} Eckert, Bouchard, Bohlen, & Heston (1986) describe the experience of six pairs of monozygotic twins who were reared apart. Researchers recruited these pairs from Minnesota and evaluated them for various environmental factors, including developmental problems, birth weight, onset of puberty, history of same-sex relationships and behaviors, and identification as heterosexual/homosexual/bisexual. Despite a small sample size, the article concludes that, because three of the four female pairs were discordant for homosexual behavior, it seems that same-sex attraction in females could be an acquired trait as opposed to a genetic contribution. For the two male pairs, one pair was concordant for homosexuality, while the other was not clearly concordant or discordant, implicating genes as possible contributors. Hypotheses were made about correlations between various characteristics and homosexuality, although the researchers encouraged these findings to contribute to future research questions, as opposed to explanatory of homosexuality. 


{Heston & Shields} The first objective of this study was to report the number of concordant and discordant, monozygotic (MZ) and dizygotic (DZ) pairs observed in their sample with a second objective of examining the frequency of homosexuality in twins per se. Participants in the study included 12 male twins from the Maudsley Twin Register at Maudsley Hospital, London. These researchers also conducted a case study of a particularly unusual family wherein 14 siblings included three sets of male MZ twins, also obtained through the hospital registry. The authors conducted at least two clinical interviews with each twin and performed psychological tests of intelligence and personality. Zygosity was determined by interpair resemblance in fingerprints, blood groups, and plasma proteins using the Smith and Penrose method as well as the Slater method. All twin pairs in the family case study were found to be very likely MZ, with probabilities greater than 99.0%. Among the three sets of MZ twins, these authors found what they considered to be a high level of concordance in sexual behavior within each set of twins, but also pointed out differences in experience and sexual preference within pairs. The author’s overall study of the twin registry revealed no evidence that monozygotic twins per se are particularly prone to homosexuality. The authors conclude their discussion by arguing for the interaction of genetic and environmental factors in the determination and etiology of sexual orientation.


{Chaladze} The authors of this study address the question of whether or not decreased fecundity in homosexual males corresponds with increased fecundity of the mothers who carry them by using an individual-based modeling (IBM) approach. The authors treated a single, X-linked locus with alleles A 1 and A 2 , with A 1 predisposing males to homosexuality and increasing the female carrier’s fecundity. The authors carried out three different tests in a population genetics model, with a constant of: all females with A 1 A 1 and A 1 A 2 genotypes having higher fecundity than females with A 2 A 2 . The fecundity rates of homosexual males as well as the percentage of homosexual males with the A 1 allele was a variable throughout all three tests. The first test showed that single locus X-linked models cannot explain the persistence of homosexuality. Tests 2 and 3, however, did predict wide ranges of parameters where homosexuality can exist with low and stable frequencies in a polymorphic population. In summary, the authors concluded that population genetics IBMs demonstrate that persistence of homosexuality in a human population with low and stable frequencies can be explained by X-linked inheritance if coupled with an increased fecundity of females carrying an allele that predisposes males to homosexuality.


{Wang et al, 2012} Wang et. al. (2012) investigated the possibility of a link between the human Sonic Hedgehog gene (SHH) and male sexual orientation. SHH makes a protein called sonic hedgehog, which plays an important role in embryonic development, particularly in normal patterning of the body and in separating the brain into right and left hemispheres. The authors performed a genotype analysis of SHH in 361 homosexual Chinese men recruited from clinics that target treatment of this population and 319 heterosexual Chinese men recruited from routine adult health screens. Results showed significant genetic variation between the heterosexual and homosexual groups. Although the authors cite the necessity of replicating this study and particularly in a cross-cultural context they conclude that their findings indicate an association between male sexual orientation and variations in the SHH gene.


{Witelson et al, 2008} Witelson et al. (2008) examine the correlation between the size of the corpus callosum and male sexual orientation in a study involving 12 homosexual men, recruited through ads in community-based organizations and a university campuses, and 10 heterosexual men, recruited through ads on a university campus and matched in age and education with the homosexual group. All participants underwent MRI scans and were assessed for hand preference and certain cognitive functions. Results indicated that both groups were strongly right-handed and also showed no significant difference on the cognitive measures. However, the callosal isthmus, the posterior area of the corpus callosum that connects the parietotemporal cortical regions in the left and right hemispheres of the brain, was significantly larger in the homosexual group. These results contribute to existing evidence for a correlation between male sexual orientation and structural brain differences that influence patterns of motoric functional asymmetry, such as handedness.


{Ponseti et al, 2007} Research shows that structural brain differences exist between men and women both in total brain size, which is bigger in men, and in volume of gray matter, which is greater in women. Ponseti et al. (2007) examined the association between structural brain differences and sexual orientation in men and women through MRI scans performed on 80 subjects: 25 heterosexual women, 15 homosexual women, 24 heterosexual men, and 16 homosexual men. MRI scan results indicated no structural differences between hetero- and homo- sexual men but homosexual women appeared to have less gray matter in the temporal basal cortex. This area is involved in memory encoding, and olfactory and spatial processing, all of which are related to processing sexual stimuli. Although the cause for such structural differences is still unknown, these results indicate that male and female homosexuality do not manifest in the same way at the level of structural brain differences.


{Green & Stoller} Green and Stroller (1971) looked at two case studies, one of a monozygotic male twin pair, and the other of a monozygotic female twin pair. In both cases, the twins had extremely different gender identities. For the boys, one twin (the more masculine) looked more dominant at infancy, was more active, and was closer to his father while the other (the more feminine) was less active, played with dolls, claimed his sister as his best friend, and he was closer to his mother. For the female twin pair, one twin (masculine) dressed like a male, was built like a male (taller, fatter, and stronger), was given more masculine chores, and even desired for a sex-change while the other lived an average feminine life. In both cases, the parents often accepted and encouraged the differences. The comparison of the twins shows that postnatal experiences and parental attitudes might be very influential in the formation of gender identity.


{Davison et al, 1971} In this study, the authors assert that several reports of monozygotic twins discordant for sexual orientation demonstrate that, since they have an identical heredity, environmental factors are likely to be significant in determining sexual orientation. A single pair of 18-year- old monozygotic twins was surveyed, with one being overtly homosexual. A repertory grid study of familial relationships and attitudes was conducted, specifically examining the homosexual child’s relationship to ten figures in his life. A close similarity in the twins’ appearance, fingerprints, and blood group left the authors with no doubt that these twins were monozygotic. Hence, the authors concluded that the parent-child relationship was the most probable etiological agent. Notably, the homosexual twin suffered a fatal illness in his early years, which resulted in the mother fixing most of her attention on him. Meanwhile, the authors paradoxically found that the androgyny score of the homosexual twin was more masculine than that of the heterosexual twin.


{Frias-Navarro et al, 2015} Frias-Navarro, Monterde-i-Bort, Pascual-Soler, and Badenes-Ribera (2015) conducted a study to ##### attitudes on same-sex parenting based on the participants foundation of knowledge on the development of sexual orientation.  The researchers hypothesized that a biological explanation of homosexuality (genetics) would produce decreased negative attitudes on the rights of homosexuals and rearing of children with same-sex parents while an environmental explanation of homosexuality (choice) would produce increased negative attitudes.  In the study, participants completed a questionnaire on their beliefs after reading a text either about the biological or environmental explanation of homosexuality.  Results showed that those that read the biological text had more supportive attitudes toward homosexuals while those that read the environmental text had more rejection.


{Marchant-Haycox et al, 1991} The authors of this study tested the association between left-handedness and homosexuality as well as the tendency of left-handedness of individuals positive for HIV/AIDS. The authors based their study off the work of Geschwind and Galaburda, who pointed out that mid-pregnancy stress causes a high testosterone level in male fetuses, low testosterone level in the adult offspring, and homosexual behavior. 791 male homosexuals and male and female heterosexuals, some of whom had been tested for HIV infection, and others of whom had AIDS responded to the authors’ questionnaire. Analysis of directed handedness found a significant relationship between handedness and homosexuality, but this was not significant when an HIV/AIDS status was taken into account. There was, though, a significant association between handedness and HIV/AIDS, which remained significant after homosexuality was taken into account. In summary, the authors failed to find any statistically significant evidence that handedness is related to homosexuality, and thus could not support the hypothesis put forward by Geschwind and Galaburda. Additionally, the authors found a statistically significant association between HIV/AIDS and the overall percentage of left-handers, but this was not easily interpretable in support of Geschwind and Galaburda.


{McCormick et al, 1990}  McCormick, Witelson, and Kingstone (1990) examined the association between sexual orientation and hemispheric functional asymmetry, which they measured through hand preference. The study recruited 38 homosexual men and 32 homosexual women from one homophile organization, screening subjects for homosexuality using Kinsey Scale ratings of 5 or 6 and assessing for hand preference through a self-administered questionnaire. Participant hand preferences was compared to a general population survey on hand preference and results indicated a significantly higher rate of non-consistent right-handedness among homosexual women compared to heterosexual women and a insignificant trend toward non-consistent right-handedness among homosexual men compared to heterosexual men. The insignificant difference between homosexual and heterosexual men in hand preference was attributed to the small sample size since an earlier study with a much larger sample size found a significant difference. The authors concluded that there appears to be a correlation between sexual orientation and hemispheric functional asymmetry and suggested that future studies on the etiology of homosexuality may benefit from the neuropsychological approach used in this study.


{Gotestam et al, 2009} The authors of this study sought to test the theory that, based on a study from Geschwind and Galaburda (1985), maternal stress and intrauterine testosterone changes both lead to a higher rate of left handedness and homosexuality. In particular, the authors hypothesized that they would find a higher occurrence of left-handedness in a sample of homosexual men than in the general population, and that they would find an increased occurrence of stuttering and reading among said sample. They did, however, predict that the incidence of twins would be lower than in the general population. The subjects were all respondents in the continuing AIDS Behavioral Research Project at UCSF, 394 of whom returned a suitable questionnaire for data analysis. In summary, the authors did find a clear and significant left-handedness among their sample population (17.5% compared to 8.4%) as well as an increased occurrence of stuttering (7.1% compared to 1.6%) and reading difficulties (7.9% compared 1-3%), thus confirming Geschwind and Galaburda’s 1985 hypothesis. Also, as predicted, the authors found the incidence of twins to be lower in their sample than in the general population.


{Lalumiere et al} The authors of this study were interested in reviewing research from the past decade that identifies early neurodevelopmental determinants or correlates of sexual orientation, particularly focusing on the study of handedness while arguing for the important and perhaps more direct information it provides on the early neurodevelopmental basis of sexual orientation. The authors conducted a meta-analysis of 20 published and unpublished studies that compared the rates of non-right- handedness in 6,987 homosexual (6,182 men; 805 women) and 16,423 heterosexual (14,808 men; 1,615 women) participants. The main statistic for the meta-analysis was the odds ratio, calculated by dividing the ratio of non-right- handers to right-handers among the target participants by the similar ratio calculated for the comparison participants (heterosexual participants). A value larger than 1.0 indicates a larger proportion of non-right- handers in the target samples. The authors found that homosexual participants had 39% greater odds of being non-right- handed (an odds ratio of 3.0 is generally considered to represent a large effect). A significant relationship between handedness and sexual orientation was obtained in both sexes but was stronger in women. The corresponding values for homosexual men (20 contrasts) and women (9 contrasts) were 34% and 91%, respectively. The findings in this article support the view that sexual orientation has an early neurodevelopmental basis. The authors argue that the notion of developmental instability can explain why non-right- handedness is related to homosexuality in both men and women, but it does not identify the specific neurodevelopmental mechanisms underlying sexual orientation.


{Ellis et al, 2007} In this study, the researchers explored sexual orientation in relationship to genetically determined traits, such as hair color, eye color, blood type and Rh factor. The goal was to find a possible genetic influence on sexual orientation. No relationship was found with sexual orientation and hair color/eye color. In regards to blood type, there was no sex difference, however type A was rare in male homosexuals (18.5%) but was rather common in female homosexuals (44.2%). For Rh factor, both gays and lesbians had a higher prevalence of being Rh- than heterosexuals. Results indicate that there could be some connection between sexual orientation and genetics with regards to blood type and Rh factor, but further research must be done. 


{Klar} In this study, researcher Amar Klar observed gay men’s hair whorls at a popular gay beach. Going on three different days, he walked through the beach and noted whether each assumed gay man had a clockwise or counter-clockwise hair whorl. The results showed that 28% of these men has a counter-clockwise hair whorl. After observing men in malls, gyms and stores, he noted that 8.4% of the general population had a counter-clockwise whorl. There is a margin of error in that not necessarily all the men at the gay beach were gay and not everyone in the mall, gym and store is straight. Nevertheless, this study shows that there is an excess of counter-clockwise hair whorls in homosexual men, indicating that sexual preference in some men could be influenced from a genetic factor which also determines direction of hair whorl. 


{Hamer et al, 1993} The authors state the goal of their work was to determine whether or not male sexual orientation is genetically influenced by completing pedigree and linkage analyses of 114 families of homosexual men and an additional analysis of a selected group of 40 families in which there were two gay brothers and no indication of non-maternal transmission. The study participants were self-acknowledged homosexual men and their relatives over the age of 18. The initial sample was recruited through the outpatient HIV clinic at the National Institute of Health Clinical Center, the Whitman-Walker Clinic in Washington, D.C., and local homophile organizations, as well as with advertisements in local and national homophile publications with sexual orientation being assessed by the Kinsey scales. In summary, the authors found that their data indicates a statistically significant correlation between the inheritance of genetic markers on chromosomal region Xq28 and sexual orientation in a selected group of homosexual males. In a selected population of families in which there were two homosexual brothers and no transmission through fathers or to females, 33 of 40 sib-pairs had coinherited genetic information in this subtelomeric region, with a 99% level of confidence. The authors offer several possible explanations as to why seven pairs of brother did not coinherit all of the Xq28 markers, explaining that given the overall complexity of human sexuality, it is not surprising that a single genetic locus does not account for all of the observed variability.


{Bradley et al, 1998} Bradley et al. present a case study that investigates the influence of biological and environmental influences on the sexual identity of a biological male reassigned female sexual identity after circumcision at age 2 months irreparably damaged the infant’s penis. Sex reassignment and surgery took place between the ages of 2 and 7 months, the patient was raised as female. Although she continued to identify as female in follow-up interviews at the ages of 16 and 26, she also identified as bisexual in attraction and behavior. This study contrasts results with a similar case study in which a biological male, reassigned a female identity between 17-21 months, rejected his male identity at age 14 and reported exclusive sexual attraction to women. Bradley et al. conclude that it is possible for a female gender identity to develop in a biological male and that nurture, specifically parents’ decision to raise their children in a gender-specific manner, may be the most important factor in the development of gender identity.


{Lippa} The authors of this study focused on possible associations between index-to- ring-finger (2D:4D) finger-length ratios and sexual orientation in men and women, basing their study on previous research showing that men are more likely than women to have ring fingers relatively longer than their index fingers (i.e., low 2D:4D ratios), whereas women are more likely than men to have index fingers relatively longer than their ring fingers (i.e., high 2D:4D ratios). Sex differences in 2D:4D ratios likely result from the early effects of sex hormones, particularly androgens. These ratios vary substantially across ethnic and nationality groups. The current study had 2,000 participants, nearly all college students and staff at California State University, Fullerton, with participants completing an anonymous questionnaire. Participants’ hands were photocopied and were measured by researchers blind to the gender and sexual orientation of participants. The current study found that heterosexual men had lower (more male typical) 2D:4D ratios than gay men. After controlling for ethnicity, there was no evidence that heterosexual women differed from lesbian women in 2D:4D ratios. Heterosexual—homosexual differences in men’s 2D:4D ratios tended to be consistent across hands, across ethnic groups, and in age-matched groups. The researchers state that there was a consistent and significant relationship between 2D:4D ratios (a possible marker of prenatal androgen levels) and adult sexual orientation.


{Hall & Love} Various studies have indicated that lesbian sexual orientation is associated with a lower 2D:4D ratio (second to fourth finger digit ration), a ratio that is determined by prenatal levels of sex hormones. Hall & Love (2003) investigate genetic and environmental factors in this association through a study using monozygotic (MZ) female twins comparing an experimental group of 7 MZ twin pairs discordant for sexual orientation (1 twin heterosexual the other lesbian) with a control group of 5 MZ twin pairs concordant for sexual orientation (both twins lesbian). The twins were recruited by ads in homophile print publications and Internet websites, sexual orientation was assessed through the Kinsey Scale and Klein Grid, and the twin’s hands were ink-printed for digit measurement. Results for the MZ twins discordant for sexual orientation showed a significantly lower 2D:4D ratio on both hands than their heterosexual twin while there were no significant differences in the MZ twins concordant for sexual orientation. Although the authors advise interpreting the results with caution duo to the small sample size, these results appear indicate that prenatal environmental factors impact sexual orientation to a greater degree than genetic factors since MZ twins share the same genetic makeup.


{Bailey et al, 1991} Bailey, Willerman, and Parks (1991) tested the neurohormonal hypothesis that prenatal stress delays the surge of testosterone needed for sexual differentiation of the brain, hoping to provide the evidence that two previous, small studies could not provide. They surveyed 200 male (116 non-heterosexual) and 97 (25 non-heterosexual) female individuals, and then received permission to interview their biological mothers, who provided retrospective reports on their prenatal stress levels for the individual’s as well as a sibling’s pregancy, and also reports of gender conformity in childhood. For the males, the results showed no tendency for non-heterosexuals to have mother’s report greater stress in pregnancy, even in relation to siblings. For females, there was only slight correlation between stress in pregnancy and later homosexuality, but no correlation to gender nonconformity, and there was little support from the within family analysis. Bailey, Willerman, and Parks concluded that the study failed to support the hypothesis.


{Ehrhardt et al, 1985} Ehrhardt et al. (1985) investigate the influence of prenatal exposure to diethylstilbestrol (DES), a nonsteriodal synthetic estrogen, on adult female bisexual and homosexual orientation. Thirty DES women were recruited from a clinic a DES-screening clinic, matched with a control group of thirty non-DES women with abnormal pap smears, and a subsample of DES women were compared to their biological sisters who did not have DES. The study assessed sexual orientation and development through an 8-hour semi-structured interview process that relied heavily on the Sexual Behavior Assessment Schedule-Adult (SEBAS-A) and the Kinsey Rating Scale. Results indicated a significantly higher rate of bisexuality and homosexuality in DES women compared to non-DES groups. However the authors note that, at best, this study indicates a correlation but not a strong causal link between DES exposure and adult sexual orientation because 75% of the DES women identified as somewhat or exclusively heterosexual.


{Swaab & Hofman} Swaab and Hofman (1990) investigated an association between structural brain differences and male sexual orientation by performing brain autopsies on 34 male subjects and measuring the suprachiasmatic nucleus (SCN) and the sexually dimorphic nucleus (SDN). All 34 subjects had died either with early onset Alzheimer’s or with AIDS-dementia complex and were grouped into the following categories: 18 with no known sexual preference, 10 non-demented homosexual subjects who died from AIDS, and the control group of 6 non-demented heterosexuals who died from AIDS. The SCN controls circadian rhythms and stimulates certain neural and hormonal activity in the body, while the SDN is involved in sexual behavior and is usually larger in volume among males compared to females. Results indicated a significantly larger SCN volume in the homosexual group compared to the reference group but no significant difference compared to the heterosexual group who died from AIDS This indicates an association between a larger SCN and homosexuality but as yet, no causal relationship. Furthermore no significant difference was observed in SDN cell numbers among the three groups, which contradicts the popular hypothesis that the etiology of male homosexuality lies in having a more female brain.


{Herschberger 1997} Hershberger sampled the Minnesota Twins Registry to examine the influence of heredity on sexual orientation. Of the 2,230 twin individuals from the registry who were surveyed with a sexual orientation questionnaire, 1,314 twin individuals participated and these participants included monozygotic, same-sex dizygotic, and opposite-sex twin pairs. Results indicated that genetic effects on sexual orientation were significantly higher for women than men. Furthermore sexual orientation in both men and women appear to be associated with the same set of genes. Hershberger concludes that while sexual orientation appears to be heritable, there is no evidence yet for where these genetic effects are located on the human genome or what exactly those genetic differences would look like.


{Dorner et al, 1980} Dorner et al. examine the association between male sexual orientation and prenatal or perinatal stress using data on 865 German homosexual males registered at various venerologists in Germany. Of the 865 homosexual males, a significantly higher percentage was born between the years of 1941 and 1947, the height of World War II, compared to 1932-1940 and 1948-1953. Studies have shown that male rats who were exposed to prenatal stress and lower levels of androgens during sexual differentiation in the womb displayed higher rates of preferring male partners. The authors conclude that the same relationship appears to exist in this group of German homosexual human males and that wartime and immediate post-war stress is associated with male sexual orientation. The authors also conclude that much more research is needed in this area for a conclusive association to be determined.


{Bailey et al, 1993} Bailey et al (1993) evaluates whether there is a genetic component to female homosexuality and to explore the behavioral expression of it, utilizing a sample of lesbian women with either female co-twins or adoptive sisters. Two hour interviews were conducted with 147 women, 115 with female twins and 32 with adoptive sisters. 85.7% of the sample identified as lesbian, while the remaining 14.3% of the sample identified as bisexual. Family member sexual orientation was reported by the sample participants, although relative self-report was used when available. Information on twin zygosity and childhood gender nonconformity were also found. Probandwise concordance rates are given, identifying the proportion of relatives in each group who were homosexual.  Of the 71 monozygotic twin pairs, 34 (48%) identified as homosexual or bisexual. This rate was significantly greater than that of dizygotic twin pairs and adoptive sisters, while the rates for dizygotic and adoptive pairs were not significantly different. Of the 37 dizygotic twin pairs, 6 (16%) identified as homosexual or bisexual. Of the 35 adoptive sisters, 2 (6%) identified as homosexual or bisexual. Even when excluding bisexual participants and relatives, the rate of monozygotic twin significance exceeded the other groups. Heritability estimates ranged from .27 to .76. 


{Bailey & Pillard, 1991} Bailey & Pillard (1991) evaluates whether there is a biological explanation for male homosexuality, and evaluates the contribution of nongenetic factors. 161 Participants completed a 1-2 hour interview in which they responded to questions regarding sexual orientation, twin zygosity, childhood gender nonconformity, and sibling sexual orientation. They were also asked to contact their twin sibling/adoptive sibling for follow-up information regarding their sexual orientation. Of the participants, 115 individuals had male twins and 46 had adoptive brothers. 52% of the monozygotic co-twins were homosexual/bisexual, while 22% of the dizygotic co-twins and 11% of the adoptive brothers were homosexual/bisexual. The difference between rates in monozygotic co-twins was significantly different from that of both dizygotic twins and adoptive brothers, even when only considering the twin-pairs where data was received from contacting the sibling. Findings indicated that genetic factors are important in determining individual differences in sexual orientation. Heritability estimates range from .31 to .74. Findings did not indicate that childhood gender nonconformity increased likelihood of homosexuality in one’s relatives. This study confirms that there does not appear to be perfect concordance for homosexuality for monozygotic pairs, although substantial heritability is evident.


{Whitehead 2014} Whitehead explores the research on the influence of prenatal hormone exposure, which seems to show an effect of 16-27% of prenatal testosterone of total influences. Early research on guinea pigs by Phoenix et al., (1959) found that variable exposure to testosterone impacted the regularity of same-sex behavior, resulting in a theory called the organizational-activational hypothesis. For research on rat, it appeared that estradiol was the masculinizing hormone that impacted the female reproductive system. It is unclear as to how much animal models can be applied to humans, since there is a great deal of interspecies diversity with regard to the impact of hormonal exposure. It would seem that nature and nature play a part in sexual orientation. Congental adrenogenital syndrome (CAS) is explored, which allows us to understand the impact of overactive adrenal glands on producing masculinized genitalia, which makes them similar to the guinea pigs given highest testosterone does. 10 to 20% of CAS girls report a lesbian/bisexual orientation, and 10% request sexual reassignment surgery. The article then explores the development of sexual differentiation in brain anatomy, which is apparent at around age 4. Sex differences earlier than age four are not sharply divided, and there is a great deal of overlap, as the two sexes are more similar than different. Twin studies were presented which explained the modest impact of prenatal factors, specifically fetal testosterone on SSA and OSA development. Finally, the article highlights the multitude of other recognized factors in sexual identity development, including but certainly not fully explained by prenatal hormones.


{Genetic Arguments} List of articles and summaries regarding genetic arguments. 


Chapter 7: Change is Possible: The Therapeutic Effectiveness of Treatment of Homosexuality

‘I am here as the champion of one’s right to choose…It is my fervent belief that freedom of choice should govern one’s sexual orientation…If homosexuals choose to transform their sexuality into heterosexuality, that resolve and decision is theirs and theirs alone, and should not be tampered with by any special interest group.’  

Address at the NARTH Conference, 2009, Dr. Robert Perloff – Past APA President.


{Dean Byrd} Byrd (year not stated) composed a paper pointing out the American Psychological Association’s (APA) acts of fraud in the science of homosexuality. In the paper, 6 statements the APA claimed as fact were countered and disproven. First, the APA removed homosexuality as a mental disorder from the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, the removal was said to be by a political vote to minimize discrimination, rather than a decision based on evidence seen as how homosexuality is actually associated with mental disorders. Second, The APA claims to be open-minded, yet they banned the practice of reorientation therapy as a possible resource for any gay oriented individuals who do not have a gay identity. Third, the APA claimed that homosexuals have comparable health to heterosexuals yet in truth they tend to participate in more dangerous sexual practices and have a higher percentage of AIDS (70% of all cases. Next, the APA supported same-sex marriage even though homosexuals have higher rates of relationship instability, domestic violence, and infidelity than heterosexuals. Fifth, the APA stated that homosexual parental is fine for a child, yet lesbians commonly masculinize their daughters and feminize their sons leading to a stronger likelihood their children will become homosexual and display mental health issues. Lastly, the APA asserts that change is not possible for homosexuals, but also that it is influenced by cognitive, environmental, and behavioral factors. If the latter is true, then by previous definitions change should be possible. In addition, 2 court cases (Lawrence v. Texas and Romer v. Evans) were discussed that relied on the APA’s claims though they contained misinterpretations and false support of research. Finally, a hypothetical situation was used to display possible consequences of the scientific fraud committed by the APA. The researcher concluded that if the APA continues fraudulent behavior, the organization will become discredited.


