Reference: Pachankis, J. E., et al. (2026). Harms associated with “conversion therapy” (sexual orientation and gender identity and expression change efforts): A systematic search and review. American Psychologist. Advance online publication. https://doi.org/10.1037/amp0001794
If you’re thinking about ex-gay counseling, or you’re still hurting from it, you deserve a clear picture of what the research shows. A task force commissioned by the American Psychological Association and two other professional groups has just published the most thorough review of it so far. It’s in the journal American Psychologist.
What they did
The researchers screened 6,309 published articles and kept 130 that met their criteria. They looked at a wide range of practices, from electric shocks to talk therapy meant to help people reject or suppress their attractions, delivered by therapists, religious counselors, clergy, and laypeople. About a quarter of the older studies and a third of the newer ones were about gender identity or expression, not just sexual orientation.
They looked only at harm. The review did not ask whether these efforts work.
The older studies (average year: 1974)
These 86 studies followed people through treatment. They were mostly small studies, and about 85 percent included only men. About three in four treatments used aversive methods such as electric shocks, nausea-inducing drugs, or humiliating or degrading procedures. Some used aversive suggestions under hypnosis.
Overall, 67 of the 86 (about 78 percent) reported at least one of five kinds of harm. The other 19 either found none or didn’t report enough to tell. A harm was counted if even one participant experienced it, so this doesn’t mean most people were hurt. The paper’s authors also warn that their strict counting may have undercounted harm.
Many studies, unfortunately, simply didn’t say how people fared afterward. Of the 19 that reported enough about mental health, 13 had at least one participant who became more depressed, anxious, or distressed. Of 21 that reported on daily life and quality of life, 15 had at least one participant who got worse, including some who lost sexual functioning. Of 22 that reported on relationships, 10 found at least one person whose relationships suffered.
Pressure to participate was rarely documented. Frankly, in an era when being gay was illegal or labeled an illness, many participants were eager to change. The authors say this societal pressure makes “free choice” hard to judge.
Sixteen of the studies included young people. In the nine where researchers could tell, all nine found at least one harm.
The newer studies (average year: 2012)
These 44 studies asked people, usually at one point in time, about past exposure and current well-being. On average about 480 exposed people took part. More than half looked at suicidality, and about a third at depression.
Thirty of the 44 studies, or 68 percent, found a statistically significant link between exposure and at least one harm. The other 14 didn’t report enough to say, and none showed that harm was absent. Of the 10 studies that included both youth and adults, nine found a link. One study of transgender adults, using a more advanced statistical method, linked exposure to a 55 percent higher risk of suicide attempt.
What this can’t tell you
The researchers say clearly that this is a pattern of associations. They couldn’t calculate how large or how likely harm is for any one person.
The older studies were small and often short. The newer ones rely on memory and self-report. Nearly all recruited participants non-randomly, and mostly people who identify as LGBTQ. People who feel counseling helped them, and no longer identify that way, are probably underrepresented. People with bad experiences may be more likely to take part. The authors say the effect of this is unknowable.
The two studies that followed people through a religious ex-gay ministry couldn’t say whether anyone was harmed. One set of authors wrote, “We cannot conclude that particular individuals in this study were not harmed by their attempt to change.”
Why the authors take limited studies seriously
Ethics rules bar researchers from assigning people as test subjects to treatment that may hurt them. So the evidence comes from two different kinds of studies, older ones that followed people and newer ones that looked back, and they point the same way. The authors note that observational research also helped establish the dangers of tobacco, alcohol, lead, and mercury. They add that if a chemical showed this pattern, regulators “would be likely to seriously consider recommending against its use.”
What this means for you
If you’re weighing ex-gay counseling, wanting help is not a flaw. Faith, family, and community are strong pulls. The research just says the risks are real, so it’s worth going in with your eyes open and asking any counselor how they’d watch out for harm. Then assess whether the counselor has actually ever done that.
If you were hurt, you’re not imagining it. Researchers keep finding the same patterns.