In {Martin Luther King}‘s advice to a young man with homosexuality, he responds to the young man’s plight by saying it is very common to experience this. He says, “however, it does require careful attention…it is necessary to deal with this problem by getting back to some of the experiences and circumstances that led to the habit.” He suggests that the young man see a psychiatrist who can help him bring to the forefront of the conscience all of his experiences that led him to his current situation. With compassion, King tries to help this young man out. He doesn’t say something like this is totally normal, just try to accept that this is who you are. Instead he gives the man hope. He says, “You are already on the right road toward a solution, since you honestly recognize the problem and have a desire to solve it.”


{NARTH #1 – Journal of Human Sexuality} NARTH (2009), the researcher protested the APA’s statements against homosexual reparative therapy. While the APA discourages it, the researchers in this article protest that sexual orientation therapy can actually be successful if the client is self-determined to do so and that homosexuals should be allowed to seek professional help if they desire to live a heterosexual lifestyle. It was found that through methods such as behavioral therapy (i.e. aversion therapy), cognitive therapy, systematic desensitization, classical conditioning, group therapy, sex therapy, religious therapy, hypnosis, and psychoanalysis, about one third of homosexuals can switch their sexual preference. In regards to psychoanalysis, Freudian literature explained how by discovering childhood traumas, issues with homosexuality in the present can be changed. Researchers thus concluded that homosexuals can change to become heterosexual because homosexuality is a developed and learned behavior.


This study by {Kelly K. Kinnish et al, 2005} was designed to discover if there were sex differences in the flexibility (i.e., change over time) of sexual orientation. “Retrospective, life-long ratings of sexual orientation were made by 762 currently self-identified heterosexual, bisexual, and gay men and women, aged 36 to 60, via a self-report questionnaire.” The study found “significant sex differences in reported change in orientation over time for gays and heterosexuals, with women reporting greater change in orientation over time than did men.”


In this experiment “Mostly Heterosexual and Mostly Gay”, {Zhana Vrangalova et al, 2012} explored the nature of the sexual orientation continuum by focusing on three sexual orientation components: sexual orientation identity, sexual attraction, and sex partners. The goal was to assess the adequacy of the traditional three identity labels (heterosexual, bisexual, and gay/lesbian). Results showed that the two added labels (mostly heterosexual and mostly gay/lesbian) were frequently chosen by the participants and/or showed unique patterns of attractions and partners. Furthermore, those who reported an exclusive label were not necessarily exclusive in other components: some reported attraction and/or had partners of their non preferred sex.  Lastly it was found that having more same-sex sexuality did not necessarily imply having less other-sex sexuality, and vice versa.


In this article Polyamory, Monoamory and Sexual Fluidity {Melissa H. Manley et al, 2015} “explore[d] how polyamorous and monoamorous individuals experience their relational identity, sexual identity, sexual attractions, and romantic and sexual partnering over time” (3). In this longitudinal study, the results indicated that 34% of the participants reported some kind of sexuality shift. “Polyamorous individuals were more likely than monoamorous participants to identify their sexuality in nonpolar and nontraditional ways” (1). “Sexual attraction shifts were most common among gender-nonexclusive (‘bisexual’) attractions, and particularly likely among polyamorous women” (5). 


In the legal testimony of {Michelle Cretella}, M.D. she discusses the fact that change is possible. Since “decades of research and clinical experience confirms that homosexuality is not a biologically determined trait,” then it is the “environment…that plays a major role in forming one’s sexual orientation (page 3).” Furthermore, the APA “acknowledges the existence of sexual fluidity” in which one’s orientation develops and changes during their life. She quotes Dr. Neil Whitehead who stated, “About half of the homosexual/bisexual population (in a non-therapeutic environment) moves towards heterosexuality over a lifetime (page 5).” Similarly, in a therapeutic environment, success rates for change are somewhere between 20-50% and they are similar to success rates of other behavioral challenges such as drinking problems and for criminal behavior. 


In “Hope and Homosexuality,” Sutton, et.al. section on possibility of change, {Sutton et al.discuss the possibility of change. The authors document that sexual orientation is fluid and doesn’t necessarily remain stable over a lifetime. They note that while some people experience spontaneous change without any professional intervention, others seek out therapy with the goal of change. Through such therapy “approximately 30% of motivated patients can achieve a change in orientation. Furthermore, an additional 30% are able to remain celibate or eliminate high-risk behavior (page 34).”


In “Adolescent Sexual Orientation: Surprising Amounts of Change,” {Neil Whitehead} proposes that the assumption that adolescent same-sex attraction will always become adult same sex attraction is quite incorrect.  Data from the large USA ADD-Health survey (Savin-Williams and Ream, 2007) confirm that adolescent homosexuality/bisexuality both in attraction and behaviour undergoes extraordinary change from year to year. Much of this could be experimentation. The changes are overwhelmingly in the direction of heterosexuality, which even at age 16-17 is at least 25 times as stable as bisexuality or homosexuality, whether for men and women. That is, 16 year olds saying they have an SSA or Bi- orientation are 25 times more likely to change towards heterosexuality at the age of 17 than those with a heterosexual orientation are likely to change towards bi-sexuality or homosexuality. Under the most extreme conservative assumptions heterosexuality is still 3x more stable for men and 4x for women. Whitehead concludes that “clinical samples of homosexual/bisexual people who find change nearly impossible, may well be expressing what is valid for them, but their experience does not at all reflect the norm in society.”



James Phelan, MSW, Psy.D., {Phelan} did an extensive review of the literature on successful sexual orientation change through various forms of psychotherapy including psychoanalytic, cognitive-behavioral, group therapies, sex therapies hypnosis pharmacology and various other modalities. He includes a chapter on Met-analysis and syntheses of results.  His conclusion chapter reviews the results of his survey and argues against the APA’s political stance against such treatment. “This is a comprehensive review of the literature documenting successful outcomes of therapeutic efforts aimed at changing client’s homosexual behaviors, attractions, identification, and/or feeling to various degrees of heterosexual adaptations. Having reviewed many reports, the author has attempted to include a discussion of measurements used, types of treatment or modality of treatment used, sample size, and identification of outcomes, for each one, whenever possible. Outcome, or success rates, in these cases, have generally been defined by a shift in homosexuality toward heterosexuality either through self-reporting, or through different paradigms and approaches have been applied to yield various outcomes”(from the introduction) (page 1).


{Savin Williams et al, 2007}  A nationwide, six-year study of over 12,000 adolescents and young adults showed non heterosexual attraction and behavior have lower chances of stability across time, damaging the notion of homosexuality as a stable trait.  The authors suggest doing away with the concept of sexual orientation and instead measure the components of orientation: attraction, behavior, and identity.


 {William Stanus ThesisStanus (2013) conducted open-ended interviews on 5 men (ages 22 to 44) with unwanted Same Sex Attraction (SSA) undergoing reparative therapy to assess the experience those men had during the process. The interviews were concurrent with their therapy, and participants volunteered to partake in them. Some interviews were conducted by telephone, the others were done face-to- face. In accordance with the researchers’ hypothesis, this study showed that the experiences of clients undergoing reparative therapy can be positive, and change from SSA to a more heterosexual lifestyle can be possible. Two techniques were used in the therapy sessions and were found to be extremely helpful as reported by the participants: Body Work (the exploring and repairing of past traumatic experiences) and Eye Movement Desensitization Reprocessing, or EMDR (the changing of addictive perceptions on homosexual actions; i.e. gay porn becomes a chore rather than a desire). Eleven important themes were discussed regarding the reparative process and the healing of a masculine identity: 1) emerging sources of concern (SSA, interest in gay porn, presence of a gay identity), 2) spiritual integrity, emotional health, and unexpected attractions (the reasons for a rising concern with SSA), 3) Body Work and EMDR (forward shifting strategies), 4) moving past shame (shame is a huge source of contribution to SSA), 5) trusting and relating men to women (the shift of creating friendships with men and attractions to women), 6) a painful disconnect (masculine identity and family-father figure- searching), 7) productive relationship with therapists (positive therapy experience), 8) feelings about self, connection, abuse, and masculine development (confidence of the healing process), 9) awareness and masculine growth (recognition where SSA came from), 10) legitimacy of therapy (clients believe it should be available to all who desire the help), and 11) the significance of talking in therapy (the idea that more should be done with this field. The main focus of many of the themes is on the origins of SSA, and where to go from that point of recognition. Researchers concluded that reparative therapy can lead to positive change and that clients have a right to seek professional help if they do not have a sexual orientation aligned with their sexual identity whether the identity is influenced by a marriage, religion, concern for mental health, or other reasons. This study shows that with goals tailored to the client, change is possible, and banning that opportunity for change would be distressful to the unwanted SSA community.


{Berger 1994} This paper, written in 1994, discusses the controversial topic of the etiology and treatment of male homosexuality. Despite the fact that many experts deny the existence of successful treatment outcomes, results do show that some people who have experienced homosexual fantasies, behaviors, or self-identification can become comfortably and satisfyingly heterosexual after receiving psychotherapy. This is due, in part, to the idea that sexuality can vary on a continuous spectrum as it is affected by different psychodynamic influences. One such factor not commonly discussed in the literature is the abortion of a pregnancy caused by a male patient, which may have led to a self-declaration of homosexuality. Therefore, young people should have the opportunity to explore their sexual identity with a therapist before “coming out” as homosexual.


{Byrd & Nicolosi 2002} Byrd and Nicolosi (2002) performed a meta-analytic review of 14 studies of the treatment of homosexuality. Of the 146 studies identified, the 14 chosen studies met the following criteria: treatment of homosexually identified males, the modality must be some form of psychotherapy, outcomes must be stated in terms that can be represented as effect size (ES) estimates, and must be written in English. The studies ranged in date from 1969 to 1982 and, save one that used a psychodynamic approach, they utilized behavioral techniques. Before and after treatment, the participants completed both self-report and various physiological measures of sexual arousal. The average client had better symptom reduction than 79% of control groups. The more rigorous studies reported significant but lower ES. Ultimately, the studies lacked specificity regarding the treatment factors, calling for the need for more rigorous research. However, these studies did show that clients can change symptomatically over the course of therapy (but whether or not symptomatic change equals orientation change is unknown). The analysis also revealed that the rate of change for homosexual symptoms is similar to that of treatment of adults for other general issues like depression and anxiety.


{Harris 2001} In this paper (2001), Harris attempts to address the needs of the Christian struggling with same-sex attraction using excerpts from current literature. He advises the counselor to hold a deep conviction that homosexuality can be overcome and to build a committed relationship with the client. The author also addresses the client’s desire for change and recovery and presents them with ten facts about homosexuality. He furthermore highlights the importance of sound emotional and social development in infancy and childhood, and points to homosexuality being linked to a disordered early emotional development. Lastly, in terms of change, he proposes reorientation therapy to diminish the external behavioral outlets that reinforce homosexuality and reminds the struggling Christian that recovery can be a process.


{Nicolosi, Byrd & Potts 2000} In this study Nicolosi and Byrd survey a group of dissatisfied homosexual people to examine whether these survey participants believed their past experiences of conversion therapy were helpful in reducing their unwanted homosexual behavior and attractions. Paper copies of the survey were delivered to ex-gay ministries and conversion therapists and clients identified through personal acquaintance with the first author or through the membership directory the National Association for Research and Therapy on Homosexuality (NARTH) and participants mailed completed surveys to the first author who received responses from 882 people, both men and women. Although results of the survey cannot be generalized beyond this sample, the authors conclude that the data (1) documents the existence of a group of homosexual people who are dissatisfied with their sexual orientation, the majority of whom perceive that conversion therapy has benefited them psychologically, interpersonally, and spiritually. Nicolosi and Byrd conclude that conversion therapy is not appropriate for all clients and that the change process involved in this therapy is long and difficult. Nevertheless the authors argue that conversion therapy should continue to remain an option for those clients who decide that this type of therapy aligns best with their beliefs and values.


{Schaeffer et al, 2000} Survey research was conducted between the years of 1993-1995 to examine the success of 248 individuals (184 males, 64 females) attempting to change their sexual identities from homosexual to heterosexual because of their religious beliefs. All individuals surveyed were participating in conferences with Exodus International, a religious organization that aims to help the homosexual Christian. The results of the study show that these individuals experienced a change of sexual orientation associated with a high degree of religious motivation and positive mental health. Religious motivation was found to be a predictor of current sexual orientation. No evidence was found to support the effectiveness of therapy in changing sexual orientation.


{Schaeffer et al, 1999} This article (Schaeffer et al., 1999) summarizes the follow-up research to the initial study conducted on individuals attempting to change their homosexual orientation because of religious convictions. Of the original 248 participants, 140 individuals (102 males, 38 females) were surveyed regarding their homosexual behaviors in the year following the initial study. The results of the survey indicated that 60.8% of males and 71.1% of females were behaviorally successful in their change (success was defined as having abstained from any type of physical homosexual contact). Those who were considered successful also showed strong religious motivation and positive mental health. The majority of those who were not successful (88.2%) were still attempting to achieve a change in sexual orientation, which suggests that these individuals still believed that reorientation was possible.


As have past reviews, recent reviews “of the large body of psychotherapy research, whether it concerns broad summaries of the field of outcomes of specific disorders and specific disorders and specific treatments” lead to the conclusion that, while all clients do not report or show benefits, “psychotherapy has proven to be highly effective” (p. 176) for many clients. Unfortunately, research “literature on negative effects” also offers “substantial…evidence that psychotherapy can and does harm a portion of those it is intended to help.” These include “the relatively consistent portion of adults (5% to 10%) and a shockingly high proportion of children (14% to 24%) who deteriorate while participating in treatment” (p. 192). {Lambert, M.} (2013). The efficacy and effectiveness of psychotherapy. In Michael J. Lambert (Ed.) Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change (6th edition), pp. 169-218. Hoboken, NJ: Wiley.


{Spitzer} This study investigates the current, popular claim that even if overt homosexual behavior changes following therapy, sexual orientation itself remains unchanged. Spitzer (2003) conducted structured phone interviews with 200 participants (143 male and 57 female) who responded to ads in various ex-gay ministries (43%), the National Association for Research and Therapy on Homosexuality (23%), referrals from participants’ former therapists (9%), and referrals from other counselors and organizations (25%). This study defines “therapy” as any help received for the purpose of changing sexual orientation and “sexual orientation” was operationalized by measures of attraction, arousal, fantasy, yearning, and being bothered by homosexual feelings. The structured phone interview included 114 closed-ended questions and several open ended questions encompassing 13 different measures of sexual orientation both pre- and post-therapy. Results indicate that some homosexual men and women experience some change in sexual orientation following therapy and that homosexual women experienced significantly more change than homosexual men.


{Tanner 1973} Tanner (1972) evaluated the modification of homosexual behavior in 26 males who were randomly assigned to either a 5-mA shock group or a self-assigned current level group.  Individuals were evaluated for outcome scores, number of sessions attending by level of stimulation, fear rating and drop-out rate, as well as fear rating and self-selected level of shock in the current level group. Participant total outcome scores indicated that aversive learning improves at higher shock intensity. It seems that more than minimal aversive stimuli are needed to lead to more effective learning.  However, there was no significant difference in number of sessions attended based on shock level. Fear did appear to significantly impact attendance to subsequent sessions. A limitation of this study includes the small sample size and limited statistically-significant findings.


{McConaghy 1976} McConaghy (1976) explored whether homosexual orientation is reversible, utilizing different forms of aversive therapy or positive conditioning procedures. Sexual orientation was determined by measuring penile volume responses to moving pictures of nude men/women. This method was introduced by Freud (1963) as a method of assessing male sexual orientation. 157 homosexual patients treated with various forms of behavior therapy in four studies.  Sexual orientation was measured prior to treatment and after the treatment of either apomorphine therapy, aversion-relief, avoidance conditioning, classical avoidance, positive conditioning, or backward conditioning. Individuals then completed follow-up interviews at six and twelve months after treatment to evaluate orientation change in that time. 25% of participants reported that all forms of treatment contributed to definite increase in heterosexual feelings. Aversive therapies reportedly led to reduced homosexual feelings and behavior in half of participants who received that therapy. In study 4, 25% of participants indicated definite reduction in homosexual feelings due to positive reinforcement. Sample sizes in all study were small. The measured sexual orientation of homosexual clients was significantly different from that of heterosexual patients receiving aversive therapy for sexual anomalies. It was hypothesized that increases in heterosexual feelings and behaviors were due to a placebo effect, because there was no change in penile volume responses after the treatments. Conclusions drawn from the studies indicate it is unlikely that the aversive therapies altered sexual orientation.


{Bancroft 1969} Bancroft (1969) examines the effectiveness of aversion therapy in treating 10 homosexual men who had expressed a desire to change homosexual orientation to heterosexual orientation. The experiment consisted of 30-40 sessions (1-1.5 hours each) in which each subject received electric shocks whenever he experienced an erection while viewing pictures of males and imagining erotic homosexual fantasies. An additional method was used for 3 of the 10 subjects in which shocks were contingent on the presence fantasy not the presence of an erection. Treatment and follow up interviews up to two years post treatment indicated a significant reduction in – but not absence of – homosexual interest and behavior in the short term but only minimal evidence of lasting, long term change. Because these results did not produce lasting change as behavior modification techniques with animals have tended to, Brancroft concludes that it may be more helpful to consider these results and future similar research in terms of attitude change rather than behavior change.


{Kendrick & McCullough 1972} Kendrick & McCullough discuss the method and outcomes of a particular behavior modification technique used to treat a 21-year- old male interested in shifting his sexual interest from males to females. Treatment included weekly sessions that lasted for a period of 56 days consisted of two phases and focused on decreasing homosexual urges and increasing heterosexual urges. In Phase I the subject imagined himself in a heterosexual activity and this image was then being reinforced with a homosexual fantasy. In Phase II homosexual fantasies were paired with nausea and heterosexual imagery was paired with highly reinforcing non-sexual imagery. At 2 and 3- month follow-ups post treatment the subject reported fewer homosexual urges and more positive heterosexual interactions, leading the authors to conclude that using homosexual imagery to reinforce heterosexual imagery may be useful in some cases.


{Larson 1970} This paper (Larson, 1969) describes the method and results of applying anticipatory avoidance learning to the Feldman and MacCulloch approach to the treatment of homosexuality. The adapted approach was tested on three clients in a university counseling center. The adapted method began with a discussion with clients involving the goals and technique that will be used in therapy. It then proceeded with the presentation of an attractive male photograph, followed by an electric shock if the client failed to remove the photograph within 8 seconds. Once the photograph is removed, the electric shock ceases and the photograph of an attractive female is introduced. Of the three clients tested with this modified procedure, all three reported immediate results of a decrease in homosexual interest, fantasy, and behavior. These results seem to demonstrate that this adaptation to the Feldman and MacCulloch approach to the treatment of homosexuality is still maintaining the desired effect.


{Huff 1970} This case study was conducted by F. Huff in 1969 and is an example of the use of desensitization therapy for treatment of a homosexual. The results of the therapy in the case of this 19-year- old male demonstrated that desensitization to his irrational fear of the female sex opened the way to an appropriate heterosexual adjustment. His lack of interest in and fear of women seemed to have some roots in the relationship he had with his then-deceased mother. For the method of therapy, a hierarchy of anxiety to physical intimacy with women was established. Deep muscle relaxation techniques were also taught. Desensitization was then started, beginning with the lowest anxiety-producing situation on the hierarchy, and then working up towards the highest anxiety-producing situation over a span of several sessions. The client was also asked to keep a daily record of his sexual behavior, preoccupations, and fantasies. In this case, the client’s aversion and fearful perception of women was desensitized; when the approach value of women became greater than their avoidance value, he began to feel less homosexual and more heterosexually aroused. His therapy sessions can be deemed successful because the client’s self-concept and ideal self-concept became more alike.


{Gray 1970} A case study of a young man with exclusive homosexual arousal but in a nearly asexual relationship with a girlfriend (who had her own anxiety about sex) demonstrated the three main factors of homosexuality to be attraction toward the same sex, anxiety associated with the opposite sex (especially in sexual situations), and general interpersonal anxiety (Gray, 1970). After a comprehensive behavioral therapy program over 21 sessions, his heterosexual arousal developed and increased while his same-sex attractions decreased significantly and were less upsetting. The behavioral techniques employed included switching from male to female fantasy while masturbating just before climax, thinking about men he otherwise found attractive when in a non-aroused state (to shift his association to them), mentally undressing women and reading erotic literature, and gradual flooding by increasing proximity to his girlfriend while lying in bed together and consciously focusing on arousing himself (this led to them spontaneously engaging in intercourse for the first time in three years of dating, which they continued to repeat). Beyond the aftercare self-appraisal of sexual attraction and activity, no long-term follow-up was reported.


{McConaghy et al 1981} McConaghy et al. (1981) begin their article discussing the methodological and ethical objections to the use of behavior therapy in homosexuality, particularly aversive therapy. The ethical objections to behavior therapies in homosexuality are often based on misconceptions of the aims of therapists using them. More often than not, therapists are not conducting the therapies because they view homosexuality as “bad”, but rather because their patients are requesting it and they believe that it is unethical to deny them treatment. Despite this, there is still a need to evaluate the use of aversive therapy in homosexuality. The yearlong study conducted by the authors examined twenty subjects who requested behavior therapy to reduce their homosexual compulsions. Half were randomly allocated to receive aversive therapy using electric shocks, while the other half were selected to receive covert sensitization treatment. At the end of the year period, the findings showed that one therapy was not more effective than the other in reducing the strength of compulsive homosexual urges, and that the subjects’ responses were similar to those reported in previous studies. Both therapies were found to reduce aversive arousal produced by behavior completion mechanisms when subjects attempted to refrain from homosexual behavior in situations that had repeatedly provoked such behavior in the past. It did not establish a conditioned aversion or alter the subjects’ sexual orientation.


{McConaghy & Barr 1973} McConaghy and Barr conducted a study in the early 1970’s in which they randomly allocated 46 patients to receive a different model of aversive therapy: classical, avoidance, or backward conditioning. The methods included showing the patients slides of nude women preceded by a red circle and of nude men preceded by a green triangle, and they were also conditioned to tones followed by painful electric shocks. Their galvanic skin and penile volume responses were measured during all procedures. After the first round of treatments and the subsequent booster follow up treatments, it was found that there was no significant difference in the effectiveness of the three treatments. Approximately half of the patients reported a decrease in homosexual feeling, half reported an increase in heterosexual feeling, a quarter reported an increase in heterosexual intercourse, and a quarter a cessation of homosexual relations.


{James 1962} Basil James reports to the British Medical Journal (1969) of the case of a homosexual male treated by aversion therapy. The subject was a 40-year- old male who had reported homosexual desires and practices since the age of 15. He greatly desired to alter his sexual orientation, as his behavior and relationships with others had become negatively affected by his efforts to repress his homosexuality, to the point of attempting suicide, and no treatments had worked. The method of aversion therapy performed on him consisted of using a controlled mixture of drug and alcohol to produce a feeling of nausea while being shown photographs of attractive nude males and being asked to describe his homosexual fantasies. He was also played a tape explaining the origin of his homosexuality and how his behavior was “sickening”, followed by the sounds of vomiting. After a few days of this treatment, the patient was then awakened every two hours during the night and a tape was played explaining in positive and congratulatory words, how his behavior would be if his homosexuality were reversed. He was then shown photographs of sexually attractive young women, given an injection of testosterone, and asked to retire to his room when sexually excited. As a result of treatment, the patient reported a positively altered demeanor, no same-sex attraction, and entirely heterosexual fantasies and practices. He describes himself as happy and successful, and his family and friends are in accordance. The results of his “cure” fulfill the criteria as defined by Hadfield (1958) and can be attributed, in part, towards the patient’s desire to change.


{James 1963} A follow-up was conducted 18 months after treatment of the man who received aversion therapy treatments for homosexuality. After interviewing the patient, his family, friends, and supervisors, he shows no recurrence of homosexual desires or behavior and is in a steady heterosexual relationship with satisfactory sexual relations. His family relationships are reported as “extremely good” and he has regained their trust. He his highly thought of at his place of employment and is set to receive a promotion. His self-confidence has remained high and there has been no recurrence of suicidal ideations or attempts. In summary, the patient has maintained heterosexual tendencies and well-adapted social behaviors.


 {Rosario et al, 2011} Rosario, Schrimshaw, & Hunter (2011) explores patterns of sexual identity development in LGBT youth, as it relates to psychological adjustment. This was a longitudinal study of 156 youth (ages 14-21) in New York City. Drawing from Erikson’s stages of identity development, identity integration is the acceptance of an unfolding identity, continuity over time and settings, and a desire to be known by others as such. The opposite of this, identity diffusion or confusion, is a sense of self as other or inauthentic, either by assuming an invalid identity or by searching for a meaningful identity. The study evaluated formation and integration of a LGB identity by way of milestone events, including first awareness of same-sex attraction and first same-sex sexual behavior, involvement in LGB-related activities, positive attitudes towards homosexuality, comfort with others knowing about one’s homosexuality, disclosure to others, as well as psychological adjustment by way of psychological distress and self-esteem. Measured covariates included negative social relationships, gay-related stressful life events, and social desirability. Level of Sexual Identity Integration was clustered into three groups, High integration, middling integration, and low integration. Greater identity integration, and not timing of identity formation, was found to be related to less depressive and anxious symptoms, fewer conduct problems, and higher self-esteem, even after controlling for potential covariates. Youths with greater family and friend support experiences less depressive symptoms, friend support was associated with fewer conduct problems, and family support was related to higher self-esteem. Those who experienced gay-related stress reported more anxious symptoms. Those who identified as gay or lesbian were less likely than those who identified as bisexual to show consistently low identity integration over time. Changes in individual-level identity integration were found to be associated with changes in adjustment over time.


{Francis 2008} Francis (2008) draws from a nationally representative sample (Add Health, 2003) of young adults to identify family-demographic correlates of sexual orientation in men and women, in order to test the maternal immune hypothesis. The maternal immune hypothesis indicates that a woman’s immune system observes the number of male fetuses and, with each male child, responds differently, impacting the sexual differentiation of the male brain. Thus, with each successive male child, it is hypothesized that it is more likely that a male child will experience same-sex attraction. The relationship between male sexual orientation and multiple older brothers is not significant. Identifying as “not 100% heterosexual” is significantly negatively correlated with having one older sister or multiple older sister, meaning that one is less likely to identify as “not 100% heterosexual” when he or she has multiple older sisters. Growing up without a biological parent is positively associated with homosexuality in both men and women. Identifying as black and less education in high school is positively associated with homosexual behavior and desire in men, whereas college education is positively related to homosexual identity. In women, being black or other race is negatively related to female homosexual desire and identity, while graduating from highschool is positively related. Findings indicate that other factors beyond the maternal immune hypothesis may be related to the development of sexual orientation, including family structure, race, and education, indicating that biological and social mechanisms appear to play a role.


{Hines et al, 2004} This study evaluated the core gender identity, sexual orientation, and recalled childhood gender role behavior in 50 subjects between the ages of 18 and 44:16 women and 9 men with congenital adrenal hyperplasia (CAH) and 15 unaffected female and 10 unaffected male relatives. Using a 10-item questionnaire, participants were asked about their core gender identity and sexual orientation for both their lifetime and the past 12 months. They were also administered the Pre-School Activities Inventory to retrospectively describe their childhood behavior and play interests. Consistent with prior studies, the results of this study found that women with CAH recalled significantly more male-typical play behavior as children, less satisfaction with their assigned female sex, and less heterosexual interest than did unaffected women. Males with CAH, on the other hand, did not differ significantly in these respects. These findings suggest that girls with CAH who show more childhood male play behavior may be the most likely to be dissatisfied with their female sex assignment and develop a bisexual or homosexual orientation as adults.


{Karten & Wade, 2010} The current study aimed to analyze the psychological and social characteristics of 117 men dissatisfied with their same-sex attraction who had sought sexual orientation change efforts (SOCE). Additionally, the study explored the motivation of the participants in seeking SOCE and which therapeutic interventions and techniques they found to be most and least effective. The researchers reached out to SOCE organizations to find willing participants, who completed questionnaires regarding the above points as well as their past and current sexual feelings and behaviors. The results demonstrated that being married, feeling disconnected with other men prior to seeking help, and reduced conflict in expressing nonsexual affection towards other men were positively correlated with reported positive change. Contrary to the authors’ hypotheses, intrinsic religiosity and a heterosexual identity were related to reports of not changing one’s sexual feelings and behavior. In terms of most and least helpful therapeutic interventions, participants rated the most helpful sexual orientation change interventions to be a men’s weekend/retreat, a psychologist, a mentoring relationship, understanding better the causes of one’s homosexuality and one’s emotional needs and issues and developing nonsexual relationships with same-sex peers, mentors, family members and friends.


{Jones & Yarhouse, 2011} Jones & Yarhouse (2011) is a 6-7 year naturalistic, quasi-experimental longitudinal study exploring the  attempted religiously mediated sexual orientation change of 72 men and 26 women who were involved in a variety of Christian ministries through Exodus International. Over the course of the study, the retention rate was 64%. This study addresses whether sexual orientation is changeable and whether the attempt is harmful for those who pursued it. Strategies to effect change within these groups included prayer, discussion, worship, and education. Measures of sexual orientation included the 7-point self-report Kinsey scale, the Shively and DeCecco scale, and the SCL-90-R to assess psychological distress. Indiviuals were organized into 1 of 6 qualitative outcome categories, including Success: Conversion, Success: Chastity, Continuing, Nonresponse, Failure: Confused, and Failure: Gay Identity. Findings indicated that change of homosexual orientation appears to be possible for some and that psychological distress did not increase on average as a result of involvement in the change process. Between Time 1 and Time 3, there was a reported decline in average homosexual fantasy, and then a plateau between Time 3 and Time 6. These statistically significant changes for modest. There was some shift in the population away from homosexual experience and toward heterosexual experience. Many subjects made no significant shift as a result of Exodus involvement or shifted in the opposite direction of what was valued by Exodus. More individuals experienced a shift toward heterosexual experience (n = 31) than did those who experienced either no shift (n = 8) or a shift towards homosexual experience (n = 22) for attraction, and positive shift (n = 32) versus no shift (n = 11) and negative shift (n = 17) for fantasy. Modest improvement in overall distress symptoms were measured. The group that grew the most over the course of the study (T1 to T6) was the group that can be categorized as Failure: Gay identity. Those that showed greatest stability of outcome T3-T6 in absolute terms were the Success: Chastity (n = 16) and Continuing (n = 15). The largest shift from T3-T6 was from Success: Chastity to Failure: Gay Identity. 53% of the T6 sample that self-categorized did so as some version of success, either as Success: Conversion (23%) or Success: Chastity (30%). At T6, 25% of the sample self-categorized as a failure by Exodus standards (Confused or Gay Identity).


{Elmore 2002}  The author presents the case of a 53-year- old white male homosexual who had engaged in ego-dystonic homosexual activity since his youth. While seeking treatment for depression, anger, and irritability, he was prescribed 20 mg of fluoxetine (Prozac) twice a day for dysthymia. He found that the fluoxetine suppressed his sex drive, and coupled with his desire to avoid homosexual activity, he ceased to engage in the active gay lifestyle that he had been leading. Years later, he reduced his fluoxetine dosage for three weeks, but found that his homosexual thoughts and urges returned. SSRIs (selective serotonin reuptake inhibitors) have been found to decrease sexual activity in men and women, as seen in this case. However, other factors could very well have also contributed to this outcome, such as his strong motivation to abstain from homosexual activity, the natural decrease in sexual intensity with age, and his recovery from depression.


{Byrd & Olsen 2002} Byrd & Olsen (2002) explores question of whether homosexuality is medically or psychologically harmful, can be “cured”, or whether it is an immutable biological trait, or it is a product of one’s environment. Levay (1991) indicated differential size of the hypothalamus INAH3 region in nineteen homosexual men when compared to sixteen heterosexual men. It was critiqued for its small sample size, post-mortem sampling, and poor generalizability. Bailey & Pillard (1991) explores the incidence of homosexuality in identical twins, non-identical twins, and regular siblings, drawing from fifty-six sets of identical twins and fifty-five sets of non-identical twins. For every homosexual twin, the chances were about 50% that his twin would also be homosexual. For non-identical twins, the rate of concordance was 22%. The concordance for non-twin brothers was only 9.2%. Hamer et al., (1993) found that 33 of the 40 participants (83%) received the same sequence of markers within the studied region of the X chromosome. This was indicated by Hamer to mean that 33% more homosexuals had a particular sequence of genes than the sample of the heterosexual population. The effect of prenatal hormonal influence was also explored, but studies have not overwhelmingly indicated significant differences in hormonal levels between homosexuals and heterosexuals. While homosexuality appears to be traced, in part, to one’s genetic makeup, genetic traits do not determine whether a person will use the traits he or she has been given. A combination of many factors appear to contribute to male homosexual development, including feelings of being different from other children, parent, sibling and peer relationships, premature introduction to sexuality, and gender confusion. Gender nonconformity and gender atypical behavior is the most common observable factor associated with homosexuality. NARTH studies were cited which offered information regarding perceived meaningful shifts in sexual attraction over the course of therapy by both clinicians and clients. Studies were also presented which revealed associated risk factors with homosexuality including increased risk of  decreased life expectancy, suicide, incest, AIDS, and psychopathology. 


{Nicolosi 2014} Dr. Nicolosi’s article highlights the need for the American Psychological Association (APA) to advocate for the homosexual client who does not wish to claim a gay identity. He presents the case as to why certain individuals with homosexual tendencies may be motivated to become heterosexual and how therapy has worked for them, but how, over the years, the APA has discredited the effectiveness of sexual orientation change therapies. Through the use of testimonies and professional opinions, he clearly underlines the need for the APA to adopt a true spirit of inclusion based upon ethics and the client’s right to determine his own therapeutic goals and not based on political correctness.




Chapter 8: Treatment Harm

The D.C. Catholic Conference testimony by {Michael Scott} in opposition to the Conversion Therapy for Minors Prohibition Amendment Act of 2014. They contend that such an act violates free speech and parental rights. The Act defines “sexual orientation change efforts” to mean “a practice by a provider that seeks to change a person’s sexual orientation, including efforts to change behaviors [or] gender…expression.”  The Conference has concern that this definition may go beyond the Act’s intent and, rather than merely addressing sexual orientation change efforts, may also prohibit simple speech regarding what a religion teaches about human sexuality. For example, the Act could be read to prohibit the counselor from answering a question on Church teaching that might cause a student to change behavior”. The Church stresses that “Parents should also have recourse to specialists with solid scientific and moral formation in order to identify the causes over and above the symptoms [of same-sex attraction], and help the subjects to overcome difficulties in a serious and clear way.” The Conference believes that the proper oversight of psychological care resides with mental health professionals rather than city officials, who should not infringe on physician-patient relationships. 


In the article  “Moving Back to Science” {Christopher Rosik et al, 2012} critique a commentary by Adrienne Dessel regarding sexual orientation change efforts (SOCE). They first begin by discussing the APA task force which said “there is little in the way of credible evidence that could clarify whether SOCE does or does not work in changing same-sex attractions” (1). While Dessel opposes such a therapy, Rosik and Byrd wish she could consider the traditionally religious worldview that motivates some to pursue SOCE. Rosie and Byrd recommend Haidt’s moral foundation theory to mental health professionals and social workers like Dessel. This theory “integrates anthropological and evolutionary accounts of morality to identify and explain the standards by which liberals and conservatives formulate their moral frameworks” (2). If mental health professionals can understand this theory, then people who seek SOCE have a better chance of having their motivations and morals understood correctly by others. Rosik and Byrd claim that Dessel avoids addressing the traditional viewpoint of homosexuality. They conclude that “though Dessel is an advocate for the GLB clients with whom she works, it is important to understand that science only progresses by asking questions, not by avoiding those questions whose answers might not favor a particular group” (2). 


“Laws Banning Sexual Orientation Change Therapy are Harmful” is a lengthy summary put out by {Family Watch International} of a policy brief, which aims to outline the value of SOCE. The main points addressed in the brief are: 1. This type of therapy can influence a person’s sexual orientation. 2. There is no research showing that SOCE is more potentially harmful than any other psychotherapy. 3. Banning SOCE would be harmful to adolescents. It would further victimize those who had been sexually molested (and for that very reason became confused about their sexual orientation or developed SSA). 4. Banning SOCE would be a serious violation of fundamental human rights. If someone has unwanted SSA, they shouldn’t be forced to go to Affirmative Therapy. They should have the freedom to choose to seek change. “There is no ethical or scientific basis for limiting or banning therapy that has helped countless people with unwanted same-sex attraction (page 1).”


{Sutton 2} In critiquing the Shidlo and Schroeder 2002 study, upon which SOCE opponents primarily derive their claims of harm, Sutton argues that medical and mental health professionals would not prohibit a specific treatment approach based on the kind of insufficient and questionably acquired evidence the study offers.  Participants for the retrospective, subjective interview were recruited by the National Lesbian and Gay Health Association for a project explicitly meant to document the damage of “homophobic therapies.”  Participants recollected treatment from an average of 12 years prior to the study, and they reported that approximately one third of the administering providers were not licensed professionally trained practitioners, and the study did not specify which types of harm were associated with which type of clinician.  The claims of harm were dubious and uncorroborated, though still actually showed pre-existing suicidality that the providers helped manage.  Prohibiting SOCE even to individuals freely seeking it, may cause more harm as they may continue in risky sexual behavior and self-harm.  Alternatively, the International Federation for Therapeutic Choice and NARTH have developed the Practice Guidelines for the Treatment of Unwanted Same-Sex Attractions and Behavior, which minimizes potential for harm, enhances helpfulness, and honors the client’s right to self-determination, which are ethical principles all mental health associations claim to hold.  They additionally call for more extensive research which includes interviews with SOCE therapists and analysis of sessions by independent third parties.



In this article The Ideological Lion’s Den, {Andre Van Mol} responds to California’s ban on therapeutic sexual orientation conversion efforts (SOCE) involving minors. Mat Staver of Liberty Counsel warned, “This law intrudes on the fundamental right of self-determination to seek counseling that aligns with the client’s religious and moral values.” Decades of studies meeting the scientific standards of their time showed positive results of sexual orientation change efforts (SOCE) for those who wish it.    Homosexual practice itself leads to many well documented health hazards, including the loss of 25-40% of life expectancy with higher rates of infectious disease, cancers, substance abuse, depression, anxiety, multiple psychopathologies, domestic violence, and suicide. The modern move to change the professional view of change came when the American Psychiatric Association through the efforts of its GLBT faction decided in 1973 to delete homosexuality from the Diagnostic and Statistical Manual, thereby rejecting it as a disorder. Mol reviewed the evidence against the “born that way” theory. Psychologist Nicholas Cummings, as Kaiser Permanente HMO’s Chief of Mental Health, estimated that during his tenure 16,000 clients presented at Kaiser facilities with conflicts over their homosexuality. Dr. Cummings stated 67% had good outcomes, with 20% being successful in reorientation, with the remaining 80% “pursuing sane, sexually responsible gay lives.” He observed, “There are as many kinds of homosexuals as heterosexuals. Homosexuality is not a unitary experience,” and “. . . our clinical experience contradicts efforts to reduce homosexuality to one set of factors.” According to Dr.  Cummings, “Given the state of research, the APA should not reject the possibility that sexual orientation might be flexible for some.


{Christopher Rosik} Rosik (2012) conducted a study to disprove a statement made by Senetor Ted Lieu basically stating that allowing a therapist to begin Sexual Orientation change efforts (SOCE) on a minor is equal to the level of harm drugs and alcohol can produce on a child. The Researcher hypothesized that if banning SOCE for minors is in similar need to banning drugs and alcohol, research in both categories would be equivalent. Rosik simply researched several key words related to drugs and alcohol and minors, as well as SOCE on minors in two well-known databases: PsycARTICLES and MEDLINE. Opposing the scientific basis of Sen. Lieu’s statement, for drugs and alcohol the researcher found over 15,000 publications. However, for SOCE, the researcher only found 4. The researcher concluded that more research needs to be conducted in SOCE before any laws can be put in place banning SOCE in therapy for minors.


{Christopher Rosik 2} Rosik’s critique outlines several apparent biases in the APA Task Force’s (2009) review of the literature on SOCE and provides extensive documentation that change is common for non-heterosexual identities, attractions, and behaviors.  Rosik further examines the literature regarding the dynamics of stigma and discrimination as it pertains to LGB mental and physical health and notes several alternative explanations to minority stress theory that should be considered.  In the conclusion, he states that there is simply not a sufficient scientific basis to ban SOCE for minors or adults and recommends further research as the only scientifically responsible way to address the concerns of critics.


{NARTH #2 – Journal of Human Sexuality} NARTH (2009), discussed that there is simply not enough literature to show that reparative therapy is psychologically harmful. However, there is literature that shows it can be helpful. Researchers discussed that even if there is a 1% chance that a therapy can be helpful, it is worth trying. Therapy should never be recognized as all powerful, meaning that it is not a perfect method to help patients. For example, suicide still occurs after patients have had therapy and 20% of rapists still rape after therapy. Therefore, if some homosexuals remain homosexual after therapy, it should not be ruled that therapy in general is not helpful.


{Joint Therapy Ban Letter 2017} The American College of Pediatricians, the American Association of Physicians & Surgeons, the Christian Medical & Dental Associations, and the Catholic Medical Association present a petition of various valid reasons why legislators must not ban therapy for minors with unwanted same-sex attractions and/or gender dysphoria on the premise of the minor’s right to therapy and the right of licensed professional counselors to provide ethical care. 


Chapter 9: Public Health: Harmful Behaviors Associated with a Gay Lifestyle


{Mayer & McHugh: see part 2} In Part 2 of this study, which evaluates data from over 200 peer-reviewed studies regarding sexuality and gender, it was revealed that non-heterosexuals are at a higher risk for many different mental health problems. They are 1.5 times more likely to experience anxiety disorders than heterosexuals, 2 times more likely to experience depression, 1.5 times more likely to suffer from substance abuse and 2.5 times more likely to commit suicide. There is also limited research which indicates that social stressors, such as discrimination and stigma, can cause these elevated risks for non-heterosexuals, but more longitudinal research must be done in this area. 


{2015 Amicus Brief} (The American Psychological Association, The American Psychiatric Association and The National Association of Social Workers all consented to the filing of this brief.) “For decades, the consensus of mainstream mental health professionals and researchers has been that homosexuality and bisexuality are normal expressions of human sexuality; that they pose no inherent obstacle to leading a happy, healthy, and productive life; and that gay and lesbian people function well in the full array of social institutions and interpersonal relationships (page 8).”


{Mathy et al, 2009} In the 12 years after the legalization of same-sex marriage (registered domestic partnerships; RDP) in Denmark (1990-2001), men in same-sex partnerships were eight times more likely to die by suicide than men heterosexually married (or formerly married) at the time of death.  They were at twice the risk of suicide mortality than men who were never married.  Because Denmark does not record sexual orientation in death certificates, researchers determined sexual orientation by RDP status or existence of surviving or former RDP partners.  The suicide mortality rate in lesbian women was statistically insignificant, which led the researchers to suggest that the difference may be related to the impact of HIV in males.


{Greenwood et al, 2002} One study of 3700 same-sex partnership households in San Francisco, Los Angeles, Chicago, and New York found an increased risk for domestic partner violence (physical, sexual, and psychological/symbolic) in MSM (men who have sex with men) couples compared to heterosexual men and women.  Occurrence of violence in the past five years was 34% for psychological, 22% for physical, and 4% for sexual abuse, whereas studies of heterosexual males show a risk of 7.7% for lifetime physical or sexual abuse. The prevalence of total violence in MSM was even 11.6% greater than comparative studies of women.  MSM age 40 or younger were at six times greater risk for all types of abuse—particularly sexual—compared to MSM age 60 plus.  And men with positive HIV status showed an increased risk of physical and psychological abuse.


In this review and analysis of the literature, “Homosexuality and Comorbidity” {Neil E. Whitehead} compares the behaviors of gay men and heterosexual men. Results show that exclusively homosexual men: have 5 times more sexual partners than heterosexual men, sexual compulsivity is more than six times greater (6.7) than heterosexual men, are nearly three times (2.75) more sexually promiscuous (“out-of-control sexual experience”) than heterosexual men, have been paid for sex (including payment in kind, such as accommodation or food) almost four and a half times more often than (4.4) heterosexual men, engage in partner interpersonal violence three times more often (3.0) than heterosexual men, engaged in the sexual practice of “fisting” fifty five times more often (55) than heterosexual men,
emotionally unstable family backgrounds are suggested by greater emotional and adjustment problems, such as: mood disorders almost three times greater (2.78) than heterosexual men, anxiety disorders almost three times greater (2.83) than heterosexual men, generalized anxiety disorders almost three times greater (2.8) than heterosexual men, panic disorder is more than four times greater (4.21) than heterosexual men, bipolar disorder is more than five times greater (5.02) than heterosexual men, conduct disorder is almost four times greater (3.8) than heterosexual men, agoraphobia (fear of being in public places) is little more than six and a half times greater (6.32) than heterosexual men and obsessive-compulsive disorder is more than seven times greater (7.18) than heterosexual men, self-destructive behaviors are indicated by: deliberate self Harm, (suicidality) is more than close to three times (2.58) to over ten (10.23) times greater than heterosexual men nicotine dependence is five (5) times greater than heterosexual men, alcohol dependence is close to three (2.9) times greater than heterosexual men, other drug dependence is more that four times (4.2) greater than heterosexual men, In addition, Whitehead addresses the argument that these symptoms are the result of social pressure and discrimination.


 In this 2010 report, “HIV Infections and Irresponsible Behavior” by the {CDC}, gay and bisexual men accounted 78% of infections among all newly infected men. From 2008 to 2010, new HIV infections increased 22% among young (aged 13-24) gay and bisexual men. The large percentage of gay and bisexual men living with HIV. Many gay and bisexual men with HIV are unaware they have it. Most gay and bisexual men acquire HIV through anal sex, which is the riskiest type of sex for getting or transmitting HIV. Having more sex partners compared to other men means gay and bisexual men have more opportunities to have sex with someone who can transmit HIV or another STD. CDC suggests homophobia, stigma, and discrimination may place gay men at risk for multiple physical and mental health problems. The CDCs’ response is to support preexposure prophylaxis (PrEP) and postexposure prophylaxis. HIV treatments dramatically improve the health of HIV-positive persons and iIndividuals whose HIV viral loads are suppressed have a greatly reduced chance of transmitting the virus to their partners.   


When looking at the bigger picture, the data in the {CDC} article from The National Intimate Partner and Sexual Violence Survey does show that the violence rates are higher in a homosexual/bisexual relationship. However, when looking ONLY at gay men (26%) vs heterosexual men (29%), then it does indicate that heterosexual men experience more violence than gay men. But looking at the lesbians, they clearly experience more violence (44%) then the heterosexual women (35%). 


The Royal College of Psychiatrists in England submitted a paper by {Peter May} to the Government’s consultation on Equal Marriage in 2012 claiming that allowing same-couples to marry would reduce discrimination and improve the health of LGB persons. (RCPsych 2012) Peter May argues that this claim is based on irrelevant and ambiguous research and ignores intrinsic lifestyle factors, which affect the health of LGB persons. There is agreement that in the UK rates of depression, anxiety, obsessive-compulsive disorder, phobia, self-harm, suicidal thoughts, and alcohol/drug dependence are all significantly higher in homosexual respondents. (King 2008) May disputes the claim that lowering discrimination will change this since discrimination is already low in the UK. He points out that in Denmark, which has long been extremely tolerant of LGB persons, a study found that suicide among men in same-sex registered partnerships was eight times greater than among men in heterosexual marriages. (Mathy 2001) Same-sex relationships are more likely to be non-exclusive and unstable and this can lead to depression and anxiety. Gays and lesbians are more likely to contract STIs and cancer. Physical illness and the death of friends can cause anxiety and depression. The RCPsych claim there are no health arguments in favor of restricting marriage. However, a study by Regnerus found that children raised for their entire childhood with their married are more likely to succeed, while the children raised by lesbians had suboptimal outcomes in education, depression, employment status, and drug use. (Regnerus 2012)


In this study, {Bryan N Cochran et al, 2006} examined the differences between openly LGBT and heterosexual clients entering substance abuse treatment. Comparing the two groups, they looked at the difference in development of substance abuse problems and the prevalence of substance abuse between the two groups. The results indicated that “…openly LGBT clients entered treatment with greater frequency of substance use, a history of more mental health treatments, higher rates of homelessness, a greater likelihood of being victims of domestic violence, and more treatments for physical problems than heterosexual clients (page 143).”



This meticulously referenced forty page document, (Hope and Homosexuality, Sutton, et.al. section on comorbidity) {Sutton et al.}presented from a Catholic perspective deconstructs the argument for biological determination and offers an evidence based psychological developmental model.  Other subjects addressed are causes of childhood gender identity disorder and its link to adult homosexuality. Other issues include comorbidity and the possibility of sexual orientation change. The document concludes with recommendations for ministry to individuals with unwanted same-sex attractions, and the politics of diagnosis.


{Sean C. Beougher et al, 2013} conducted interviews on 35 discordant gay couples to assess how ones perception of their partners serostatus (HIV positive or HIV negative) effects sexual behavior.  Although the results were not statistically significant, the researchers found higher tendencies for couples who met discordant (one partner HIV positive the other not) to be more satisfied with their relationship and intimacy than couples who did not meet discordant and rather discovered their partners serostatus later on.   The latter of the two scenarios typically resulted in higher levels of regret and anxiety, and a decreased sex life as well.


{Chadwick K. Campbell et al, 2013} In a study of same-sex male couples with either concordant negative or discordant HIV status, HIVdiscordant couples that engaged in unprotected anal intercourse tended to believe that the risk of HIV transmission was significantly reduced if the infected partner was on medication and had a low viral load.  Those who participated in explicit decision-making regarding condoms were more likely to choose to forsake condoms.  Of couples that did not have explicit discussion about condoms, white and interracial couples were more likely to continue practicing unprotected anal intercourse after an unplanned incident.


{Deepalika Chakravarty et al, 2012} Chakravarty, Hoff, Neilands, and Darbes investigated the rate of HIV testing among gay men in committed relationships with the presence of sexual risk-taking. They found that gay men in committed relationships get tested for HIV at lower rates than the general population of gay men, even after participating in risky sexual behavior that could have exposed them to the virus. The authors offer speculations for why this might be the case, including the possible feelings of false security among gay men in committed relationships who have agreements about sexual activities with outside partners.


In this article titled “The Myth of Gay Monogamy,” {Jeff Allen} discusses numerous studies in the past that disconfirm gay monogamy. In the first study, it was found that “…83% of the homosexual men surveyed, estimated they had had sex with 50 or more partners in their lifetime.” Gay activists responded by saying these stats were from a “bygone era of extreme homosexual excess prior to the HIV/AIDS epidemic scare.” Allen, thus, continues to show research data from recent studies (as recent as 2010), that prove that the vast majority of gays have open relationships and have sex with multiple partners. He concludes, “Male homosexual monogamy is most certainly a monumental myth.”


{Van de Ven et al, 1997} A descriptive study in Australia comparing homosexually active men above age 49 to younger homosexually active men showed that the older men continued to have as many male and female sexual partners in the last six months as younger men, though they were less involved in the homosexual community.  The typical range of lifetime sexual partners was 101 to 500.  The older homosexually active men were also less likely to have disclosed their orientation and to be tested for HIV.


{Chris Beyrer et al, 2012} This meta-analysis shows how in developed nations, incidence of HIV is decreasing, except among the population of men who have sex with men (MSM).  In the US, incidence has been increasing 8% per year since 2001, qualifying it as a sustained epidemic.  The HIV risk associated with receptive anal intercourse is 80-98% greater that of unprotected vaginal intercourse. The authors conclude that even substantial behavior changes, such as reduction in number of partners, would be insufficient to lower HIV transmission rates among MSM.


{Colleen C. Hoff et al, 2012} In a study of 566 couples of men who have sex with men (MSM) in the San Francisco Bay area, researchers found trends of risky sexual behaviors that could contribute to the spread of HIV to their primary partners and men outside their relationship.  Fifty-five percent of the sample had open relationships, and couples that had concordant positive and discordant HIV statuses were more likely to have open agreements.  Overall, 13% of couples reported unprotected anal intercourse with an outside partner in the past 3 months.  Couples with a combined discordant HIV serostatus and open relationship agreement were six times more likely to have unprotected anal intercourse with outside partners.


{The Alpha Zena Research Group} conducted a literature review in 2009 of Homosexuality and Violence. The report reviews and summarizes published peer reviewed and other reports that discuss violent interpersonal behavior among male homosexuals. “The research suggests that male homosexuals have higher rates of relationship violence and rape than do heterosexual males and that homosexual and bisexual men are considerably overrepresented in cases of child sexual abuse. Well over 100 articles are cited.”
According to a study by Greenwood et al., in a study of urban MSM approximately 39% reported experiencing at least 1 type of battering by a partner during the previous 5 years. MSM are more likely to be raped and sexually assaulted and therefore at high risk for HIV infection. Most of the sexual violence against homosexual men is committed by other homosexual men. The most serious forms of violence are those that directly target children. Holmes and Slap conducted a thorough review of the empirical research on the sexual abuse of boys and found, that sexually abused males were at increased risk for: increased rates of posttraumatic stress disorder, major depression, anxiety disorders, borderline personality disorder, antisocial personality disorder, paranoia, dissociation, somatization, bulimia, anger, aggressive behavior, poor self-image, poor school performance, running away from home and legal trouble. Several studies found that those who abuse children were themselves more likely to have been sexually abused as children. The research suggests that homosexual and bisexual men are more likely to commit acts of sexual violence against children than are heterosexual men.   

The report is presented in two parts:

Part 1{Male Homosexuality and Interpersonal Violence: Part 1} summarizes an extensive published literature almost all from peer-reviewed sources that relates to male homosexuality and violent behavior.  After documenting seven theoretical reasons to expect a connection between homosexuality and interpersonal violence – primarily violence toward men and boys – evidence for specific kinds of violent interpersonal behavior is reviewed.  Although about 2.5% of the male population is homosexual, research shows that as a group they are very over represented in sadomasochistic behavior and among serial killers and have higher rates of suicide and propensity for homicide. Over 120 scholarly and research articles based on populations from various countries are cited that give support to the conclusions.

Part 2, {Male Homosexuality & Violence, Part 2} reviews and summarizes additional published reports, as in Part 1, mostly from professional peer-reviewed or other official sources that relate to male homosexuality and violent interpersonal behavior. The research shows that male homosexuals have much higher rates of relationship violence and rape than do heterosexual males and they are considerably over represented in cases of child sexual abuse. Well over 100 articles are cited.


{Herrell et al, 1999} In a study by Herrell et al, the previously studied association between homosexuality in men and suicidality was analyzed. In their study, “Sexual Orientation and Suicidality: a Co-twin Control Study in Adult Men,” Herrell et al. interviewed 103 pairs of male-male twins, where one member of the pairs identified as homosexual, and taking into account the possible covariate of substance abuse, they analyzed their levels of suicidality using the five following measures: thoughts about death; desire to die; suicidal ideation; suicide attempts; and presence of at least one lifetime suicidal symptom. Consistent with the findings of similar studies previously conducted on this topic, the results of the present study indicate, “Reports of lifetime measures of suicidality are strongly associated with a same-gender sexual orientation.” However, substance abuse did not help explain these effects.


{Cochran et al, 2003} In a 2003 study by Cochran, Sullivan, and Mays, the prevalence of mental disorders, psychological distress, and use of mental health services among lesbian, gay, and bisexual adults in the United States as compared to the prevalence among heterosexual adults was analyzed and reported. Unlike most other studies conducted on this topic, Cochran, Sullivan, and Mays directly measured sexual orientation instead of just sexual activity. The findings indicate that there is a higher rate of mental health disorders, as well as use of mental heath services, among gay and bisexual adults than heterosexual adults. In addition, there is a higher rate of psychological distress among gay and bisexual men than heterosexual men, but not among women.


{Cochran et al, 2000} The results of the study conducted by Cochran et al. from 2000 indicated that alcohol use did not differ among homosexually and heterosexually active men in the U.S. However, there was a significant difference between the rates of alcohol use of homosexually and heterosexually active women in the U.S. Homosexually active women “reported using alcohol more frequently and in greater amounts and experienced greater alcohol-related morbidity than exclusively heterosexually active women.”


{Frisell et al, 2010} conducted a survey to assess the morbidity of mental health, alcohol use, and eating disorders among the SSA (same-sex attracted) community as compared to heterosexuals.  Participants included Swedish twins from the ages of 20 to 47.  Of the participants, 102 male and 307 female SSA twins were included. Participants responded to phone interviews and completed surveys and questionnaires regarding their stress levels with certain categories such as age, education, and relationships.  Results showed that SSA’s were more likely to have a psychiatric disorder (such as depression, general anxiety disorder (GAD), or ADHD) than their heterosexual counterparts.  In addition, SSA women used alcohol more than heterosexual women, and SSA men had more eating disorders than heterosexual men.


{Sanfort and Keizer} (2001) composed a literature review of 19 former studies on sexual problems in gay men. It was found that general sexual problems in gay men occur in 6 categories: sexual desire (low sexual desire due to traumatic experiences, presence of AIDS, etc.), sexual aversion (due to issues with father or family, desire to avoid AIDS, etc.), excitement and arousal (erectile dysfunction, performance anxiety, etc.), orgasm (premature, delayed, or inhibited ejaculation), sexual pain (anal sphincter irritation, etc.), and sexual compulsivity or addiction. In addition, gay men struggle with sexual scriptss regarding which partner will be dominant and which partner will be submissive. Researchers concluded that little is known about gay men’s sexual disorders and what is known is limited.


{Parsons et al} Parsons, Kelly, Bimbi, DiMaria, Wainberg, and Morgenstern (2007) conducted qualitative interviews assessing sexual compulsivity (SC) in homosexual and bisexual men and the origins of their sexual compulsions. The study included a targeted sample of 180 homosexual and bisexual men from New York City. Participants reported the number of hours spent searching for sex on the internet per week, as well as hours of porn watched, and hours spent masturbating. There were no concrete predictions in this article, however findings show that the majority of the roots for participants SC stems from intrinsic issues such as mental well-being and/or depression. Another explanation found are extrinsic issues such as relationship and/or parental issues, childhood sexual abuse, and/ or availability of a sexual activity. The researchers concluded that this information is pertinent in providing treatment for men suffering from SC to improve their quality of life, thus avoiding sexual compulsions.


{Wang et al, 2014} Wang, Dey, Soldati, Weiss, Gmel, and Mohler-Kuo (2014) conducted a questionnaire on 5875 Swiss men to assess sexual orientation on personality traits, mental health, prevalence of psychiatric disorders, and risk of psychiatric disorders. Participants first completed a baseline questionnaire to determine their eligibility for the study. To assess the participant’s health and personality, the researchers used the Major Depression Inventory (MDI) for depression, the Adult ADHD Self-Report Scale Screener for hyper active deficit disorder, the Multi-International Psychiatric Interview for lifetime anti-social personality disorder, and the European School survey project on Alcohol and other Drugs for suicide attempts. This study was purposed to bring closer attention to the psychiatric disorders and suicidality experienced by homosexual men. Findings show that men who reported being solely attracted to women were significantly more social and mentally healthy than men who were attracted to men. Also, heterosexual men had a lower prevalence of having or being at risk of having psychiatric disorders than homosexual men. Researchers concluded that homosexual men reported poorer mental health than their counterpart heterosexual.


{Warner et al, 2004} conducted a questionnaire on 2430 gay, lesbian, bisexual, transgendered, and heterosexual men and women in the UK to assess their mental health. Researchers used the Clinical Interview Schedule (CIS-R) to assess the mental health of the participants, the General Health Questionnaire (GHQ-12) to assess psychological distress, and the Short Form Quality of Life (SF-12) to assess quality of life. Results found that Bisexual men have more mental health issues than gay men and that gays, lesbians, and bisexuals have higher rates of self-harm (such as suicide) and psychological distress compared to heterosexuals. Also, it was found that discrimination can possibly be linked to sexuality. Researchers concluded that gays, lesbians, and bisexuals are much more vulnerable to psychological distress, mental illness, and self-harm than heterosexuals.


{Jorm et al, 2002} Jorm, Korten, Rodgers, Jacomb, and Christensen (2002) conducted a cross-sectional survey to assess the mental health of homosexuals, bisexuals, and heterosexuals. The researchers surveyed 2331 Australians between the ages of 20 to 24, and 2493 Australians between the ages of 40 to 44. Of the sample, 78 participants reported being homosexual and 71 reported being bisexual. To assess mental health, numerous tests were used: the Goldberg et. al. anxiety and depression scale was used to assess anxiety and depression, the Alcohol Use Disorders Identification Test (AUDIT) assessed alcohol misuse, emotional well-being was measured by the Positive and Negative Effect Scales (PANAS), and the physical component summary of the SF- 12 was used to assess physical health. Other items tested were social support, childhood adversity, suicidality, and socioeconomic status. Results found that homosexuals have more mental health and social problems (childhood adversity, socioeconomic, etc.) than heterosexuals, yet bisexuals have even more mental health and social problems than homosexuals. The researchers concluded that the inclusion of bisexuals in research on homosexual mental health would result in an overestimation of the amount of mental health problems in homosexuals.


{Gilman et al} 2001 conducted a study to assess the risk of psychiatric disorders among homosexuals. The researchers assessed the psychiatric mental health of nearly 5,000 participants using the Composite International Diagnostic interview (CIDI). Of the total number of participants, only 74 males and 51 females were identified as homosexual. It was found that homosexual women had significantly more prevalence of psychiatric disorders than heterosexual women; specifically in the categories of major depression, simple phobia, and PTSD. It was also found that homosexuals have higher rates of HIV. In regards to suicide, there were no significant findings, however homosexuals seem to have slightly higher rates than heterosexuals. It was discussed that these psychiatric patterns could be due to the feelings of isolation and discrimination that homosexuals commonly experience.


{Stall et al, 2001} conducted a cross-sectional interview to assess the usage of drugs and alcohol in the MSM (men who have sex with men) community. The researchers surveyed 2172 MSM from 4 major US cities (Los Angeles, San Francisco, Chicago, and New York). Participants answered interview questions over the phone about their health, mainly regarding drug and alcohol use. Findings show that the use of alcohol and drugs with MSM is very common: 52% of the MSM sample use recreational drugs (ranging from marijuana to opiates) and 85% use alcohol. Other findings showed that 23% of MSM use stimulant drugs, higher usage of alcohol is related with lower education, and childhood sexual abuse is related to multiple drug use. In comparison to a general sample of men, it was found that MSM us a comparable amount of alcohol, but a much higher amount of drugs. Researchers concluded that the risk of heavy substance use is prevalent for MSM.


{Stall et al, 2000} composed a literature review to examine possible correlations between substance use and the AIDS epidemic among the men who have sex with men (MSM) community. It was found that although gay men do not necessarily consume more alcohol than heterosexual men, they do tend to use more and a larger variety of drugs. Additionally, MSM tend to display more high risk sexual behaviors. In association to their substance use and sexual behaviors, MSM have higher health risks than their heterosexual counterparts, such as HIV/AIDS. MSM and bisexual injection drug users are at an especially high risk for HIV infections. The researchers concluded that there are increased health risks in the MSM population and that more knowledge is needed in this field.


{Sanfort et al} (2001) The 1996 Netherlands Mental Health Survey and Incidence Study showed that homosexually active men had higher rates of past year and lifetime mood disorders (such as bipolar and major depressive disorders) and anxiety disorders (such as obsessive compulsive disorder and agoraphobia). Gay men reported multiple mental health disorders more frequently than heterosexual men. Lesbian women showed a higher lifetime rate of mood disorders and substance abuse and dependence than heterosexual women (Sandfort, de Graaf, Bijl, &amp; Schnabel, 2001).


{Sanfort2 et al} In a sample representative of the general population, the 2001 Dutch National Survey of General Practice revealed that individuals with same-sex sexual preference reported nearly twice as much frequency of mental health problems than heterosexual people, and significantly more than bisexual people. They reported a higher incidence of acute physical symptoms, such as respiratory problems, itching, pain in neck or shoulders, dizziness followed by falling, and—especially for gay men—serious intestinal problems and urinary incontinence. Bisexual individuals reported significantly higher rates of soft drug use (Sandfort, Bakker, Schellevis, &amp; Vanwesenbeek, 2006).


{Fergusson et al} A New Zealand longitudinal study (Fergusson, Horwood, &amp; Beautrais, 1999) following 1265 children from birth showed LGB adolescents and young adults have by age 21 significantly higher rates of suicidal ideation and attempts, major depressive disorder, generalized anxiety disorder, conduct disorder, nicotine dependence and other substance abuse and dependence, as well as the presence of multiple disorders.


{Michael King et al, 2008} A meta-analysis of research spanning 1966 through 2005 (25 studies that met criteria) showed that homosexual people are at 1.5 – 2 times greater risk for suicidal ideation, anxiety, depression, anxiety, substance abuse, and deliberate self-harm than heterosexual counterparts.


{NARTH #3 – Journal of Human Sexuality} NARTH (2009), composed a complete literature review to reexamine the homosexual lifestyle and discuss the risks of living in such a lifestyle. Over 500 sources were used to compose the work from studies conducted all over the world, therefore numerous findings were discussed. First and foremost, many physical health risks accompany the lifestyle of homosexuals (lesbians included). It was found that gay men and lesbian women, as compared to heterosexuals, have higher rates of being HIV positive which is most likely due to their higher rates of unprotected sex and minimal condom use and are 3 times more likely to drink and abuse alcohol (such as binge drinking) and drugs. In fact, 2/3’s of gay teens are alcoholics and drugs are often used by homosexuals to enhance their sex life (AIDS risking behavior). It was discussed that many lesbian alcoholics relate their struggle with alcoholism back to earlier childhood traumas and current social abuse. In addition to AIDS, homosexuals are at a higher risk for other STDs such as syphilis and gonorrhea than heterosexuals are. This may be due to their high inclination to have sex: in some cases, 23% of homosexuals report having 500 or more sexual partners. Finally, due to the amount of anal sex and practices such as fisting, homosexuals risk getting severe wounds; the anal canal is not anatomically designed to withstand friction like the vagina is. All health factors considered, it was found that homosexuals have a shorter life span than heterosexuals. In addition to physical health, some mental health issues were also discussed. As compared with heterosexuals, gays and lesbians are raped more, experience more loneliness, have lower self-esteem, especially with body image which leads to eating disorders such as bulimia (in gay men), represent a large portion of the people with Borderline Personality Disorder (BPD), and have higher suicide rates (almost half of the gay youth attempts suicide and 1/3 of all suicides are attempted by homosexuals). Finally, social health was discussed as well. One third of homosexuals have high sexual compulsivity leading to more sexual partners, more frequent addictions to pornography, and masturbate more frequently. Domestic violence is more commonly a problem in homosexual relationships (especially with butch, masculine lesbians) and gay youth have higher rates of homelessness. Most homosexuals had a large history of molestation, abuse, or incest in their childhood, and many were also reared with a non-conforming method (girls are allowed to do boy things, vice a versa). Therefore it was presumed that childhood factors can lead to homosexuality.


{Mehmet Eskin et al, 2005} In a research study published in the Archives of Sexual Behavior, Vol. 34, No. 2, Eskin, Kaynak-Demir, and Demir examined the “prevalence of self-reported same-sex sexual orientation and its relationship to childhood sexual abuse, sex of the perpetrator, and suicidal behavior in university students in Turkey.” They also investigated predictors of same-sex sexual orientation and the impact of a perceived distance between fathers and their sons on the development of same-sex sexual orientation. The study had several findings: “… sexual abuse was related to same-sex sexual behavior”; “… students with a same-sex sexual orientation perceived their fathers as distant but not their mothers”; “having been abused sexually during childhood by someone of one’s own sex was related to a same-sex sexual orientation”; and “identifying oneself as homosexual or bisexual was related to suicidal ideation.” These findings suggest that it is not just an individual’s identification of having a same-sex sexual orientation that can lead to mental health problems but more so the negative and harmful social ramification often associated with having such sexual orientations across cultures.


{CDC 1} The Center for Disease Control (CDC, 2016) produced an article showing the statistics of the emergence of new HIV infections in the United States. The most prevalent finding was that the MSM community (men having sex with men) accounts for 78% of all new HIV infections. In regards to ethnicity, 55% of people infected with HIV are among the young black population, even though all blacks only account for 12% of the general population. Next, is Whites (31%), and finally Hispanics (17%).


{CDC 2} The National Center for HIV/ AIDS Prevention (2016) examined statistics regarding HIV/ AIDS to call attention to the risk of diagnosis. It was found that 1 out of every 2 black men who have sex with men (MSM) and 1 out of every 4 Latino MSM are diagnosed with HIV at some point in their lives. For men in general, the risk of HIV is severely lessened, concluding that MSM are at a much higher risk for HIV/ AIDS.


In this article by {Mary Ann Moon} it was found that young transgender women have a greater prevalence of psychiatric disorders (2-4 times higher) than the general population. Of all the participants, 41.5% of the transgender women had a psychiatric disorder such as depression, suicidality, anxiety or PTSD. 


{Gay and Lesbian Medical Concerns} In “Ten Things Gay Men Should Discuss with their Health Provider”, the Gay and Lesbian Medical Association warns gay men about their increased risk for HIV, HPV, Hepatitis, and other STDS; prostate, testicular, colon, or anal cancer; depression, anxiety, anorexia, bulimia, obesity, substance abuse, and tobacco use.


{Paul Sullins} Sullins (2016) conducted a longitudinal study to assess delayed onset depression among adults with same-sex parents.  Twenty same-sex parent families were included in the study. Participants responded to the CES-D scale to ##### depression, completed a questionnaire about mistreatment or abuse, and provided weight information to evaluate BMI.  In the first wave of the study, children of same-sex parents actually had a lower risk of depression than children of opposite-sex parents.  However, in the fourth wave of the study, more than half of children from same-sex parents became depressed, while depression in children of opposite-sex parents slightly decreased.  In addition, children of same-sex parents were at a higher risk for suicidality, parental distance, and obesity.


{Regnerus} (2016) composed a review of a longitudinal study done by Professor Paul Sullins testing the “No Differences” thesis in regards to same-sex parenting in comparison with opposite sex parenting.  Though a small sample of 20 children from same-sex parents was used, results showed that children of same-sex parents are significantly more depressed going into adulthood (51%) than children of opposite-sex parents (20%).  In addition, children of same-sex parents are significantly more physically and sexually abused, and reported more obesity as children of opposite-sex parents.  The researcher concluded that children raised with same-sex parents could face problems and even danger to their dignity and security.


{Haverluck} Haverluck (2016) reported on a National Health Interview Survey of 69,000 adults, 1664 of whom were lesbian, gay, or bisexual. The LGB participants were much more likely to engage in behavior hazardous to health, such as abusing alcohol and cigarettes. Lesbian women were 91% more likely to have “poor” or “fair” health, and 51% more likely to have multiple chronic health conditions. Gay men had a 26% likelihood of experiencing psychological distress, versus 17% of heterosexual men. Bisexual individuals demonstrated the greatest mental health risk, having twice the likelihood of psychological distress than their heterosexual counterparts (40% in males, 46% in females, compared to 22% heterosexual females). Without providing a measure for stigma and discrimination, and without further exploration of alternative explanations, the researchers attributed the stark differences to societal discrimination against sexual minorities.


{Mills et al, 2004} Mills et al., (2004) evaluates the prevalence of depression and its correlates among U.S. men who have had sex with other men, interviewing 2,881 men between 1996 and 1998. The sample was taken from the Urban Men’s Health Study, using disproportionate and adoptive sampling methods after obtaining a household-based probability sample of 2,881 men. 7-day prevalence of depression in men who had sex with men was 17.2%. Distress and depression were both associated with no domestic partner, dis-identifying as gay, queer, or homosexual, multiple experiences of anti-gay violence, and high community alienation. Distress was associated with anti-gay harassment experiences. Depression was associated with history of attempted suicide, child abuse, and recent sexual dysfunction. A limitation of this research is the lack of a control group. Men who have sex with men appear to be 2.7 times more likely to be at-risk for distress and depression than a general population of men, although there was no direct control group in this study. These findings led to conclusions regarding the importance of long-term intimate partnerships and efforts to reduce stigmatization of men who have sex with men. 


{Garofalo et al, 2007} This study (2004-2005) was conducted in Chicago Illinois among young men (ages 16-24) who have sex with men with the objective of analyzing the widespread use of the Internet for meeting sexual partners and high-risk behaviors that place these individuals at risk for contracting HIV and other sexually transmitted infections. A voluntary, computer-assisted survey regarding sexual behaviors and use of the Internet to facilitate sexual encounters was administered to a sample of 270 young men who have sex with men. The results determined that 48% of the sample had sex with a partner they met online. Of these, only 53% consistently practiced safe sex (condom use) and 47% had sexual partners more than 4 years older than themselves. Risky behaviors such as increased age, a history of unprotected anal intercourse, multiple anal intercourse partners, and engaging in sexual activity at a sex club or bathhouse were found to be associated with meeting sexual partners via Internet. Though the study is limited in terms of causality, method, and geography, it points to the conclusion that male adolescents and young adults who have sex with other men and who use the Internet to find and meet a sexual partner also engage in other unsafe behaviors that can lead to contracting HIV and other sexually transmitted diseases.


{Choi et al, 2003} In 2001, it was determined by the United Nations that China was undergoing a serious HIV-1 epidemic among certain populations, reporting about 30,736 cases. Between 2001 and 2002, the committee for human research of the University of California and by the institutional review board of the Beijing Association of STD/AIDS Prevention, approved the direction of a study to analyze the HIV-I prevalence rates and levels of risk behavior in men who have sex with men in Beijing, China, the Chinese city with the largest recorded number of HIV-1 infected men in this group. The resulting data showed that there is low but significant HIV-1 prevalence in men who have sex with men in Beijing. Men older than 39 years were 4-5 times more likely to be infected than men younger than 39 years, regardless of the number of sexual partners. 64% of the older men (&gt;39 years) had been married, compared with only 11% of the younger men. This finding shows that this mixing could contribute to the sexual transmission of HIV-1 to women and heterosexually active adults. Given the high rates of unprotected sex reported among men who have sex with men, HIV-1 infection rates will continue to rise both in this group and the general population unless prevention measures are implemented.


{Garofalo et al 2, 2007} There is a growing concern about methamphetamine use and sexual risk for HIV infection among men who have sex with men. This study (2004-2005) was conducted in Chicago, Illinois, to explore methamphetamine use in young men (ages 16-24) who have sex with men. The primary objectives were twofold: the first was to describe patterns and consequences of methamphetamine use and the second was to analyze the relationship between methamphetamine use and sexual risk, individual psychological factors (such as psychological distress, self-esteem, and loneliness) and sexualized social contexts. 310 subjects completed an anonymous, compute-assisted survey which measured methamphetamine use in the past year and other high-risk sexual and substance abuse behaviors. 13% of the sample reported using methamphetamines in the past year. Methamphetamine use was more common in HIV infected participants and older, non-African American men who have sex with men. These young men were 6 times more likely than their peers to report unprotected anal intercourse in the past year, more than 4 times more likely to report multiple anal sex partners in the last 3 months, and substantially more likely to report having had sex in a bathhouse or sex club, with a partner met over the Internet, having had sex in exchange for money or drugs, or with older (&gt; 10 years) partners. Methamphetamine use was also slightly correlated with lower self-esteem and increased psychological distress, although not with romantic loneliness. Though this study is limited, it demonstrates that methamphetamine use and HIV risk were strongly related and that patterns of drug use were predicted by demographics, sexualized social contexts, and certain psychological variables. Because methamphetamine use has become such a public health problem and because of the limitations of this study, additional research should be conducted to better understand the social and psychological context of substance use and risk for HIV and other sexually transmitted infections.


{Smith et al, 2009} A meta-analysis of research in sub-Saharan Africa of HIV/AIDS and the link to men who have sex with men (MSM) revealed that this population has ordinarily been overlooked, despite Africa having the greatest HIV epidemics (Smith, Tapsoba, Peshu, Sanders, and Jaffe, 2009). The need to develop and implement HIV prevention and intervention for MSM is urgent. Unprotected anal sex is common, knowledge and access to prevention measures is lacking, and in certain settings MSM engage in prostitution. High numbers of MSM also report having heterosexual sex and being married. Stigma, violent victimization, and incarceration for MSM are widespread. Thirty-one sub-Saharan nations have outlawed sodomy. Most MSM conceal their behavior for years out of fear of repercussion. Responses to the HIV epidemic have primarily focused on heterosexual and mother-to- child transmission, while early estimates show that MSM make up 20% of the infected. HIV/AIDS prevention workers tend to demonstrate apprehension or hostility toward helping MSM, raising the need to sensitize and better inform responders.


{Koblin et al, 2003} This study (2003) analyzed the baseline prevalence of risk behaviors of 4,295 men who have sex with men (MSM) enrolled in a behavioral intervention trial conducted in 6 major US cities (Boston, Chicago, Denver, New York, San Francisco, and Seattle). Data from questionnaires and blood, urine, and rectal specimens from HIV-negative MSM who reported having engaged in anal sex with one or more partners in the previous year were analyzed. The results showed that 45.2% of MSM reported engaging in unprotected oral sex with ejaculation, 48.0% reported unprotected receptive anal sex and 54.9% reported unprotected insertive anal sex in the previous 6 months. Unprotected sex was significantly more likely with one primary partner or multiple partners. Drug and alcohol use were significantly associated with unprotected anal sex. This data illustrates the different risk profiles of this population and corroborate the need to establish effective intervention strategies to help curb the continuing HIV epidemic in the US.


{Van Heeringen & Vincke} The objective of this study (2000) was to determine the risk of attempted suicide and the potential risk factors for suicidal ideation and behavior among homosexual and bisexual young people. A sample of 404 homosexual and bisexual young people (and a control sample of school peers) was administered a questionnaire assessing the association between suicidal ideation and behavior and potential risk factors. The results demonstrated that homosexual or bisexual orientation was twice as likely to be associated with an increased risk of suicidal ideation. Females, in particular, were found to have a significantly increased risk of attempted suicide associated with homosexuality or bisexuality. Depression was identified as a significant risk factor for suicidal ideation, independent of sexual orientation, while suicidal behavior was associated with low self-esteem, higher levels of hopelessness, and suicidal behavior in a close acquaintance. Less satisfying homosexual friendships were an additional risk factor for suicidal behavior in homosexual youth.


{Lebson} Lebson (2008) writes that the existing studies regarding the incidence of completed and attempted suicide among homosexual youths show that homosexual youths that attempt suicide share many of the same risk factors of heterosexual youths that attempt suicide. However, their sexual orientation contributes added stressors in the developmental, social, and familial realms that they will be challenged to overcome. These stressors present an increased risk of suicidality. While some homosexual youth may use suicidal ideation as a means of rediscovering a reason to live, this population is more likely than their heterosexual peers to actually attempt and complete suicide. In order to draw more accurate conclusions regarding the patterns of suicide risk among homosexual youth, more concrete evidence is required. To attain this, a population-based longitudinal study would need to be conducted with a large sample of homosexual, emerging homosexual, and heterosexual youths.


{Blosnich et al, 2016} Blosnich, Nasuti, Mays, and Cochran (2016) conducted a study to assess the rates of suicidal ideation and suicidal attempts in sex minority youth. Participants completed the California Quality of Life Survey and proceeded to answer questions about suicide, sexual orientation, and mental health. It was found that homosexuals had higher rates of suicidal ideation, suicide attempt, and depression. In fact, bisexual women were 3.5 times more likely to have these higher rates, and men were 2 times more likely, than heterosexuals. The researchers concluded that early intervention is needed to help these sex minorities.


{Relf et al, 2004} Relf, Huang, Campbell, and Catania (2004) conducted a correlational study on a sample of over 1000 participants to create a model that could explain the causal factors of gay identity development, interpersonal violence, and HIV risk among MSM (men who have sex with men). In the article, the researchers address factors such as battering, childhood abuse, substance use, and aversive emotions, and their effect on the risk of HIV through high-risk sexual behaviors. Identities of MSM minorities is also discussed. With the results of the study, the researchers concluded that this model lays out HIV risk factors and can be used to help with HIV prevention.


{Tjepkema} Data from a large national probability Canadian Community Health Survey from 2003 and 2005 showed differences in health care usage between heterosexual adults and gay, lesbian, and bisexual adults, which Tjepkema (2008) noted as remarkable considering Canada’s universal healthcare system ensures all Canadians have healthcare coverage, eliminating the possibility of sexual minorities not accessing services due to denial of insurance coverage. Gay men and bisexual women reported more chronic health conditions. Bisexual men were more than two times more likely than heterosexual men to self-report poor mental health; bisexual women were three times more likely than their heterosexual counterparts. All of the sexual minorities reported greater incidences of mood disorders than heterosexuals, and they were all more likely to report having unmet healthcare needs in the past 12 months. For women, lesbians were less likely to see a family doctor and to undergo breast cancer screenings.


{Steele et al, 2009} Steel et al. (2009) explored the association with health status and risk behaviors by variation in sexual identity among Canadian women. This cross-sectional data analysis was taken from the nationally-representative Canadian Community Health Survey sample, including 354 lesbian, 424 bisexual, and 60,937 heterosexual participants. Sexual orientation was measured by asking if individuals identified as belonging to a sexual minority. Health status was evaluated to include a host of chronic conditions, including diagnosed mental health conditions, hypertension, asthma, suicidal ideation, and BMI. Self-perceived mental health status and health status were also assessed using a 5-point global assessment scale with ratings ranging from excellent to poor.  Health risk behaviors included tobacco use, high-risk alcohol consumption, and the diagnosis of an STD, in order to connote high-risk sexual behavior. After controlling for possible confounding variables, bisexual women had an increased rate of hypertension increased likelihood to report poor or fair physical health, were 3.6% more likely to report mood or anxiety disorders when compared to heterosexual women, were 5.8% more likely than heterosexual women to endorse serious consideration of suicide, were 3.7 times more likely to report poor or fair mental health status when compared to heterosexual women, and were most likely to endorse and STD diagnosis (3.3 times as likely as other groups). Lesbian women were 3.5% more likely than heterosexual women to endorse seriously considering suicide. Lesbian and bisexual women were more likely to report smoking and risky drinking habits than heterosexual participants. Strengths of the study include a large sample size. Limitations include self-report of risky behaviors, as well as the measure for sexual orientation, which likely under-estimates the number of sexual minorities, as it limited to self-identification, and may not capture individuals who have experienced same-sex attraction or engaged in same-sex sexual behavior.  The mechanism for the relationships found in this study is unclear, although potential conclusions include stigmatization, minority stress, psychological distress, and experiences of discrimination.


{Skegg et al, 2003} Skegg, Nada-Raja, Dickson, Paul, and Williams (2003) conducted a survey to assess self-harm rates in association with same sex attraction (SSA).  During the study, participants completed a survey on sexual attraction as well as an interview about their level of self-harm.  Results showed that people with SSA did in fact have higher rates of self-harm than people attracted only to the opposite race.  Also, men with SSA were at a higher risk than women with SSA even if their SSA was reported as minor.


{Selvidge et al, 2008} Some scholars now posit that the “coming out” experience may be inadequate for self-esteem, life satisfaction, or a healthy LGB identity. A study of 373 lesbian and bisexual women (77 of whom were women of color) explored their relationship with sexist and heterosexist events, self-concealment (managing and hiding information about one’s identity), self-monitoring (the ability to modify self-presentation and sensitivity to the expressive behavior of others), and positive psychological well-being (Selvidge, Matthews, &amp; Bridges, 2008). As the researchers expected, higher levels of self-concealment related to diminished psychological well-being. But contrary to common belief, disclosure alone was inadequate for well-being; self-monitoring was associated with greater well-being. They also found that sexist and heterosexist events did not significantly impact well-being, which contradicts minority stress theories.


{Meyer et al, 2008} Meyer, Dietrich, and Schwartz (2008) conducted a study of the prevalence of mental disorders and suicidality among a diverse group of 388 gay, lesbian, and bisexual individuals in New York City, expecting to see higher rates among blacks and Latinos based upon the theory of minority stress. Instead, they found that the blacks had fewer DSM-IV diagnoses than the whites, and Latinos were equivalent to whites. They found no difference in gender. The younger cohorts had lower prevalence than the age 45 to 59 cohort, especially as it regards mood disorders over the past 12 months. They did observe, as they predicted, that bisexuals had greater incidence of substance use disorders. And the black and Latino LGB individuals had higher rates of serious suicide attempts, which most often occurred in young adulthood.


{McCabe et al, 2010} McCabe et al (2010) explored the relationship between discrimination and substance-use disorders in sexual minority adults. It explored discrimination by race, gender, and sexual orientation, drawing from a large national sample (National Epidemiologic Survey of Alcohol and Related Conditions) of 577 lesbian, gay, and bisexual adults. Substance use disorders were assessed using DSM-IV criteria. 2% of the population self-identified as LGB. Prevalence of last- year substance use disorders was twice as high among LGB adults when compared to heterosexual participants. Over 2/3 of LGB adults reported at least one type of discrimination over the course of their life. If individuals reported all three types of discrimination (race, gender, and sexual orientation), odds of past-year substance use disorders was 4 times greater. In final regression models, there was no statistically significant relationship between substance use disorders and sexual orientation discrimination alone. However, the relationship between discrimination and substance use disorders were found when all three types of discrimination were experienced. Large sample size was a strength of this study, although cross-sectional data leaves a limitation regarding causal conclusions being drawn. 


{Stirratt} Stirratt et al (2009) explored how socially disadvantaged status impacts social and psychological wellbeing in self-identified LGB adults (n = 396). This was a community-based sample collected through Project STRIDE. Social wellbeing was Bisexuality and younger age were associated with lower social wellbeing. Bisexuality was mediated by connectedness with other members of the gay community and sexual identity valence, defined as the percentage of positive attributes associated with one’s sexual identity.  There were no differences in social wellbeing between men and women or between racial/ethnic groups. There were no significant differences in psychological wellbeing between Caucasian and African-American individuals, although Latino social status was related to lower psychological wellbeing than Caucasian status. Women reported more depressive symptoms than men on the CES-D, and Latino individuals endorsed significantly more depressive symptoms than White counterparts. Sexual identity valence and community connectedness both were associated with increased psychological wellbeing, although identity valence was more associated with individual wellbeing than social wellbeing, whereas social connection was more strongly associated with social wellbeing. Researchers concluded that evidence for an additive stress model is not clear from this study in all groups, although Latino individuals appeared to be impacted more by additive stress. Further, identity valence and community connectedness did not appear to significantly alleviate this stress in Latino individuals. 


{Josephson and Whiffen} Josefson & Whiffen (2009) offers a model to account for increased depressive symptoms in gay men. It suggests a potential relationship between gender-related personality traits, namely agency and unmitigated communion, and peer harassment self-discrepancies in agency, and cold-submissive interpersonal behaviors. Agency is defined as orientation towards self and individuation. Unmitigated communion refers to orientation towards others and connection with others that is focused on others at one’s own expense. Self-discrepancies in agency are defined as the difference between actual versus ideal orientation towards self. Cold-submissive interpersonal behaviors are defined as those behaviors interpersonally that could characterize depressed individuals, including hostility and coldness, withdrawing from attention, and being unresponsive to the engagement of others. 510 gay-identified adults were recruited via internet and newspapers in three Canadian cities. 254 of the participants (Sample A) were then randomly selected to test the hypothesized model and 254 (Sample B) were used to validate the model, which was re-specified after analysis on the first sample.  Findings indicated that in gay men who were less agentic than their ideal, agency and unmitigated communion are not directly related to depression. Rather, less agentic men reported greater self-discrepancies in agency, which in turn predicted higher levels of depressive symptoms. Less agentive men and those focused on the needs of others more than their own reported more unassured-submissive interpersonal behavior, which in turn predicted higher levels of depression. Peer harassment was associated directly with depressive symptoms and indirectly via unassured-submissive interpersonal behavior. Limitations include cross-sectional data, lack of longitudinal data which would allow for causal conclusions, and evaluating adult level of agency as opposed to adolescent level of agency. This third dilemma highlights that the researchers assumed that gender-related personality traits are stable, which may or may not be the case.


{Hegna and Wichstrom} Hegna and Wichstrøm (2007) conducted a study of 407 Norwegian self-identified gay, lesbian, and bisexual youths (ages 16-25) to identify specific factors that affect the risk of attempted suicide in this population. 26% of the participants (both genders) reported a previous suicide attempt. A questionnaire was administered in which the subjects were asked about general risk factors (not specifically related to sexual identity) such as anxiety and depression, self-esteem, familial and peer support groups, and drug, alcohol, and tobacco usage. The subjects were also questioned regarding specific risk factors related to their sexual orientation. Of these specific factors, the following were found to increase the risk of attempted suicide in gay-lesbian- bisexual youth: currently being in a heterosexual relationship, early heterosexual debut, young age of coming out, infrequent contact with heterosexual friends, and openness in “coming out” to all heterosexual friends. While the act of “coming out” and revealing one’s sexual identity at a young age is important for the psychological well being of the young person, it can also be a serious stressor with potentially negative consequences, particularly in the person’s social well-being.


{Hatzenbuehler et al, 2008} Hatzenbuehler, McLaughlin & Nolen-Hoeksema (2008) compared emotional regulation and internalizing symptoms in a longitudinal study of sexual minority and heterosexual adolescents. Emotional regulation is defined as the processes involved in monitoring, evaluating, and modifying emotional reactions in the pursuit of goals. Longitudinal data was taken from an ethnically diverse community-based sample of 1,071 middle school students (ages 11-14). Adolescents endorsing same-sex attraction (n=29) also indicated higher rates of internalizing symptoms at time 1 and time 2. They also exhibited greater risk of rumination and poor emotional awareness, categorized as poor emotional regulation, than their heterosexual peers. Deficits in emotional regulation was an important mediator between sexual minority status and symptoms of depression and anxiety. Small sample size is the most significant limitation of this study, as well as generalizability concerns to older adolescents from a middle school aged group. 


{Hatzenbuehler et al, 2009} Hatzenbuehler, Keyes & Hasin (2009) explored the modifying effect of state-level policies on the association between LGB status and prevalence of psychiatric disorders. Data was collected from a nationally-representative sample of noninstitutionalized US adults (N = 34,653) taken from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). 577 participants (1.86% of men and 1.52% of women) identified as LGB. Two aspects of state-level policies were explored: 1) states with hate crime laws which specify sexual orientation as a protected category 2) state policies which ban sexual orientation employment discrimination in public/private settings. Living in states without policies extending protections to LGB individuals predicted a stronger relationship between lesbian, gay, or bisexual status and psychiatric comorbidity. Association between LGB status and psychiatric disorders was stronger in states with policies that did not extend protection to them than those with protective policies, particularly for dysthymia, generalized anxiety disorder, and post-traumatic stress disorder. State-level policies were associated with greater prevalence of psychiatric comorbidity. Those individuals who lived in a state that did not extend policy protection to LGB individuals had 4.76 times the odds of a comorbid psychiatric disorder than those living in a state with protective policies.


{Cochran and Mays} This article by Cochran and Mays (2009) expressed how individuals who are, bisexual, gay, and homosexual with HIV, have an increased risk of morbidity due to mental health and substance abuse, and an increased risk for various disorders.  The study was conducted by using a structured interview, via telephone with trained interviewers.  It was found that sexual minorities had an elevated risk for common anxiety, affective, and substance use disorders for some individuals.  Lifetime heterosexual men were found to have the greatest risk for psychological morbidity, and bisexual women also had an increased risk.  HIV infection among minority sexual oriented men was found to have a strong correlation with psychological morbidity, specifically for panic attacks, though HIV was not found to exclusively increase the risk.  Lastly, this study found no significant evidence that those who are homosexual, but do not identify as lesbian or gay, would have increased substance dependency difficulties.  It is suggested that minority sexual orientation groups have a greater risk of experiencing discrimination, victimization, and antigay stigma which can influence the disorders that may be apparent.


{Almeida et al, 2009} Almeida et al., (2009) evaluated emotional distress among LGBT youth, considering how perceived discrimination based particularly on their sexual orientation could mediate the experience of emotional distress in those who identify as LGBT. A school-based sample (n = 1,032) was taken from Boston, Massachusetts school-aged children (9th-12th graders), of which 10% identified as LGBT. When compared to heterosexual, non-transgendered youth, the LGBT group endorsed significantly higher depressive symptoms, suicidal ideation (30% vs. 6%), and self-harm behaviors (21% vs. 6%). Prevalence of self-harm behaviors was particularly high among LGBT males (41.7%). 7% of respondents reported some level of discrimination for being perceived as LGB. Discrimination was significantly more likely in non-heterosexual youth than heterosexual youth (33.7% vs. 4.3%), and significantly more likely in LGB males than females (50% vs. 25.3%). Perceived discrimination based on sexual orientation and LGBT status were associated with increased depressive symptoms in men, but not in women.


{Toro-Alfonso and Rodriguez-Madera} Toro-Alfonso & Rodriguez-Madera (2004) offers a descriptive study of 199 Puerto Rican gay males in order to outline the prevalence of domestic violence in same-sex relationships, violence in family of origin, addictive behaviors in the participants, exposure to addictive behaviors and violence in childhood, and conflict resolution skills.  2/3 of the sample were in a stable relationship at the time of the study, and 74% indicated having had no more than three committed relationships in their lives. Nearly half of participants reported domestic violence in their intimate partner relationships. Two perspectives were offered on domestic violence, namely the report of the partner’s action and the report of the participant’s action towards the partner. Participants tended to report that they were victims as opposed to aggressors, and the most frequent abusive behavior was identified as emotional violence as opposed to physical and sexual. Severity of these experiences was not explored. While forty percent of the participants indicated emotional abuse from their partner, few perceived this as domestic violence. 54% of participants reported experiencing or witnessing violence in childhood households. A relationship was found between childhood experiences of violence and adult physical and emotional violence with partners. Compulsive or addictive behaviors with alcohol, drugs, food, and/or sex were identified by half of participants, and were also highlighted as habits in their family of origin. Most of the participants showed a violent approach to conflict resolution, and 69% indicated moderate skills of assertiveness. ¼ of the participants indicated that they were victims of sexual manipulation or coercion, potentially putting them at risk for HIV infection. 


{Stanley et al, 2006} Stanley et al., (2006) explores the characteristics of male same-sex intimate violence, including patterns of violence, surrounding context, resulting consequences, underlying motives, and reoccurring themes in violent relationships. A sample of 69 gay and bisexual men, all reporting 1+ violent episodes in an interview exploring their intimate relationships, were taken from 300 recruited individuals who did a preliminary phone interview. Physical violence was defined as an act carried out with the intention, or perceived intention, of causing physical pain or injury to another person. Emotional or psychological aggression, more difficult to define, was also examined in the study. 75% of the sample indicated 4 or less violence incidents, while 44% indicated only one violence incident. Emotional abuse was endorsed by 63 participants, and the average rating included behaviors such as yelling, using harsh language or engaging in passive-aggressive behaviors. Physical violence indicated increased likelihood of emotionally-abusive behaviors, higher rates of emotional abuse were related to more severe physical and emotional consequences as well. 88% of incidents resulted from escalation of an argument. Consequences included physical injuries, hurt, anger, embarrassment, and fear. The seriousness of an injury positively correlated with emotional impact of the incident. 84% of these relationships had ended at the time of the interview, although the end of the relationships were not typically consequences of the violence. Those who did end their relationships as a result of the violence seemed to experience the more extreme forms of physical violence. Control only appeared to be central in the violence in six of the interviews. A demand-withdraw interaction led to greater likelihood of physical violence. Other themes emerging were uneven emotional investment in the relationship (28% of sample), infidelity (20% of sample), and violence as the relationship was coming to an end (23% of the sample). 


{O’Leary et al, 2003} O’Leary et al (2003) considers whether a history of childhood sexual abuse predicts sexual behavior with risk of HIV transmission to others in an HIV positive cohort. This is not a population-based sample. A sample of 456 HIV positive men who have sex with men from New York and San Francisco were recruited and child sexual abuse was significantly associated with unprotected anal sex in the last 90 days with partners who were HIV-negative and partners with unknown serostatus. Predictors of this effect included anxiety and hostility with insertive acts, and anxiety, hostility and suicidality with receptive acts. While childhood sexual abuse predicts anxiety, hostility, and suicidality, which in turn predict sexual risk behavior, mediation was found for receptive, but not insertive intercourse. Additional mediators are also likely, as the mediation by factors related to distress and anxiety only accounted partially for the association between childhood sexual abuse and receptive intercourse. This indicates the importance of mental health services for those who are victims of childhood sexual abuse to protect against sexual risk behaviors.  


{Nieves-Rosa et al, 2008} Nieves-Rosa, Carballo-Dieguez & Dolezal (2008) evaluated the risk for domestic abuse and HIV-related risk behavior in a Latin American male sample of 273 men having sex with men in New York. 51% of men reported one experience of domestic abuse in same-sex relationships, although only 26% considered themselves victims of this abuse. 20% endured physical abuse in their current relationships. Since 1981, 12% indicated coercive sexual behavior without condoms by one of their partners. 33% indicated verbal and psychological abuse, and 35% indicated physical but not sexual abuse by atleast one partner. 50% of individuals stated they were sometimes or always under the influence of alcohol or recreational drugs when the abuse occurred. Those who experiences domestic abuse were likely to have lower self-esteem and lower self-worth than those who had not. Significant relationships emerged between domestic abuse and engaging in unprotected anal sex, use of marijuana, cocaine, and heroin and domestic abuse victimization. Another relationship was found between having experienced childhood sexual abuse and feeling hurt by it, and experiencing physical and sexual abuse in adulthood. 


{Krahé et al, 2000} The article by Krabé, Schütze, Fritsche, and Waizenhöfer (2000) seeks to find a prevalence of sexual victimization, aggression, and an overlap of the two within the homosexual population. This study was tested by completion of surveys in a test group of 310* homosexual men in Germany. These surveys are derived from a “Sexual Experience Survey,” but for the purpose of this study they revised it to target their population. First, the authors found that when it came to sexual victimization the most prominent category was sexual touch with exploitation of incapacitated state. Second, the authors found that when it came from a perpetrator perspective again the men used sexual touch while their victims were in an incapacitated state. Lastly, this study found that one third (35.4%) of these men fell into both categories of being a victim and a perpetrator. Meaning that homosexual men who have been victimized still have the possibility of becoming the perpetrator. * N dropped from 310 to 161 men due to the fact that some men were neither victimized or perpetrators.


{Kalichman et al, 2001} Kalichman et al., (2001) explores the relationship between unwanted sexual experiences in childhood/adulthood and HIV risk behavior in men attending a gay pride event in GA (N=595), utilizing survey data which measures sexual history, substance use, sexual-risk behavior and symptoms of dissociation, trauma-related anxiety, and borderline personality. 1 in 3 men (35%) reported lifetime history of unwanted sexual intercourse because of threats or use of force. Half of the sample indicated coercive sexual experiences in adulthood while half indicated sexual abuse in childhood. Among those who were sexually coerced as adults, 44% had unwanted sexual intercourse due to the threat of abandonment, 50% were due to the threat to use force, 53% were a result of force, and 37% of coerced men experienced more than one type of adulthood sexual coercion. The average age of first unwanted sexual coercion was 21.8 years and the average age of the man who was sexually coercive at that time was 29.4 years. Men who were sexually coerced into unwanted sexual relationships in adulthood were more likely than those who were not pressured or forced as adults to report substance use treatment in the last six months, high-risk sexual behaviors such as unprotected anal intercourse, symptoms of dissociation, trauma-related anxiety, and borderline personality. Sexual victimization in adulthood, after being victimized in childhood was not associated with increased risk behavior beyond that of those who experienced adult unwanted sexual experiences. Lower income, positive HIV status, greater powered cocaine use, all significantly predicted multiple unprotected anal intercourse partners. Sexual coercion in adulthood was also a significant predictor of multiple unprotected partners, although childhood sexual abuse history was not. 


{Krahé et al, 2001} Krahe et al. (2001) conducted a study to examine possible risk factors of sexual aggression and victimization among homosexual men. After surveying 310 self-identified homosexual males in Berlin, Germany, their findings showed that sexual aggression is a real issue among homosexual men. Over 25% reported severe victimization. Almost 20% of respondents reported sexually aggressive behaviors. Participants responded to a questionnaire regarding 2 primary potential risk factors for sexual victimization and aggression: adverse childhood experiences (physical and sexual abuse and emotional neglect) and sexual lifestyle (number of partners, age of first sexual intercourse, age of coming out, accepting/paying money for sex, and rape proclivity). The results demonstrated that the risk of victimization increased for those who experienced childhood abuse, as well as for those who reported a high number of sexual partners and acceptance of money for sex. The perpetration of sexual aggression was positively related to childhood abuse, acceptance and payment of money for sex, high number of sexual partners, and rape proclivity. The findings of this study, though not exhaustive, support the view that the dynamics of sexual aggression and victimization are similar for both hetero- and homosexuals.


{Garcia et al, 2002} Garcia, Adams, Friedman, and East (2002) conducted a questionnaire to assess the links between childhood abuse, suicidal tendencies, and sexual orientation. In the study, the researchers found that gay, lesbian, and bisexual individuals typically had higher rates of sexual abuse in their childhood and were significantly more likely to consider committing suicide than their heterosexual counterparts. In fact, gay and bisexual individuals were 2.9 times more likely to consider suicide as compared to heterosexuals, and lesbian women specifically were 3.7 times more likely.


{Dank et al, 2014} Dank, Lachman, Zweig, and Yahner (2013) conducted a cross-sectional survey to compare physical, psychological, cyber, and sexual violence within dating relationships between LGBT (lesbian, gay, bisexual, and Transgender) and heterosexual youth. The survey, conducted on middle school and high school students, also assessed risk factors such as performance in school, parental involvement, risk behaviors, and mental health. The results of the study showed that LGBT individuals had significantly more violent relationships (both as a victim and a perpetrator) than heterosexuals with transgenders having the highest rates. Additionally, LGBT also had worse grades, higher rates of delinquency, worse mental health, used more alcohol, and were involved with more sexual behaviors.


{Diamant and Wold} Diamant and Wold (2003) conducted a survey to compare the levels of mental and physical health among lesbian and bisexual women to that of heterosexual women. To survey the participants, the researchers used the Los Angeles County Health survey to determine sexual orientation, physical, and mental health. Results of the study showed that lesbians and bisexuals had significantly higher rates of medical conditions such as heart disease as well as higher rates of depression as compared to their heterosexual counterparts.


{D’Augelli et al, 2005} In order to determine predictors of LGB related suicide attempts, D’Augelli et al. conducted three interviews over a 2-year period with 528 LGB female and male teenagers between the ages of 15 and 19 during which they collected data on development of sexual orientation, childhood gender-atypical behavior, victimization experiences, suicide attempts, and family history of mental health problems. Criteria for meeting serious suicide attempts reduced the final sample size to 361 LGB youth. Results indicate that youth whose suicide attempts were due to sexual orientation were more likely to have behaved in gender-atypical ways as a child and more likely to have experienced psychological and verbal abuse from parents responding to their behavior or their identification as LGB. Compared to lesbian and bisexual females (38%), more gay males (59%) reported suicide attempts directly related to sexual orientation. While cautioning the generalizability of the study’s results, the authors conclude that childhood gender development, parental conflict over gender atypical behavior and other sources of victimization may contribute to mental health concerns, including serious suicide attempts.


{Alexander 2002} Alexander (2002) examines the incident rates for domestic violence in gay and lesbian relationships. Citing five studies he estimates prevalence rates at 25% – 50%, which he notes is comparable to rates of violence in heterosexual relationships. Of particular interest to Alexander is a recent study by Merrill and Wolfe (2000) that surveyed 52 gay men between the ages of 25 and 50 and reported that 87% of these respondents experienced severe abuse and 79% of the respondents had suffered at least one injury. Alexander concludes that the issue of violence in gay and lesbian relationships is a serious safety concern that professionals in mental health, law enforcement, and the medical fields must address in a more consistent, effective manner. The author stresses that this is especially important given the consistency of these particular findings compared to other areas of research in gay and lesbian mental health.


{Rawstorne et al, 2007} Rawstorne, Digiusto, and Worth examine the link between crystal use and risky sexual behavior using data from the Sydney Gay Community Periodic Survey (SGCPS) and the Positive Health (PH) study of HIV+ gay men. The SGCPS sampled 7,354 men between the years of 2002 and 2005 and is a self-administered questionnaire that gathers data on sexual behaviors, unprotected anal intercourse (UAI), HIV status, drug use, and general demographic information. The PH is a longitudinal study that collects data from its enrollees through interviewer-administered questionnaires on various aspects of their HIV/AIDS treatments and sexual behavior. Although analysis of the data from these two surveys is consistent with other findings that indicate an association between crystal use and risky sexual behavior, the authors found no evidence for a causal relationship since increasing use of crystal over time was accompanied by either a decrease or no change over time in unprotected anal intercourse with casual partners. The authors conclude that crystal use and risky sexual behavior should be addressed as two separate problems and suggest further research on other variables that may influence the association between the two such as relationship status, mental health, personality factors, cultural and community influences and experiences.


{Hughes} In an attempt to challenge possible over-inflation of alcohol abuse reported in earlier studies of lesbians, Hughes (2003) conducted a study of 63 lesbian and 57 heterosexual women, focusing on recruiting women aged under 25 and over 50, with income below $10,000, with education of high school or less, and who are black or Hispanic (about a third were white), in order to arrive at a more diverse sample. The rates of alcohol abuse were lower than in previous studies, but still higher than the heterosexual control group. In the past 12 months, the lesbian women were more likely to have had a drink (24% versus 16% for the heterosexual women) and to have experienced negative consequences from drinking. The lesbian women were also significantly more likely to be in recovery for alcohol use disorders (16% versus 2%) and to perceive themselves as having a drinking problem (46% versus 16%). Hughes (2003) also studied risk factors that might predict alcohol use. Sixty-eight percent of the lesbian women reported childhood sexual abuse (compared to 47% for the heterosexual women). Both lesbian and heterosexual women reported similar rates of adult sexual assault (39% lesbian, 42% heterosexual); with the perpetrator more likely to be a family member for the lesbians and more likely to be a boyfriend or a date for the heterosexual women. The lesbian women reported higher rates of having at least one depressive episode over the past 12 months (67% versus 53%), suicidal ideation (65% versus 40%), and suicide attempts (30% versus 21%).


{Wong et al, 2010} Wong, Weiss, Ayala, and Kipke (2010) studied 526 gay- and bisexual-identified white, black, and Hispanic men from Los Angeles ages 18 through 24 and the relation between violence, discrimination, and drug use over the past three months. They found that financial hardship, social discrimination (both sexual and racial), and intimate partner violence were predictors of substance abuse. While growing up, 25% reported witnessing violence in the home, 23% reported sexual abuse, and 20% reported physical abuse. Ninety-eight percent experienced forms of harassment and assault over their sexuality and/or gender nonconformity in their lifetime. The ethnic minorities reported 79% incidence of experiencing racism in gay and sexual relationships, and 51% claimed experiences of institutional racism. Of the types of intimate partner violence (IPV), 41% reported emotional abuse, 23% physical, 18% sexual, and 12% reported being the perpetrator. The white participants were more likely to report emotional and physical IPV and drug use. However, the black and Hispanic participants showed that they were more likely to use substances when they experienced racism in a sexual context, yet institutional racism was related to a decreased risk of drug use.


{Needham & Austin} A study of 11,513 young adults found that gay, lesbian, and bisexual men and women reported both lower levels of parental support and connection and higher rates of depression, suicidal ideation, and substance abuse (Needham and Austin, 2010). The authors concluded that these health risks were partially or fully mediated by the lack of parental support.


{Pathela & Schillinger} Pathela & Schillinger (2010) explored the sexual behaviors, sexual identity, and sexual violence amongst adolescents with opposite-sex, same-sex, and both-sex partners. The sample was taken from the 2005-2007 New York City Youth Risk Behavior Surveys of 3898 (55.2%) male and 3501 (43.8%) female teens reporting having sexual intercourse. Of these individuals, 9.3% (approximately 1/10) reported a same-sex partner, a higher estimate than other published rates. Similar numbers of sexually active male (3.2%) and female adolescents (3.2%) reported only same-sex behavior, but fewer male than female adolescents reported both-sex partners. Males with both-sex partners reported higher sexual risk behaviors than males with only opposite sex partners, and increased risk to report of alcohol and drugs with the last sexual encounter, no use of condoms, and victimization of intimate partner violence in the last year than those with opposite sex partners. Males indicated fewer both-sex partners (3.7%) than women indicated (8.7%). Females with both-sex or only same-sex partners indicated higher risk behaviors than females with only opposite sex partners. Adolescents with both-sex partners reported higher prevalence of dating violence and forced sex. 38.9% of adolescents with only same-sex or both-sex partners identified as straight. Among sexually active teens, 90.9% identified as heterosexual, 1.1% as gay/lesbian, 5.4% as bisexual, and 2.6% as unsure of their sexual identity.


{Morgenstern et al, 2011} Morgenstern et al., (2011) explores the non-paraphilic compulsive sexual behavior (NPCSB) in 183 gay and bisexual men in New York City who reported difficulty with controlling their sexual behavior. Compulsive sexual behavior (CSB) is characterized by sexual fantasies and behaviors that increase in frequency and intensity in such a way that they interfere with personal, interpersonal, or vocational pursuits. NPCSB are distinct from paraphilias in that they are not identified as socially deviant behaviors, and may include compulsive masturbation, extensive pornography use, and sexual behaviors with multiple anonymous partners. This study intended to clarify the potential diagnostic classification of NPCSB, since many studies have shown that such behaviors may solely be manifestations of another underlying disorder. The study explored the reliability and descriptive validity criteria of an addictive disorder, as applied to NPCSB. Six categories of sexually problematic behaviors were identified, including anonymous/casual partners, violating relationship parameters, internet/phone, known partners, masturbation, pornography, and romantic obsession. The most frequently endorsed behavior was sex with anonymous/casual partners, with an average of 29.8 partners in the last 90 days. Internet/phone use for sexual purposes was on average 10 hours/week and the next most frequently endorsed category. 43.7% indicated other problematic behaviors, and excessive fantasy was 60% of the other category. Participants reported, on average 2.9 hour/day thinking about sex and 3.7 hours per day engaging in sexual activity, defined as sexual behavior outside of thoughts. 91.8% of the sample reported experiencing more than one problem behavior. 97.8% endorsed three or more DSM-IV dependence criteria adapted for NPCSB with the average being 5.4/7 possible criteria. 94% indicated significant distress/impairment. Results indicated that the problem is rarely temporary and has frequently stayed the same or become worse over time (76.1%) High levels of Axis I disorders were endorsed, particularly major depression. 15.8% of the sample endorsed paraphilias. 34.5% of participants did not report any current Axis I disorder, challenging the notion that NPCSB is a secondary result of another underlying disorder.


{Boroughs et al, 2015} Boroughs et al., (2015) explored the experience of childhood sexual abuse and its impact on various disorders and sexual risk behavior among 167 adult men who have sex with men. This study created five indicators of complex CSA experiences, including CSA by family member, with penetration, with physical injury, with intense fear, and first CSA in adolescence. Participants with CSA by a family member were at 2.6 offs of current alcohol use disorder, two times higher likelihood of substance use disorder, and 2.7 times higher odds of reporting an STI in the last year. CSA with penetration was associated with increased likelihood of current PTSD, recent HIV sexual risk behavior, and a greater number of casual sexual partners within the past three months.  Physical injury during CSA led to 4x higher odds of current PTSD than those without physical injury and intense fear was at 5x higher odds for current PTSD. First CSA in adolescence was related to decreased odds of major depressive disorder when compared to those abused in childhood. 81% of the sample indicated multiple episodes of CSA before age 13, while 51% endorsed sexual abuse between the ages of 13-17. All but two (CSA with penetration/with family member; first CSA in adolescence and CSA with family member) indicators were significantly related to one another.


{Alexander 2002}  Two large national studies conducted in the early 2000s seem to confirm the findings of several smaller studies conducted over the years that homosexuals are at a greater risk for psychiatric disorders and suicide. The first study (Gilman et al., 2001) was titled “Risk of Psychiatric Disorders Among Individuals Reporting Same-Sex Sexual Partners in the National Comorbidity Survey”. Using a nationally representative questionnaire of household people ages 15-54 years old, it was found that individuals with same-sex partners had a generally increased risk for mood and anxiety disorders, and particularly substance use disorders, possibly due to the stress associated with discrimination. The second study (Russell and Joyner, 2000) titled, “Adolescent Sexual Orientation and Suicide Risk: Evidence from a National Study”, is the largest comprehensive study of adolescents in the United States to date (2002), including more than 12,000 adolescents in grades 7 through 12. They reported 7% of youth having had a same-sex romantic attraction or relationship and these youths were two times more likely to attempt suicide than their heterosexual peers. Compared with their heterosexual peers, they also reported significantly more alcohol abuse and depression. Though these studies do have limitations, they confirm the results of several smaller past studies, that homosexuality does present certain risk factors, particularly in the areas of suicidal ideation in adolescence and substance dependence and psychiatric disorders in adulthood.


{Russell & Keel} The objective of this study (2001) was to determine whether homosexuality is a specific risk factor for disordered eating in men. 122 men (64 – heterosexual, 58 – homosexual) completed the following tests: the Beck Depression Inventory (BDI), the Rosenberg Self-Esteem Scale (RSE), the Masculinity and Femininity scales of the Bem Sex-Role Inventory (BSRI), the Bulimia Test-Revised (BULIT-R), the Eating Attitudes Test (EAT-26), and the Body Shape Questionnaire (BSQ). The findings of the study are consistent with previous research and show that, compared to heterosexual men, homosexual men have greater body dissatisfaction and higher levels of bulimic and anorexic symptoms. Additionally, homosexual men report higher depression, lower self-esteem, and less comfort with their sexual orientation. The fact that homosexual men report greater disordered eating, even after controlling for symptoms of general psychological distress, indicates that homosexuality may be a specific risk factor for eating disorders among men.


{Hospers & Jansen} The present study (2005) conducted by Maastricht University, The Netherlands, examined the role of gender role orientation, peer pressure, self-esteem, and body dissatisfaction in relation to eating disorder symptoms among a sample of homosexual and heterosexual men. 239 subjects responded either to online or paper questionnaires, composed of the following: personal information (sexual orientation, body height, and weight), the Eating Disorder Examination Questionnaire (EDE-Q), the Body Shape Questionnaire (BSQ), the Rosenberg Self-Esteem Scale (RSE), the Bem Sex Role Inventory (BSRI), and a peer pressure scale designed by the authors. The initial results showed an interrelation between most variables; however, multivariate regression analyses found that, contrary to the original hypothesis, it was body dissatisfaction, not self-esteem that was the dominant predictor of eating disorder symptoms. For both hetero- and homosexual male subjects, a higher level of body dissatisfaction was related to a higher Body Mass Index (BMI), more peer pressure, and lower masculinity scores. The relationship between peer pressure and body dissatisfaction was substantially more pronounced among homosexual men. When taking body dissatisfaction into account, the study found no significance in the relationships between eating disorder symptoms on the one hand and sexual orientation, gender role orientation, and peer pressure on the other hand. The results of this study indicate the primary role of body dissatisfaction in the relationship between homosexuality and eating disorder symptoms, as well as the significant role played by peer pressure.


{Boisvert & Herrell} Boisvert & Harrell (2009) explored the risks for eating disorder symptoms in 230 gay and heterosexual men. It tested a path model of eating disorder symptomatology risk factors, including sexual orientation, body shame, body mass index (BMI), weight discrepancy, and age. Higher body shame is defined as the degree to which an individual internalizes body-related cultural expectations, such as thinness, which are linked to the belief that achieving these standards is possible, and that one is a bad person if these standards prescribed to them are not met.  Gay men had significantly lower BMIs than heterosexual men and higher eating disorder symptom scale scores than heterosexual men. 45% of the variance in EDI (Eating Disorder Inventory) scores were explained by body-shame, BMI, weight discrepancy and age. Increased body shame was most strongly associated with higher eating disorder symptoms, and was a stand-alone construct, and not a mediator. None of the other variables impacted body shame. This strong effect was followed by BMI, with heavier men reporting greater weight discrepancy between their real and ideal figure size, and increased eating disorder symptomatology as a result. BMI was an independent predictor and mediating variable with weight discrepancy of eating disorder symptoms. Being gay, when controlling for BMI, resulted in greater weight discrepancy. Scores increased when individuals perceived a discrepancy between actual and ideal weight. A thin muscular body ideal, emphasizing lower weight and physical attractiveness largely based on lean muscles, applied to younger rather than older gay men. Older men had higher EDI scores to the extent they had higher BMI. 


{Alvy et al, 2011} Alvy et al (2011) collected cross-sectional data from 871 men who have sex with men using brief anonymous surveys from gay/bisexual venues in 2001 in Chicago. General population data from the National Health Interview Survey (NHIS) was used to provide a comparison sample, evaluating both health care access and behavioral health problems in men who have sex with men and a broader male sample. The study explored health care access, smoking status, depression, and alcohol use. Results indicated that men who have sex with men are reporting significantly less health care access than those in the NHIS sample. Men who have sex with men also indicate significantly more behavioral health problems, including smoking, depressive symptoms, and heavy alcohol use. Participant reports of a recent health care visit mediated smoking status differences, accounting for 46% of the variance in greater smoking rates and 57% of the variance in depressive symptoms, for men who have sex with men.  This was not a significant mediator of differences in sample heavy alcohol use, however.


{Beidas et al, 2011} Beidas, Birkett, Newcomb & Mustanski (2012) explore the relationship between psychological distress and sexual risk-taking behaviors, seeking to understand whether this is moderated by the presence of psychiatric disorders. This longitudinal study used a sample of 119 mid-western 16-20 year old men who have sex with men, observing them for 24 months utilizing structured diagnostic interviews and a measure of psychological distress administered periodically over the course of that time. The study attended to the effects of psychiatric disorders and psychological distress on total male partners and total unprotected anal sex acts, as well as the moderating effect of MDD and PTSD on the association between distress and these two sexual risk behaviors. Of the participants across four time points, they reported an average of 1.37+-2.47 unprotected anal sex acts and an average of 1.25+-1.36 male partners per wave. A mean score of distress indicated .73+-.70 out of a range of 0-4. 5.9% of participants met criteria for PTSD in the past year and 14.3% met criteria for MDD. For each additional year of getting older, participants had 22% fewer partners, indicating potential maturation effects, but age was not significantly associated with number of unprotected anal sex acts. There was no significant association between distress and number of male partners or number of unprotected anal sex acts. No moderating effect of PTSD or MDD on relationship between psychological distress and male partners was significant. A main effect of MDD was significantly related to number of unprotected anal sex acts but not when evaluated as a moderating variable between psychological distress and anal sex acts (Those with MDD at baseline had 49% more anal sex acts than those without it at baseline.) African Americans had 50% fewer unprotected sex acts than non-African American participants. Also, the effect of PTSD on the relationship between psychological distress and unprotected anal sex acts was significant, in that those who met criteria for PTSD endorsed more unprotected anal sex in Time points when their distress level was low. However, the sample size of those who met criteria for PTSD was n=7, making this finding preliminary.


{Bolton & Sareen} Bolton & Sareen (2011) explored the rates of Axis I and II mental disorders and suicide attempts in sexual orientation minorities with rates in heterosexuals. Lesbian and bisexual women demonstrated a 3-fold increased likelihood of substance use disorders and gay and bisexual men showed twice the rate of anxiety disorders and schizophrenia and psychotic illness. Bisexual men had a higher lifetime prevalence of mood disorder, anxiety disorder, Cluster A personality disorders, and suicide attempts. Suicide attempts were independently associated with bisexuality, with odds 3 times higher than heterosexual participants. One-quarter of all bisexual women have attempted suicide in their lifetime. Prevalence of schizophrenia and psychotic illness/episode were high in gay men and men who were not sure of their sexual orientation.  Lesbians were 1.5 times more likely for anxiety disorders and 3.4 times more likely for substance use disorders to have experienced a mental disorder in their lifetime, after adjusting for sociodemographic factors. For women who were unsure of their sexual orientation, they were twice as likely to experience substance use disorders and Cluster B personality disorders.


{Steele et al, 2008} Steele et al., (2008) explored mental health service use among 64 LGB mothers or prospective mothers. The measures included past-year mental health service use, perceived unmet need for mental health services, and a variety of sources of care including psychiatry, family doctors, OBGYNS, midwifes, psychologists, nurses, counselors, psychotherapists, religious or spiritual advisors. 1/3 reported some mental health service use within the past year, 30.6% reported a perceived unmet need for mental health services in the past year, and 40% of these women identified barriers to treatment keeping them from mental health services. Most frequently there were reports of unmet needs for therapy or counseling or for help with relationships. Reasons for not seeking care included a preference to manage the problems and financial barriers. Non-biological parents were least likely to have used mental health treatment, while those trying to conceive were most likely to have used mental health services in the past year. Those LGB individuals trying to get pregnant or were less open about their sexuality were more likely to have recent mental health service use. 90.5% of participants disclosed their sexual orientation to the doctor, while only 23.8% of the participants reported that providers inquired about their sexual orientation. 1/5 of participants (18.8%) reported three or more episodes of perceived discrimination.


{Reich & Zanarini} Reich & Zanarini (2008) is a longitudinal study which assessed the prevalence of homosexuality/bisexuality and same-sex relationships in 362 hospitalized individuals, 290 of whom have borderline personality disorder (BPD) and 72 comparison subjects with other personality disorders, based on DIB-R and DSM-III-R criteria. These participants were interviewed with a semi-structured interview about their sexual orientation and the gender of intimate partners. Those with BPD were significantly more likely than comparison individuals to report homosexual or bisexual orientation and intimate same-sex relationships (75% more likely) and to report changing the gender of intimate partners (more than three times as likely) but not sexual orientation at some point in the five 2-year follow-up intervals. Those borderline participants with a reported family history of homosexual/bisexual orientation were 72% more likely to report homosexual/bisexual orientation and/or same sex relationships.


{Semlyen et al, 2016} Semlyen, King, Varney, & Hagger-Johnson (2016) explores the relationship between sexual orientation and various symptoms of mental disorders, suicide and substance misuse, drawing from 12 population surveys in the UK from 2008-2013. Of 94,818 adult participants, 1.1% identified as lesbian/gay, .9% as bisexual, .8% as ‘other’, and 97.2% as heterosexual. Measured covariates included sex, ethnic group, educational attainment, smoking status, longstanding illness/disability, and married or co-habiting. Adjusting for covariates listed above, Lesbian/Gay adults had higher prevalence of a common mental disorder, comprised more men, were significantly younger, were fewer ethnic minorities, had higher levels of educational attainment, were more often smokers, and were less frequently married/cohabiting, when compared to heterosexuals, although this varied based on age group. This prevalence was apparent for those under 35, weaker at age 35-54.9, and strongest at age 55+ (2 times the risk of mental health symptoms). Effects were stronger for bisexual adults.


{Gartrell et al, 2011} Gartrell, Bos, & Goldberg (2011) explores the sexual orientation, sexual behavior, and sexual risk exposure of 17-year olds whose mother’s idenfied as lesbian. Online questionnaires provided data on 78 adolescent offspring (39 boys and 39 girls). Adolescents specified history of abuse, nature of abuse, sexual identity using the Kinsey Scale, and lifetime sexual behaviors. None of the adolescents indicated physical or sexual victimization by parent of other caregiver. Of the individuals raised by same-sex parents, 18.9% of the adolescent girls and 2.7% of adolescent boys self-rated on the bisexual spectrum. 0% of the girls and 5.4% of the boys self-rated as predominantly-exclusively homosexual. Study offspring were significantly older at the time of first heterosexual contact, and daughters of lesbian mothers were significantly more likely to have had same-sex contact and more likely to have used emergency contraception.


{Flentje et al, 2015} Flentje et al., (2015) explores the differences in mental and physical health needs of LGB individuals in substance abuse treatment in San Francisco. It identifies differences in mental and physical health problems and service utilization between LGB (n=1,441) and heterosexual individuals (n=11,770). Findings indicated that those who identified as LGB more frequently had mental health diagnoses and current mental health prescription medications, when compared to heterosexual individuals. Of the LGB individuals, Gay men and bisexual women were more likely to report physical health problems and to endorse recent reception of mental health treatment. Gay and bisexual men and bisexual women, but not lesbian women were more likely to be receiving health care. No difference was found in utilization of emergency room or hospital overnight stays. 


{Messinger} In this study Messinger (2011) investigates the association between sexual orientation and incidences intimate partner violence (IPV) by analyzing existing data from a section of the National Violence Against Women Survey (NVAWS) that dealt with violence and threats of violence. The sample size included 14,182 adult (ages 18 and older) men and women who had at some point in their life been in a romantic, cohabitating, or married relationship. Findings indicate that rates of IPV are significantly higher among gay, lesbian, and bisexual partners than among heterosexual partners. Furthermore lesbian women appear to commit IPV more than heterosexual men and IPV appears to be higher among bisexual individuals than homosexual or lesbian individuals, with acts of IPV in these cases being committed more often by the opposite sex partner. Messinger concludes that this study is important because the sample can be generalized to the national population and because it is a first step in raising awareness of an underserved need in the gay, lesbian, and bisexual (GLB) community.


{Parnes et al, 2016} This study examines the association between sexual orientation and substance use in a sample of 7,732 undergraduate college students who were over the age of 18 and recruited from psychology courses at a Colorado and Pennsylvania university. Participants took a survey that assessed for substance use with the Risky Behaviors Inventory and assessed sexual orientation using both an open-ended question and a 7-point scale based on the Kinsey scale. Results indicated that a quadratic relation exists between sexual orientation and substance use, with bisexual women using alcohol, marijuana, and tobacco more frequently than heterosexual or homosexual women. The same correlation was found among men but only with marijuana use. The authors conclude that this study suggests the importance of examining sexual orientation on a spectrum rather than in distinct categories and that men and women who are bisexual may be at a higher risk for substance use than hetero- or homo- sexual men and women only.


{van Griensven et al, 2004} A survey of 1725 adolescents and young adults showed the differences in sexual practices and related health risks between heterosexual and homosexual/bisexual males and females in Thailand (van Griensven et al, 2004). The ages of the participants ranged from 15 to 21 years old. Nine percent of the males and 11.2% of the females identified as either homosexual or bisexual (HB), with the women far more likely to be bisexual. Among males, the HB group had an earlier mean age of sexual activity debut (age 14.7 compared to 16.8 in heterosexuals), and a higher average number of lifetime partners so far (7.9 compared to 5.8). The HB males were 12% more likely to have engaged in prostitution. For nearly all HB males who experienced sexual coercion, the first assailant had been male. The HB males reported that they considered themselves at significantly greater risk for HIV and STDs, but they were much less likely than their heterosexual counterparts to be tested. The HB males also indicated and showed more signs of social isolation and depression. Among the females, the HB group reported significantly more frequent drug use in the past three months (the opposite was true for the males). Similar to their male counterparts, the HB females were far more likely than the heterosexual females to prostitute (14.1% compared to 3.5%). Both males and females who were homosexual or bisexual reported a significantly greater rate of being sexually coerced (25.9% in males and 32.2% in females, compared to 4.6% in male and 19.6% in female heterosexuals).


{Lock & Steiner} The authors conducted a community school-based health survey of 1,769 students during the 1993-1994 academic year at 2 upper middle class high schools in Northern California. The survey offered an opportunity to self identify as gay, lesbian, or bisexual, or to report that they were unsure of their sexual orientation. Consistent with other published studies, gay, lesbian, and bisexual youth were found to show an increased risk for mental health issues, sexual risk-taking, and general health risks compared with their heterosexual peers. However, differing from existing clinical and convenience sample studies, they were not found to be at a greater risk than their heterosexual peers for substance abuse, homelessness, or truancy. Though the study has limitations, these results suggest that variables such as socio-economic status and educational level may reduce risks for certain health problems in gay, lesbian, and bisexual youth.


{Kelen et al, 1992} This study tested 2,523 inner-city emergency department patients for hepatitis B virus, hepatitis C virus, and the human immunodeficiency virus – type 1 (HIV) and obtained information on the patients’ risk factors for acquiring them (intravenous drug use, homosexual or bisexual activity in men, receipt of blood products, or heterosexual activity with a partner who had any one of these risk factors). Of the 2,523 patients tested, 612 (24%) were found to have at least one of the three viruses. Individuals reporting homosexual activity as their only risk factor (21% of sample) possessed high rates of all three viral infections, with 79% of these showing signs of at least one of the viruses. Multivariate logistic regression showed that the only risk independently associated with the hepatitis B surface antigen (HBsAg) was homosexuality.


{Darrow et al, 1981} Darrow et al. (1981) analyzed data collected via questionnaire from 4,212 gay men to assess risk factors for sexually transmitted diseases among gay men. The questionnaire was distributed across the United States through 1,800 organizations listed by the National Gay Task Force and used both close ended multiple choice questions and open ended short answer and essay questions on specific sexual acts, sexual experiences, relationships, sexually transmitted diseases, self-image, and social exclusion. The authors analyzed data on 168 of the 623 multiple choice and short answer questions from the survey and found that the number of lifetime sexual partners best predicted the number of sexually transmitted diseases contracted. The study also indicated that specific sexual activities such as anal intercourse, homosexual prostitution, sex in bathhouses and secretive sexual activities were significantly associated with sexually transmitted diseases. Although the authors note that these results cannot be generalized to all homosexual men it is an important first step in developing and implementing disease prevention and treatment in this population.


{Casper et al, 2002} In this study Casper et al. (2002) examined the risk factors associated with the herpes virus KSHV infection and resulting clinical symptoms in homosexual men. The authors recruited 575 HIV-negative homosexual men in the Seattle area, all of whom were 18 years of age or older and had had anal sex in the past 12 months. Participants were screened for KSHV and assessed for sexual history and behavior at the beginning of the study and at follow up appointments periodically throughout the next 12 months. Results indicated a high prevalence and incidence rate of KSHV in this group and also noted a significant correlation between KSHV infection and a higher numbers of sexual partners and the presence of other sexually transmitted diseases. Although there appears to be an association between prevalence of KSHV and high rates of multiple sexual partners, the authors conclude that further study is needed to determine conclusive risk factors for acquiring and transmitting KSHV.


{Renzi et al, 2003} Renzi et al,. (2003) explored the association between HIV acquisition and herpes simplex virus type 2 (HSV-2), the cause of genital herpes, among men who have sex with men (MSM) by way of a nested case-control study performed within 2 multisite cohort studies drawing from individuals who were HIV-seronegative MSM and had anal sex within the past year. The subjects included 116 subjects who seroconverted to HIV after 18-month follow-up and 342 control subjects who remained HIV seronegative with follow-up duration and reported HIV-infected sex partner and unprotected anal sex within that timeframe, shown to be the two most important risk factors for HIV acquisition. Baseline HSV-2 seroprevalence was significantly higher among case (46%) than control (34%) subjects, while seroincidence was 7% vs. 4%, although this difference was not significant. 15% of HSV-2 infected MSM reported herpes outbreaks in the past year. HIV acquisition was associated with racial/ethnic minority states, lower likelihood of health insurance coverage, greater likelihood of injection drug use, prior HSV-2 infection, more than 12 sex partners, and reporting fewer herpes outbreaks in the last year. Findings indicated that HSV-2 increases risk of HIV acquisition, independent of recognizes herpes lesions and behaviors which indicate potential HIV exposure.


{Turner et al, 2002} Turner et al., (2002) explored the incidence and prevalence of Herpes Simplex Virus Type 2 (HSV-2) Infection in those who were seeking repeat HIV counseling and testing, using serologic specimen from HIV testing. HSV-2 causes one of the most prevalent sexually transmitted diseases (STDs), infecting an estimated 22% of US persons. Data came from San Francisco during the time frame of October 1997 to March 2000. Of 987 subjects included in the analysis, 752 (76.2%) were men who have sex with men (MSM). Findings indicated that the prevalence of HSV-2 infection was 23.5% (n = 987) overall, which is similar to estimates for the general United States. The prevalence was 28.7% among women, and 24.1% among MSM. In the previous year, 107, (10.%) self-reported an STD, 481 (48.7%) had more than 5 sex partners, 311 (31.5%) had sex with an HIV-infected partner, and 245 (24.8%) had unprotected receptive anal sex. 38 subjects tested HIV-positive. HSV-2 prevalence was highest among African Americans (34.4%). Independent correlates of prevalent HSV-2 infection included female sex, older age, and unprotected receptive anal intercourse. Incidence of infection of HSV-2 was 2.6 per 100 person-years of follow-up and 3.1 per 100 person-years of follow-up among MSM. Only one of the 12 HSV-2 seroconversions (incidences) did not occur among MSM.  


{Valanis et al, 2000} Valanis et al., (2000) compares characteristics of heterosexual and nonheterosexual women (ages 50-79), including demographic variables, psychosocial risk factors, screening practices, and other health-related behaviors, including emotional wellbeing, quality of life, social support, medical care and access, smoking status, disease history, nutrient intake, and height and weight. The sample included 93,311 postmenopausal diverse participants in the Women’s Health Initiative (WHI). Findings indicated that 97.1% of the sample were heterosexuals, self-identified lesbians represented .6% of the sample, bisexuals represented .8% of the sample, and 1.5% reported never having sex as an adult. The highest percentage of graduate level education was among adult lesbians (63%), but also high for bisexuals, lifetime lesbians (52% each) and women with no adult sex (55%). Heterosexuals most likely had health insurance, and adult lesbians were most likely to have mammograms in the past year (70%). Compared to heterosexuals, 2-7% more women in each of the other groups were overweight/obese. Lesbian and bisexual groups were more likely to be current smokers and alcohol users. Lifetime lesbians, bisexuals, and adult lesbians were most likely to be depressed (15-17% of sample), while those who never had adult sex had the lowest percentage who scored positive on depression (8%) . Oral contraceptive use was highest among bisexuals (55%). 35% of lesbians and 81% of bisexual women have been pregnant. The bisexual group had highest rate of breast cancer (8.4%), and non-heterosexual groups had higher rates of this than heterosexuals, although the lesbian groups had lower rates of stroke and hypertension, but highest rates of myo-cardial infarction.


{Berglund et al, 2001} Berglund, Fredlund & Giesecke (2001) describes the reemergence of gonorrhea in Sweden between February 1998-January 1999 by way of obtaining epidemiologic and microbiologic data for 357 cases (91% of all cases diagnosed in that time frame). Findings indicated that the increase of gonorrhea was due to an increase in domestic cases. 28 different serovars were identified. Of all 357 cases, 60% were domestic. Infected women tended to be younger than both heterosexually and homosexually affected men. The majority of cases involving women were also domestic. Heterosexual teens and homosexual men were identified to be core groups infected by different serovars of N gonorrhoeae. Stockholm, the capital and biggest city in Sweden, was the area of highest domestic exposure (62% of cases), and was seen especially in homosexual men, 82% of whom were exposed in that area. Of the imported cases, 47% were exposed in Asia and 6.5% were exposed in Eastern Europe. Among the imported cases, the heterosexual route of transmission was most common (86%; 118 of the 138 cases).


{Rubinstein 2010} In this study Rubinstein (2010) examines the correlation between self-esteem and two measures of narcissism. The study collected data from 90 male homosexual Israeli Jews who were recruited at a gay youth organization and gay bar and 109 male heterosexual Israeli Jews who were recruited at one university and two colleges. These participants completed questionnaires on demographic information, the Kinsey Heterosexual-Homosexual Rating Scale and several validated measures on self-esteem and narcissism. Results indicated that homosexual participants had consistently higher ratings of narcissism and lower ratings of self-esteem compared to their heterosexual counterparts and that this was true for both subtypes of narcissism. Rubinstein discusses three interpretations of the data, in which he posits narcissistic traits as coping mechanisms for dealing with expectations both in society at large and within the gay community itself.


{Boehmer et al, 2011} Boehmer, Miao, and Ozonoff (2011) investigated the impact of sexual orientation on cancer prevalence and self-reported health among cancer survivors through a secondary analysis of data gathered from 122,394 participants in the California Health Interview Survey. Results indicated significantly higher cancer prevalence among homosexual men compared to heterosexual or bisexual men while there was no significant difference in cancer prevalence between lesbian, bisexual, and heterosexual women. While sexual orientation among men did not impact health perception among cancer survivors, lesbian and bisexual women were more likely to report only fair or poor health compared to heterosexual women. While this is the first study to examine the impact of sexual orientation on cancer prevalence and health perception, the authors also discuss the limitations of the study namely that the results only represent California and the data is based solely on self-report.


{Savin-Williams 2001} Savin-Williams (2001) includes two studies meant to explore (1) the suicide attempts among sexual minority youths, as well as (2) classification of youth as sexual minorities, due to critiques of previous studies that may have had reliability problems in assessing suicide attempts, recruitment concerns, and measurement errors. The first study utilized 83 young women who maintained a nonheterosexual sexual identity or did not label their sexual orientation. Of the sample, 41% identified as lesbian, 33% as bisexual, 14% did not categorize themselves, 12% reported they were questioning or unsure. The study evaluated for suicide attempt, method, injuries, medical intervention, and reason for survival. Responses were then categorized into true attempt, false attempt, non-life-threatening attempt, or life-threatening attempt. 23% of women indicated at least one suicide attempt. Of the 34 total reported attempts, 29% were categorized as false attempts, in that they endorsed ideation, plan or means, with no attempt. Of the remaining attempts, 80% were non-life-threatening. 26% of those who endorsed an attempt did not actually attempt suicide. Thus, the total amount of youths with true attempts dropped from 23% to 17%. 5% of the sample reported a life-threatening suicide attempt. Those who came from community support groups indicated a 45% suicide attempt rate, 9% life-threatening, with no reported false attempts, while those who came from the university/community classes groups indicated a 19% suicide attempt rate, with 4% life-threatening, and with a true attempt rate of 13%. Study two expanded the first study by including mixed gender and mixed sexual orientations. Findings in this study did not show differences between sexual minority men and women on reported suicide attempts, and each was twice as likely as heterosexual women and ten times more likely than heterosexual young men to report a suicide attempt. True attempts did not vary by gender, sexual orientation, age, educational level, community size, or ethnicity. 


{Wichstrom & Hegna 2003} Wichstrom & Hegna (2003) explored the rate of suicide attempts among gay, lesbian, and bisexual (GLB) young people, as compared to those of heterosexual young people, using a sample of 2,924 Norwegian students, grades 7-12. The sample was followed in 3 data collection waves. Identified risk factors included previous suicide attempt, depressed mood, eating problems, conduct problems, early sexual debut, number of sexual partners, pubertal timing, self-concept, alcohol and drug use, atypical gender roles, loneliness, peer relations, social support, parental attachment, parental monitoring, and suicidal behavior among family and friends. Only same-sex sexual behavior was significantly predictive when homosexual attraction, homosexual identity, and same-sex sexual behavior were entered to predict suicide attempt. 6.5% of participants reported same-sex sexual contact. The proportion indicating that their sexual attraction was not exclusively directed towards those of the opposite sex was larger (15.5%) as was the proportion who stated their sexual identity was not exclusively heterosexual (11.4%). Exclusive homosexual attraction and identity were indicated by .8% and .5% of the participants, respectively. In 1999, 4.4% (n=127) participants reported a suicide attempt. Among these, 29.2% reported multiple attempts. Those with positive scores on GLB orientation had higher rates of past suicide attempts compared with heterosexuals: same-sex sexual contact was 15.4% versus 3.6%, respectively, GLB sexual attraction was 9.1% versus 3.6%, and GLB sexual identity was 9.1% versus 3.6%. Significantly more girls than boys reported some level of GLB sexual attraction, a nonexclusively heterosexual identity, and a past suicide attempt.  The majority of individuals (62%) had their first suicide attempt after realizing they were not exclusively heterosexual, and 19% attempt suicide during the year before they realized this. In time 3, increased suicide attempt risk due to same-sex sexual contact was only seen among girls. These odds were not reduced when potential general risk factors of suicide were controlled for.


{Paul et al, 2002} A survey of 2881 gay and bisexual men who have sex with men showed significant correlation between homosexuality and suicidality (Paul et al, 2002). Twenty-one percent had made a suicide plan, 12% had attempted suicide, and of the 12% about 45% made multiple attempts. The chance of suicidality was increased among those with less education, lower income, and less than full-time employment. The highest prevalence rate was with Native Americans, bisexual men, and MSM respondents who did not identify as gay or bisexual. Over the generations, the younger cohorts “came out” at earlier ages; however, the younger cohorts were also accompanied by increased rates of antigay harassment in adolescence (52% versus 28%). For the majority of suicide attempters, the first attempt was before the age of 25. Suicidality in adults after age 25 was more likely in those who had adverse childhood experiences (physical or sexual abuse, alcoholic parent).


{Qin et al, 2003} With the aim of better understanding the relative importance of risk factors for suicide, as well as gender differences in these, the authors drew data from four Danish longitudinal registers to study 21,169 persons in Denmark who committed suicide between 1981 and 1997 and 423,128 live comparison subjects matched for age, gender, and calendar time of suicide. A history of hospitalization for psychiatric disorder was found to be the highest attributable risk for suicide, particularly in females. Other significant risk factors included cohabitation, single marital status, unemployment, low income, retirement, disability, sickness-related absence from work, and a family history of suicide and/or psychiatric disorders, and the effect of these risk factors does indeed differ by gender. The results of the study showed that persons with homosexual orientation were at a higher risk for suicide.


{Perkins et al, 1994} The authors conducted a study of the prevalence of mood disorders in asymptomatic HIV-infected and uninfected homosexual men who lived in a low-prevalence HIV area in addition to analyzing the relationship between current major depression and potential depression risk factors. 98 asymptomatic HIV-infected and 71 uninfected homosexual men underwent extensive clinical, psychiatric, neuropsychological, and laboratory evaluations. In agreement with previous studies of the same populations in a high-prevalence HIV area, this study found that a similar proportion of HIV-infected and uninfected subjects reported a lifetime, an initial current, and a 6-month follow-up history of major depressive disorder. Anxiety disorders were less common. No differences were found in the severity of mood symptoms between HIV-infected and uninfected subjects. Both HIV-infected and uninfected homosexual men may be at a high risk for major depression, especially if they have a past history of the disorder; however, major depression does not seem to be secondary to HIV central nervous system effects or low vitamin B 12 levels in asymptomatic HIV-positive homosexual men.


{Oringher & Samuelson} The authors conducted a study of the lifetime prevalence of intimate partner violence (IPV) in male same-sex relationships, a field that has not been well researched. After recruiting a community sample of 117 educated and ethnically diverse gay and bisexual men residing in the San Francisco Bay Area, the subjects were measured for masculinity and IPV behaviors using pre-existing scales. The results found a high correlation between perpetrating acts of IPV and being the victim of such acts. Men who had perpetrated physical or sexual violence in their same-sex relationships reported higher levels of masculine behaviors and greater conformity to traditional masculine norms such as aggressiveness and suppression of emotional vulnerability. These specific characteristics were found to be a significant predictor of perpetrator physical violence.


{Freedner et al, 2002} A study conducted by Freedner, Freed, Yang & Austin (2002) dived deeper into the dating violence among gay, lesbian, and bisexual adolescents. An anonymous survey was conducted at a GLBT (gay, lesbian, bisexual, transgender) youth rally inquiring upon dating violence and threats of being “outed” (having one’s sexual orientation revealed). A fraction of individuals (male: 41.5%, female: 37.1%) who participated in this survey admitted that they were threatened or abused. It was also revealed that a certain portion (male: 71.0%, female: 69.0%) disclosed the abuse to a another individual. The researchers found that bisexual individuals were more likely to be threatened of being “outed,” for this is the first study to specifically examine threats of being outed. In addition, the researchers compared dating violence among GLBT individuals to heterosexual individuals and found that bisexual females were more likely to have experienced abuse than heterosexuals.


{Tjaden et al, 1999} Tjaden, Thoennes, & Allison (1999) used data from the November 1995 to May 1996 nationally representative telephone survey, National Violence Against Women (NVAW) Survey, and compares lifetime experiences with violent victimization among men and women with a history of same-sex cohabitation and their counterparts with a history of marriage and/or opposite sex cohabitation only. Of the 8,000 men and 8,000 women surveyed, .8% of men and 1% of women reported they lived with a same-sex partner at some point in their life. Findings indicated that respondents who lived with a same-sex partner were significantly more likely than those who had married or lived with an opposite-sex partner to have been raped as minors (women: 16.5% versus 8.7%; gay men: 15.4%)  and adults (women: 25.3% versus 10.3%; gay men: 10.8%), physically assaulted as children by adult caretakers (women: 59.5% versus 35.7%; men: 70.8% versus 50.3%), and physically assaulted as adults by all types of perpetrators, including intimate partners (men: 23.1% versus 7.7%; women: 39.2% versus 20.3%). Generally, same-sex cohabiting men tended to be raped by strangers and acquaintances, while same-sex cohabiting women tended to be raped by intimate partners. The study indicated that, regardless of whether the partnership is same-sex or opposite-sex, intimate partner violence is perpetrated primarily by men. Violence appears to be more prevalent among same-sex male couples than either same-sex female couples or heterosexual couples.


{Landolt & Dutton} Landolt & Dutton (1997) explored gay male intimate partner power arrangements and psychological abuse in a sample of 52 couples. The objective was to understand the association between relationship power dynamics and the perpetration of psychological abuse in gay relationships. The study also explored the relationship between abusive and borderline personality organization (BPO), as defined by Dutton (1994), and gay male intimate partner abuse. Findings indicated that the more frequent form of psychological abuse was significantly higher in relationships characterized by divided power (where partners share decision-making authority). This indicates that abuse can occur in relatively egalitarian relationships. 40% of the sample reported one member perpetrated one or more violent acts in the last year. Participants reported membership in egalitarian relationships (n = 59), self-dominated relationships (n = 8), and divided power (n = 30) relationships, although within pairs, individual members did not have similar perceptions of the power dynamic. This differential perception did not significantly impact the rates of physical or psychological abuse. Psychological abuse perpetrated by the victim was highest in self-dominant couples as compared to egalitarian couples. Psychological abuse perpetrated by the abused was significantly higher in divided power couples than in egalitarian couples, with no significant difference between divided power and self-dominant couples. BPO was a significant feature of the abusive personality organization. Partner reports of receiving physical abuse were significantly correlated with self-reports of BPO, fearful and preoccupied attachment, and recollection of maternal rejection. Partner reports of receiving psychological abuse were significantly correlated with self-reports of BOP, anger, fearful and preoccupied attachment, recollections of both maternal and paternal rejection, and negatively correlated with secure attachment. When one partner was abusive, results indicated it was more likely his partner was abusive. Dyad levels of BPO, preoccupied attachment, and paternal rejection were higher in mutually abusive relationships as opposed to unidirectionally abusive relationships.


{Waldner-Haugrud et al, 1997} Waldner-Haugrud, Gratch, & Magruder (1997) explored gender differences in victimization and perpetration experiences of gay and lesbians in intimate relationships, drawing from a sample of 283 gay and lesbian people. Participants reported on experiences of being victimized and perpetrating relationship violence in same-sex relationships. Findings indicated that 47.5% of lesbians and 29.7% of gay individuals had been victimized by a same-sex partner. Lesbians reported perpetration rate of 38% compared to 21.8% of gay men. Lesbians more frequently were victims and perpetrators than gay men, with the exception of using a weapon, lesbians more frequently reported pushing or being pushed than gay men, lesbians reported greater number of different victimization and perpetration tactics than gay men, and there were no significant differences in the severity of the violence.


{Cruz & Firestone} Cruz and Firestone (1998) performed in-depth interviews of gay-identified men ages 23 through 45 to complete a qualitative study of domestic abuse and violence in gay relationships. The respondents’ definitions of abuse all emphasized the desire to control. Some pointed out how men are socialized to be the one in control in a relationship, so having two men together can be a conflict. The types of abuse reported included all forms of physical, verbal, and emotional abuse, including the use of inside knowledge to manipulate, bait, or shame the other partner. Respondents were asked about what they considered the reasons for domestic violence in gay relationships, and answers involved the pressure from social stigma against homosexuality, both partners entering the relationship with years of unresolved emotional issues, and insecurity and jealousy. Some suggested that males lack skill in communicating in a respectful, understanding level. One respondent continued, “I think, and this is strange, that the only reason two men are really together is sex. Or it starts out to be the sex and then it falls into a comfortable pattern and they don’t want to break the pattern. I can’t truly notice or see love between two men. I can’t see that. I think that men just use men for whatever they want and that’s where the violence starts, because they don’t really care about each other” (p. 168). Similar to the abuse cycle in heterosexual relationships, another factor was intergenerational transmission, as 12 of the men reported they grew up with violence in the home. Alcohol and drug abuse, and financial strains further exacerbated the abuse. The respondents felt the need for shelters and financial assistance for partners looking to leave abusive relationships.


{Whitehead 2015} Whitehead’s article is a review of the literature on gay/lesbian relationships. The three estimates of gay/lesbian relationship lengths found from this review were 3.6/4.95 years (male/female), 4.7/3.3 years (male/female), and 2.7/3.9 years (male/female). These estimates are comparable in the US and the UK studies, and significantly lower than the rates for heterosexual couples within a marriage in the 1970’s, when divorce rates peaked, which were 27 years. In several studies, thecontrast in length between opposite-sex and same-sex relationship lengths is large. The article indicates that it is likely that .8% of same-sex male relationships and 2.6% of same-sex female relationships will reach the 25 year wedding anniversary. In a 2008 study in California, prior to the legalization of gay marriage, median rate of relationship length was 4.7 years and 3.3 years for males and females respectively. The article theorizes about the impact of cohabiting, gender, and the presence or absence of children.


{Abbott & Cretella 2012} Abbott & Cretella (2012) explore the risks of nonmarital sexual intercourse among single young women. 20% of American youth initiate a form of sexual activity before age 14 and 75% of those graduating seniors have had vaginal sexual intercourse. Risks associated with early onset of sexual activity include unwed pregnancy, STIs, mental illness, and dating violence. A 2009 study found that 70% of parents and over 60% of teens believe sex should occur only between those who are married. The study promotes risk avoidance vs. risk reduction as a goal for health-care providers. Abstinence education programs appear to delay onset of sexual debut by two years, and may be connected to a reduction in rates of teen pregnancy. Perceived benefits of engaging in non-marital sex include physical pleasure, increased bonding or closeness, testing sexual compatibility, demonstrating love in a growing relationship, and avoiding teasing or humiliation for virginity. The article then provides research regarding the flaws within these perceived benefits based on research, including the fleeting nature of early sexual relationships, and no apparent added marital satisfaction from early sexual intercourse. Other factors, like unselfishness, humor, playfulness, and ability to openly communicate needs are the qualities important in marriage for sexual satisfaction. Benefits of abstinence included not worrying about pregnancy or STIs, expectations that this will strengthen future relationships, improved self-esteem, avoidance of emotional pain of heartache, and greater emotional health. Because of the cognitive and biological limitations which inhibit self-control, including the influence of peer pressure on personal values, egocentrism, strong emotions, self-consciousness, convergent thinking, misinterpretations of others reactions, and alcohol or drug use, and poor moral reasoning.


With research already showing a strong link between sexual compulsivity and risky sexual behavior among men who have sex with men (MSM), the Pillow Talk Project studied 50 highly sexually active MSM (nine or more partners in past 90 days) using a daily diary over 30 days to see the relationship between affect and sexual behavior that could lead to HIV/AIDS or other negative outcomes {Grov, Golub, Mustanski, & Parsons, (2010)}.  Half of the sample had symptoms of sexual compulsivity, characterized by marked distress over one’s sexual behavior, hence the hypothesis that affect could be a determinant of sexual risk behavior among sexually compulsive MSM, which ultimately the research did not support.   Increased negative activation (fear, anger, sadness, disgust) correlated with reduced sexual risk behavior, but less so among sexually compulsive MSM.  Sexual activation (characterized by physiological arousal or “horniness”) was related to increased sexual risk behavior, but less so among sexually compulsive MSM.  Anxious activation related to increased sexual behavior in general, but not necessarily risk-taking.



Chapter 10: Pedophilia and Homosexuality


{John R. Hughes} (2007) reviewed 554 articles on pedophilia from the Medline database to establish a general understanding of pedophilia.  Through the research, a closer look was taken at the behaviors, patterns, and biology of pedophiles, as well as the effect they have on their child victims.  Treatments were also discussed.  Although it was found that a higher percentage of pedophiles are heterosexual, there is a possible link between homosexual pedophiles and adult homosexuality.


Mehmet Eskin and associates used a questionnaire to ascertain the prevalence of same-sex sexual orientation, childhood sexual abuse, and suicidal behavior and the relationship between the three factors, {Mehmet Eskin et al, 2005}. The sample consisted of 1,262 university students in Turkey. Almost two percent of the sample self-identified as either homosexual or bisexual. Twenty-eight percent of the sample reported that they experienced sexual abuse when they were children. Childhood sexual abuse was related to same-sex sexual behavior. Students with a same-sex sexual orientation perceived their fathers as distant, but not their mothers. Having been abused sexually during childhood by someone of one’s own sex was related to a same-sex sexual orientation in male, but not in female participants. Childhood sexual abuse was associated with an increased risk for suicidal ideation and attempts. Self-identification as homosexual or bisexual was related to suicidal ideation. Since little research on these subjects has been done in non-Western countries, this study offers another perspective.


Research published in the scientific peer-reviewed literature demonstrates a link between childhood homosexual molestation and later development of same-sex attraction for some individuals. For example, the study “Childhood and adolescence molestation in heterosexual and homosexual persons” by {Tomeo et al, 2001} found that among 942 participants, forty-six percent of the homosexual men in contrast to 7% of the heterosexual men reported homosexual molestation, while twenty-two percent of lesbian women in contrast to 1% of heterosexual women reported homosexual molestation. “Taken from abstract.”


In this study “Child Physical and Sexual Abuse in the Community”, {Harriet L. Macmillan et al, 1997} administered a questionnaire to determine the prevalence of physical and sexual abuse during childhood among the general population of Ontario, Canada. The participants were a random sample (N=9953) of residents aged 15 or older. Macmillan found that child physical abuse was reported more often by males (31.2%) than females (21.1%) while sexual abuse during childhood was more often reported by females (12.8%) than males (4.3%). Severe physical abuse was reported similarly by both males (10.7%) and females (9.2%). Severe sexual abuse was reported more by females (11.1%) than by males (3.9%).  


In this article “Sexual Abuse of Boys” {William C. Holmes et al, 1998} collected over a hundred data sources that represented 149 sexual abuse samples. From their research, they found that sexual abuse of boys appears to be common, yet underreported and under-treated. “Boys are less likely than girls to report sexual abuse because of…the social stigma against homosexual behavior.” Also it was found in the study by Shrier that abused adolescents, especially those victimized by males, were up to 7 times more likely to self-identify as gay or bisexual than peers who had not been abused. However, it should also be noted that gay or bisexual identity may precede sexual abuse. For example, boys may explore their sexual identity in public sex environments where abuse might happen more often. Another interesting finding is that adult men with past abuse were twice as likely to be single than those who never experienced abuse.


In this article {Diane Shrier et al, 1988} studied a population of boys aged 12-21, who were attending an adolescent clinic for reasons other an sexual abuse. During their first visit, the boys were asked a series of questions (are you sexually active? Have you ever been raped, sexually abused? etc.) If one of the boys reported being sexually abused, they were interviewed again in attempt to get more information. Shrier and Johnson found “that approximately one half of the victims currently identified themselves as homosexual and often linked their homosexuality to their sexual victimization experience(s). The female-molested group, in contrast, seemed no more likely to identify themselves as homosexual than the control group of nonmolested adolescents, though there was some increase in bisexuality in both male and female-molested boys” (1192). “The findings of the high rate of homosexuality in the study population are a confirmation by Finkelhor’s 1979 college student survey,’ in which nearly half of the men who reported “a childhood sexual experience with an older man were currently involved in homosexual activity.” It was Finkelhor’s impression that the boy who has been molested by a man may label the experience as homosexual and misperceive himself as homosexual based on his having been found sexually attractive by an older man. Once self-labeled as homosexual, the boy may later place himself in situations that leave him open to homosexual activity” (1192-1193).


“Self-reported childhood and adolescent sexual abuse among adult homosexual and bisexual men” (Entire article was unavailable, so here is the abstract word for word) {Doll et al, 1992} From May 1989 through April 1990, 1,001 adult homosexual and bisexual men attending sexually transmitted disease clinics were interviewed regarding potentially abusive sexual contacts during childhood and adolescence. Thirty-seven percent of participants reported they had been encouraged or forced to have sexual contact before age 19 with an older or more powerful partner; 94% occurred with men. Median age of the participant at first contact was 10; median age difference between partners was 11 years. Fifty-one percent involved use of force; 33% involved anal sex. Black and Hispanic men were more likely than white men to report such sexual contact. Using developmentally-based criteria to define sexual abuse, 93% of participants reporting sexual contact with an older or more powerful partner were classified as sexually abused. Our data suggest the risk of sexual abuse may be high among some male youth and increased attention should be devoted to prevention as well as early identification and treatment. “Taken from abstract.”


In this article “Child Sexual Abuse and HIV Risk-Taking Behavior” {Matthew J. Mimiaga et al, 2009} studied the connection between childhood sexual abuse (CSA), HIV infection and risk-taking behavior among men who have sex with men (MSM). Mimiaga found that of all the participants, 39.7% had a history of CSA. “Participants who reported experiencing CSA had an increased risk of HIV infection…relative to those who had no history of CSA.” “MSM with a history of CSA were more likely to engage in unprotected anal sex and serodiscordant unprotected anal sex.” “…harmful consequences of CSA that have been demonstrated specifically in MSM, [include] mental health counseling and hospitalization, psychoactive substance use, depression, and suicidal thoughts or actions.”


{Stephen Brady} Brady (2008) conducted 2 case studies to evaluate the impact of sexual abuse on gay men and possible treatments for a healthy formation of sexual identity following their traumatic experiences. The researcher concluded that homosexual men are at a higher risk for abuse, anxiety, mood disorders, increased sexual behaviors, HIV/AIDs, and suicide. In this article, it is discussed that the best way to help gay men struggling with these issues is to provide therapy using the Homosexual Identity Formation Model (HIF) which is a 6 stage process of “coming out” starting with confusion of identity and ending in pride. In addition, further treatment processes include healing relationships, converting dangerous behavior to safe behavior, remembering and morning past events, and avoiding isolation by reconnecting the self and others.


{Zou & Andersen} The present study (2015) focuses on childhood victimization rates among “mostly heterosexual” (MH) individuals in comparison to other sexual orientations, a population of which little research has been conducted. Current literature is unclear on whether the rates of victimization among MH individuals would be comparable to that of heterosexuals or that of LGBs. To determine this, 422 heterosexual, 561 gay/lesbian/bisexual, and 120 mostly heterosexual participants were recruited and completed surveys online to assess their adverse childhood experiences (including childhood physical, emotional, and sexual abuse; childhood household dysfunction, and verbal and/or physical abuse by peers). The results indicated that MH individuals, similar to LGB individuals, were nearly 1.5 times more likely than heterosexuals to report childhood victimization. These results support the existing research that a “mostly heterosexual” identity falls into the category of a sexual minority.


{Baldwin 2002} Baldwin (2002) examines the influence of the gay rights agenda on American culture by providing examples of how homosexual groups have targeted various groups and organizations that work with youth as their primary method of normalizing homosexuality. The author cites various studies that discuss how the homosexual lifestyle is mainly youth-oriented and that certain groups who publicly promote sex with minors such as the North American Man Boy Love Association (NAMBLA) have support from the mainstream gay community. The article also cites other studies that show a significant number of pedophilia cases involve homosexual molestation and notes that the APA has revised diagnostic criteria in the DSM for pedophilia making it harder to diagnose an individual with pedophilic disorder. Baldwin concludes that the political and legislative power of gay-rights activists make it difficult to publically and honestly address the problem of homosexual element that is present in so many cases of child molestation.


{Eskin 2016} Eskin (2016) presents a web-based self-report survey of 517 Turkish men and women in order to understand the correlates of same-sex sexual behaviors, attractions, and nonheterosexual sexual identity. The sample was overrepresented by women (95 men = 18.6%). The percentage of individuals who endorsed same-sex behaviors (8.1%), attractions (35.4%), and nonheterosexual sexual identity (7.8%) were somewhat higher than those reported in a previous study. Significant predictors of same-sex sexual behaviors included were more childhood boy-typical behaviors, more childhood cross-gender behaviors, earlier age of sexual debut in men, and more instances of childhood sexual abuse (CSA) and earlier age of sexual debut in women. Significant predictors of same-sex attractions were fewer childhood boy typical behaviors and earlier age of sexual arousal in men and greater sex drive and CSA in women. Significant independent predictors of homosexual or bisexual identity were fewer childhood boy typical behaviors and earlier age of sexual arousal in men and more childhood boy typical behaviors in women. Higher use of pornography and masturbation was indicated in men. Nonexclusive homosexual attractions were more common in women than in men but nonexclusive homosexual desires were equally frequent in men and women. Homosexual sexual identity was more common in men than women but bisexual sexual identity was more common in women than in men.


{Lehavot et al, 2012} Lehavot, Molina, and Simoni (2012) examined the association between female gender identity and expression and childhood trauma and adult sexual assault. The authors recruited 1,243 female participants from LGB listservs, websites, and other LGB organizations across the U.S., who took an anonymous online survey that assessed gender identity and expression with the Gender Expression Measure among Sexual Minority Women (GEM-SMW), childhood trauma with the Childhood Trauma Questionnaire (CTQ), and adult sexual assault with three questions from the Sexual Experiences Survey (SES). The study found no significant correlation between self-reported gender identity (defined as butch, femme, androgynous, or other) and childhood abuse but gender expression (higher masculine/butch scores) was significantly associated with childhood trauma in the areas of emotional and physical neglect. Adult sexual assault was associated with feminine gender expression and the femme gender identity and also with women who scored higher in butch/masculine gender expression.


{Austin et al, 2008} Austin et al., (2008) explores disparities in child abuse victimization by sexual orientation among women. It drew from survey data of 63,028 women participating in the Nurses’ Health Study II. Abuse was measured via emotional abuse, parent/guardian physical abuse, and adult/older child sexual abuse. 98.9% of the sample were heterosexual, .4% were bisexual and .8% were lesbian.  Findings indicated strong evidence of elevated frequency, severity, and persistence of abuse experienced by lesbian and bisexual women. Lesbian (30%) and bisexual (24%) women were more likely to report victimization in childhood and adolescence than were heterosexual women (19%). When comparing sexual abuse victimization in both age periods, lesbian (19%) and bisexual (20%) women were more likely to be victimized than were heterosexual women (9%). Compared to heterosexual women, bisexual women were more likely to report their first experience of physical abuse victimization occurred in adolescence and more likely to report sexual abuse in both age periods. Incorporating reports from childhood and adolescence, 56.9% of heterosexual, 73.3% of bisexual, and 69.2% of lesbian women reported one or both types of abuse at some point up to age 17 years.


{Stoddard et al, 2009} The present study (2009) analyzed the similarities and differences in the physical and sexual abuse experienced by lesbians and their heterosexual sisters. A survey was mailed to 324 lesbian/heterosexual sister pairs aged 40 and older. The lesbians reported significantly higher lifetime rates of both types of abuse than their heterosexual sisters (physical – lifetime: 32.7% vs. 18.8%; sexual lifetime: 34.9% vs. 20.7%). The lesbians also reported a greater incidence of childhood physical and sexual abuse and of adult sexual abuse than their heterosexual sisters. However, about half of lesbians (51.9%) and heterosexual sisters (46.4%) reported more than one type of abuse. Re-victimization rates were also similar. Both groups identified male relatives as the primary perpetrators of both childhood physical and sexual abuse and of adult physical abuse. Male strangers were identified as the most common perpetrators of adult sexual abuse.


{Wells et al, 2011} Wells, McGee, and Beautrais (2011) used the New Zealand Mental Health Survey (NZMHS) to investigate sexual identity and sexual behavior as aspects of adult sexual orientation and their prevalence among the New Zealand population. The NZMHS interviewed roughly 13,000 people using a laptop computer assisted personal interview (CAPI) and collected data on current sociodemographic status, family of origin, adverse events, sexual identity and sexual behavior and experiences. The study defined sexuality by 5 groups: homosexual, bisexual, and heterosexual with heterosexual further defined as heterosexual with no same-sex sexual experience, heterosexual with same-sex experience only, and heterosexual with same-sex experience and relationship. Results showed that heterosexual identity was reported at significantly higher percentages compared to homosexual and bisexual identity and that same-sex behavior was reported more frequently than same-sex identity. The study also replicated previous findings on the association between childhood sexual abuse and female and male adult same-sex relationships.


{Brennan et al, 2007} The objective of this study was to analyze the prevalence and frequency of childhood sexual abuse and their correlation with sexually transmitted infections and high-risk sexual behaviors in a sample of low-risk gay and bisexual men. In 1997 and 1998, men were randomly recruited from the Minneapolis/St. Paul Gay, Lesbian, Bisexual, and Transgender Pride Festivals and were questioned about their demographics, sexual activity, history of childhood sexual abuse, HIV status, history of sexually transmitted infection, use of sex-related drugs, and history of exchanging sex for payment. In line with previous studies of low-risk populations, childhood sexual abuse was reported by 15.5% of respondents and those who reported abuse were more likely to be HIV positive, have exchanged sex for payment, and be a current user of sex-related drugs. No correlation was found between childhood sexual abuse and unsafe sex or other sexually transmitted infections.


{Welles et al, 2009} A study of 593 HIV positive men who have sex with men (MSM) from five cities across the nation demonstrated that nearly half (47%) of the men reported childhood sexual abuse (CSA) and were at increased risk of infection (Welles et al, 2009). The men reporting CSA were more likely to be Latino or black and to have a high school education or less. Compared to the infected men who did not report abuse, the men who reported abuse scored higher in sexual compulsivity (40% versus 25%), depression and anxiety (39% versus 24%), and internalized homonegativity (41% versus 25%). They reported significantly less comfort with sexual interaction with partners, and they were more likely to believe they have problems with drugs and alcohol, and they would especially use during anal intercourse. Of the entire sample, 81% identified as gay, but of the remainder, those with CSA were more likely to behave bisexually. What put the abuse group at the greatest risk was that they reported significantly higher numbers of total sexual contacts, which were positively correlated with frequency of childhood sexual abuse—especially unprotected anal intercourse (1.5 to 2 times more likely than the non-abuse group).


{Heusser & Elkonin 2014} Heusser and Elkonin (2014) examined the association between childhood sexual abuse and sexual-risk behavior among 230 South African adult men who have sex with other men (MSM). Participants were recruited online through gay and bisexual social networking sites to take part in an online survey that used various standard measures to collect data on substance use, adverse childhood experiences, HIV status, mental health outcomes, and sexual risk behavior. Results indicated a high prevalence (23.48%) of childhood sexual abuse in this sample which is consistent with other studies. The study also showed high rates of recreational drug use and sex-related drug use, which were both associated with high-risk sexual behavior (measured by the number of sexual partners), which in turn correlated with increased risk of HIV infection. While the small size and homogeneity of this sample make it difficult to generalize results to the larger population, this study shows the necessity of further research and mental health interventions for MSM who experienced childhood sexual abuse.


{Lloyd & Operario 2012} The authors conducted a systematic review of relevant literature and studies that compared men who have sex with men (MSM) with a history of childhood sexual abuse (CSA) to MSM without a history of CSA on HIV risk indicators. Using systematic review methodology, 12 studies were found to meet the required criteria. 27.3% of the MSM included in these studies reported a history of childhood sexual abuse. Meta-analysis indicated that MSM with CA history were more likely to be HIV positive and to engage in recent unprotected anal intercourse. They also showed that MSM with a history of CSA were more likely to report frequent casual male partners, substance abuse, and sex while under the influence of alcohol or other drugs. This review supports the correlation between CSA and HIV/sexually transmitted infections, sexual risk behaviors, and substance abuse in MSM in the United States and highlights the need to take into account the physical and psychological traumas that can contribute to the risk behaviors.


{Rusow et al, 2014} Rusow, Fletcher, Le & Reback (2014) explored the relationship between a history of sexual abuse and negative health consequences among a racially-diverse sample of 148 men who have sex with men.  From June 2005-July 2012, participants were recruited from programs directed as those who are at extremely high risk for HIV infection/transmission. Measures included the Addiction Severity index and the Brief Symptom Inventory. Findings indicated that more than half (51.4% reported an experience of sexual abuse. This is likely due to the high-risk nature of the sample, as it is significantly higher than other studies. This was associated with increased psychological distress, an increase in rates of alcohol, and/or drug abuse treatment, increased housing instability risk, and increased risk for suicidality.


{Phillips et al, 2014} Phillips et al., (2014) explores the risk of childhood sexual abuse (CSA) and HIV-related risks among 451 men who have sex with men (MSM) in Washington D.C. Cross-sectional data was collected from three groups who are at high risk of acquiring HIV. Measures included HIV-status Assessment, CSA Assessment, IPV Assessment, Sexual Behavior Assessment, Substance Use Assessment, and Depression Assessment. Findings indicated that 17.5% of the sample reported CSA, at a median age of 8.3 years old. Perpetrator was evenly distributed between a family member (51.3%) and a non-family member (47.4%) and the perpetrator was predominantly male (88.5%). More than half of participants reported that their first incident involved physical force or penetration (60.3% and 55.8% respectively), with over half (54.%) of participants reporting oral and anal penetration. Black MSM had significantly higher odds of reporting CSA compared to white MSM. HIV prevalence was significantly higher among MSM reporting CSA (32.9%) compared to MSM who did not report CSA (11.2%). Those who reported CSA had nearly 4x the odds of being HIV positive, reporting depressive symptoms, having MSM debut before the age of 18, and having been arrested in the last 12 years than those who did not report CSA. 64.6% of those who reported CSA reported IPV in the last 12 months, and were more likely to do so than those who did not report CSA. HIV positive MSM had 4 times more the likelihood of reporting CSA when compared with HIV-negative MSM. The association between reported CSA and HIV-positivity persisted even after adjusting for IPV in the last 12 months, having been arrested in the last 12 months, and CES-D score. A history of CSA was also significantly associated with IPV in the last 12 months and having been arrested in the last 12 months.


{Hidalgo et al, 2015} Hidalgo et al. (2015) examined the association between early childhood sexual abuse (CSA) and current mental health functioning of men who have sex with men (MSM) and the extent to which childhood gender nonconformity influenced this association. This study analyzed data from Crew450, a 24-month longitudinal survey of 449 MSM, ages 16-20, recruited from MSM settings in a large midwestern city. A large percentage (45.6%) of the sample reported early childhood experiences (ESE) and those who reported ESE were more likely to report symptoms consistent with depression, PTSD, and suicide risk factors. Although a significant positive association between gender nonconformity and ESE was not found, young MSM who experienced both childhood gender nonconformity and ESE were found to be at higher risk for psychosocial disturbances compared to all groups of young MSM. The authors conclude that more research is needed to examine the link between childhood gender nonconformity and ESE/CSA and interventions targeting mental health needs of MSM should include screenings for childhood sexual abuse.


{Williams et al, 2015} This large-scale study analyzed the relation of childhood sexual abuse (CSA), intimate partner violence (IPV), and depression to HIV sexual risk behaviors among Black men who have sex with men (MSM). Between 2009-2011, 1,522 Black MSM were recruited from six major U.S. cities: Atlanta, Boston, Los Angeles, New York City, San Francisco, and Washington, DC. A significant association was found between CSA and sexual risk behaviors, with participants reporting sex before age 12 with someone at least 5 years older, unwanted sex when aged 12-16, IPV, and depression. Experiencing CSA between the ages of 12-16 led to decreased odds of having receptive condomless anal sex with a mal partner. However, pressured or forced sex was positively associated with any receptive anal sex. Experiencing CSA when younger than 12 years, CSA between the ages of 12-16, physical abuse, emotional abuse, having been stalked, and pressured or forced sex were all positively associated with having more than 3 male sexual partners in the past 6 months. These findings support that CSA, IPV, and depression are indeed associated with HIV risk vulnerability among Black MSM.


{Balsam et al, 2010}


Chapter 11: APA’s Denial of the Harm of Gay Parenting

{2015 Amicus Brief} (The American Psychological Association, The American Psychiatric Association and The National Association of Social Workers all consented to the filing of this brief.) “Same-sex couples form deep emotional attachments and commitments, with levels of relationship satisfaction similar to or higher than those of heterosexual couples (page 12).”


{Dean Byrd} Byrd found that children reared with duel-gendered parents thrive in quality of life through their developmental stages, gender identities, academics, emotional stability, and adult functions as compared with single parent homes, children with step parents, or children with same gendered guardians (i.e. a mother and grandmother). The researcher concluded that having both a mother and a father is essential for a child’s mental health, social development, and sexual orientation. Complementary parenting proves more beneficial for the child to have more positive developmental outcomes, especially with the presence of a father.


{A. Dean Byrd} Byrd (2010) was interested in researching the effects of homosexual parenting on children and whether or not it is true that homosexual parenting is similar to heterosexual parenting. Contrary to common belief, the researcher concluded that it is not in the best interest of the child to have homosexual parents; children of homosexual parents have higher mental health and well-being risks than children of heterosexual parents. Explanations for this finding include the following: Gay, Lesbian, and Bisexual’s have a higher risk for mental health problems (namely depression, anxiety, suicide, etc.), more records of emotional trauma (such as child molestation and incest), as well as lower physical health (stronger presence of HIV/ AIDS, other STI’s, higher use of alcohol leading to unprotected sex, etc.). In addition, the stability and longevity of a homosexual relationship is significantly lower than that of a heterosexual one. All these factors can effect a child’s well-being.


{Walter R. Schumm} (2013) composed a comprehensive literature review discussing the theory of the intergenerational transfer of sexual orientation (ITSO).  The research was in contrast to the “no difference” theory stating that children raised with same-sex parents develop exactly the same as those raised with heterosexual parents.  As results imply, children of LGB parents are actually more likely to become LGB themselves due to the strong influence on their identity and behavior.  Psychoanalysis revealed that a lack of a father figure in lesbian parented homes could cause problems with a child’s psychosexual development.  Social learning theory argues that this especially effects boys because they have no gender-same figure to model, observe, and imitate.  In addition, LGB parents are typically more inclined to allow stereotypes and gender roles to be broken and even encourage LGB behavior.  The literature reviewed revealed that children and adults of same-sex parents are at a higher risk of child sexual abuse, suicide, mental health problems, substance abuse with drugs and alcohol, STI’s, violence in relationships, and possibly reduced longevity.  Although the effects of discrimination on sexual minorities were controlled in some instances, one should still consider its possible effects.  The researcher concluded that the “no difference” theory should not be accepted as fact, and that more research should be done on ITSO.


{Walter Schumm} (2010) assessed the effects of lesbian parenting by reexamining previous literature claiming there is “no difference” in child rearing of same-sex parents in comparison with heterosexual parents.  In fact, the researcher found many examples of differences within lesbian parenting.  It was found that lesbian parents tend to promote less traditional gender roles for their children resulting in higher instances of gender nonconformity.  Also, children of lesbian parents are often surrounded by more LGBT role models than heterosexual ones resulting in more nonheterosexual orientation developments.  Based on the results of this study, the researcher concluded that there must be a difference between heterosexual and homosexual parenting on children.


{Kohm & Yarhouse 2002} Kohm & Yarhouse (2001) explores the context of arguments about homosexuality and integrating same-sex attraction into one’s sexual identity, and around same-sex marriage. It introduces the construct of sexual orientation and whether it is a universal and stable reality that occurs throughout history and across cultures, posed by essentialists, or it is a linguistic construct to capture differences in sexual preferences, posed by social constructionists. It presents how one comes to identify as gay, which is a self-defining attribution unique to this era and culture. Many models of sexual identity development pose that the only healthy normative way to integrate one’s same-sex attraction into one’s identity is to adopt a gay, lesbian, or bisexual identity. Another model is proposed, which acknowledges that some individuals adopt a gay identity while others dis-identify with their experience of same-sex attraction, while both are seen as sexual identity synthesis, as individuals values may impact their decision in this regard. The article explores the two arguments around gay marriage, the fundamental rights argument, which states that marriage is a basic fundamental right and the sanctity of marriage argument, which states that to alter the definition of marriage to include same-sex couples Is to alter the essential nature of a sacred institution. With regard to the first argument, one of the minimum requirements for marriage is that the individuals be of different sexes, which disqualifies those of the same sex from marrying one another. The critique comes in that, to be a constitutional right, it must be deeply rooted in our nation’s history and tradition and must be clearly articulated in the country’s legal history. The other argument poses that marriage requires the act of sex between a man and a woman in a sexually unitive capacity, which disqualifies same-sex marriages. The natural order, and historical Christian thought, also is indicative of the institution of marriage as a good of society and one which is  intended for a certain purpose, and good for children.


{Schowengerdt 2002} Prior to the US Supreme Court’s 2015 decision on same-sex marriage, Showengerdt (2002) had devised a litigation strategy for traditional marriage advocacy. Courts used to make judgments on the due process clause of the 14 th Amendment based on examining the nation’s history and tradition to determine fundamental rights of citizens, and, as affirmed in Washington v. Glucksberg, same-sex marriage had no such rich history. Subsequent case law reinforced that the fundamental right to marriage is reserved to members of the opposite sex. To satisfy the history requirement, Boswell and Eskridge would offer revisions of ancient and medieval history to argue that homosexual marriages existed in past civilizations, but even same-sex marriage advocates discredited most of their claims. Gay rights activists try to argue using the Loving case that ended discrimination against marriage between black and white people, but the analogy is weak because it fails to show how similarly situated people are being treated differently in gay marriage exclusions. They attempt to claim that the right to marriage is fairly simple in its application, but the reality is that states regularly make distinctions in the law, such as regarding age, mental capacity, and number of partners. States cannot make distinctions based on suspect or quasi-suspect classifications without a compelling reason, or without a rational basis. If marriage has no basic connection to procreation or even sex, then it makes it no different from any relationship. Furthermore, judicial activism undermines the state’s (the people’s) right to regulate marriage in general. And when social science is used in the deliberation, Showengerdt (2002) offered two main strategies: highlighting studies that show the differences (and detriments) in same-sex parenting since children are considered the most vulnerable members of society. The second strategy is to tactfully show the evidence of the instability and health risks in gay relationships.



Chapter 12: Addressing the Religious Client


The terms homosexual and heterosexual were invented in the second half of the 19th century. Michael Hannon views them as an impediment to the promotion of a true moral vision, {Michael Hannon}. These innovations changed the way public morality is measured, replacing the religiously influenced concept of human nature with the secularly safer option of individual passion.” The concept of sexual orientation has shifted attention from objective purposes of sexuality–marriage and family–to subjective passion. “The role of the champion of Christian chastity today,” Hannon argues,” is to dissociate the Church from the false absolutism of identity based upon erotic tendency, and to rediscover our own anthropological foundation for traditional moral maxims.” “Rather than struggling to articulate how to live as a ‘homosexual Christian’—or, for that matter, the even more problematic question of how to live as a ‘heterosexual Christian’—we should be teaching our Christian brethren, especially those in their most formative adolescent years, that these categories are not worth employing.” Straight and gay are not natural, neutral, and timeless classifications. According to Hannon, “I am not my sin. I am not my temptation to sin…I have been liberated from this bondage. I will have all sorts of identities, to be sure, especially in our crazily over-psychoanalytic age. But at the very least, none of these identities should be essentially defined by my attraction to that which separates me from God.”


“Observations on the “Instrumentum laboris” by {Sandro Magister}. In the period leading up to the Oct. 2015 Synod of bishops at which thepastoral care of the person and the family was scheduled to be discussed, three well-respected priest/theologians — Claude Barthe, of Paris, cofounder of the magazine Catholica; Antonio Livi, of Rome, president of the apostolic union “Fides et Ratio;” and Alfredo Morselli, of Bologna, pastor, writer, and preacher of spiritual exercises -, critiqued the working document, particularly the section on homosexuality. Their paper, “Observations on the Instrumentum laboris” presents the concerns of numerous European priests, bishops, and laity. In it, they write, “We maintain that at a synod on the family, addressing the issue of homosexuality by saying only that homosexuals must not be treated badly and their families not be left alone, is a sin of omission.” Recalling that the Church is called to be a field hospital for the proclamation of God’s mercy, they write: “it is opportune to recall that, in every self-respecting hospital, the doctors do their duty when: 1) they diagnose the illness, 2) administer treatment, 3) follow the patient all the way to recovery; moreover the Church is like “a physician who realizes the danger of disease, protects himself and others from it, but at the same time he strives to cure those who have contracted it.” The paper compares those who reduce the work of the Church to welcoming persons with same-sex attraction with “respect and delicacy” to reducing the work of a hospital to palliative care.They encourage the Church and Bishops, in particular, to foster and support “those forms of psychological support which have been provided in recent years, with encouraging results…In a particular way, we would ask the Bishops to support, with the means at their disposal, the development of appropriate forms of pastoral care for homosexual persons. These would include the assistance of the psychological, sociological and medical sciences, in full accord with the teaching of the Church.”They also encourage the Church to take an active part in unmasking all homosexualist theories (such as ‘gender’ theory) and slogans such as ‘homosexuals are born that way.’ They are concerned that such slogans suppress the hope that change is possible.


{Stroud et al, 2015} This study (Stroud et al., 2015) analyzed the relationships between personality, spirituality, suicide, and self-injury risk among lesbian, gay, and bisexual adults. 336 lesbian, gay, and bisexual individuals from Houston, Texas completed a demographic survey, the Five-Factor Mini-Markers measure (for personality), the Spiritual Involvement Scale (for spirituality), and the Life Attitudes Schedule-Short Form (for suicide and self-injury). The results supported that Neuroticism positively predicted measures of suicide and risk for self-injury, while Extraversion and Agreeableness were negative predictors. The results also identified conscientiousness as a negative predictor of suicide and self-injury proneness. In addition to this, it was found that high levels of Agreeableness and Extraversion interacted with spirituality, such that high levels of each helped mitigate the risk for suicide and self-injury. These findings highlight the interaction between personality and spirituality and point to the role of spiritual beliefs and behaviors as a potential coping mechanism for this population.