What Psychiatry's History with Gay Patients Say About Trans Care Today
Aug 21, 2026 04:33PM ● By Dr. Roberto D'Angelo
Dr. Roberto D'Angelo, psychiatrist and psychoanalyst, argues there are irreversible medical interventions for gender dysphoria in young people gaining traction despite a still-contested evidence base -- and dissenting voices face growing pressure. Photo designed by Magnific
WASHINGTON D.C. (MPG) - Medical professionals considered homosexuality a mental disorder for much of the 20th century -- and often subjected homosexual patients to ineffective treatments including invasive medical interventions such as electroshock therapy and chemical castration, to rid them of their "affliction."
It's a shameful episode in the history of mental healthcare -- one which many psychoanalysts, myself included, are committed to never repeating.
But when I look at my profession's current approach to working with young patients with gender dysphoria, I can't help but wonder whether elements of this history are resurfacing. Doctors and psychiatrists now routinely recommend "gender-affirming" medical interventions as the most appropriate course of treatment -- despite mounting research showing that the evidence for their safety and effectiveness is scant.
When we seek to "cure" young people's feelings of dysphoria through irreversible medical interventions and ignore what the scientific data is telling us about these interventions, we risk repeating the mistakes of the past.
What made the decades-long mistreatment of homosexuals possible, after all, was the medical establishment's deliberate blindness to any evidence that challenged the pathological view of gay people. Alfred Kinsey's groundbreaking empirical work on homosexuality from the 1940s -- which documented that same-sex behavior was far more widespread than previously acknowledged -- was mostly met with hostility from psychoanalysts of the time. Those therapists insisted that their clinical experience trumped any empirical data, insisting that homosexuality was a serious pathology that could be cured. They continued to administer the same ineffective treatments, even as the evidence of the harms done by these interventions grew and grew.
Simply put, medical professionals of mid 20th century viewed homosexual attraction as a disorder to be cured rather than a normal component of some people's identity.
Our field has fallen into a similar trap when it comes to treating young patients with gender dysphoria. The medical establishment is refusing to acknowledge that the evidence casts serious doubt on our approach to treating gender dysphoria in young people. We are continuing to provide invasive, irreversible medical interventions to large numbers of minors and young adults, believing that this will cure their affliction.
The evidence base for adolescent gender-affirming medical interventions is weak. It is mostly based on two Dutch studies -- both of which contain glaring problems. For instance, the first of those studies, which looked at the effects of puberty-blockers, selected only participants that had successfully undergone this intervention -- while excluding those who had responded poorly or discontinued treatment. The second study suffers from severe methodological flaws that make it difficult to determine whether medical interventions actually decreased feelings of gender
In my own practice, I have long advocated for sensitive, detailed and nuanced psychotherapy as the primary strategy for working with patients experiencing gender dysphoria.
Therapists can help patients work through their internal struggles and find relief from distress, including often becoming more comfortable in their own bodies. Crucially, psychotherapy helps young people find ways to be themselves, before they consider a potentially irreversible medical intervention.
When voices challenging prevailing theories are silenced, and treatments are based on ideology and not the scientific method, patients suffer.
Psychiatrists and psychoanalysts owe it to our patients -- and our profession -- not to repeat the worst mistakes of the past.
Dr. Roberto D'Angelo is a psychiatrist, psychoanalyst, and president of the Society for Evidence-Based Gender Medicine. This piece originally ran in Physician's Weekly.
WASHINGTON D.C. (MPG) - Medical professionals considered homosexuality a mental disorder for much of the 20th century -- and often subjected homosexual patients to ineffective treatments including invasive medical interventions such as electroshock therapy and chemical castration, to rid them of their "affliction."
It's a shameful episode in the history of mental healthcare -- one which many psychoanalysts, myself included, are committed to never repeating.
But when I look at my profession's current approach to working with young patients with gender dysphoria, I can't help but wonder whether elements of this history are resurfacing. Doctors and psychiatrists now routinely recommend "gender-affirming" medical interventions as the most appropriate course of treatment -- despite mounting research showing that the evidence for their safety and effectiveness is scant.
When we seek to "cure" young people's feelings of dysphoria through irreversible medical interventions and ignore what the scientific data is telling us about these interventions, we risk repeating the mistakes of the past.
What made the decades-long mistreatment of homosexuals possible, after all, was the medical establishment's deliberate blindness to any evidence that challenged the pathological view of gay people. Alfred Kinsey's groundbreaking empirical work on homosexuality from the 1940s -- which documented that same-sex behavior was far more widespread than previously acknowledged -- was mostly met with hostility from psychoanalysts of the time. Those therapists insisted that their clinical experience trumped any empirical data, insisting that homosexuality was a serious pathology that could be cured. They continued to administer the same ineffective treatments, even as the evidence of the harms done by these interventions grew and grew.
Simply put, medical professionals of mid 20th century viewed homosexual attraction as a disorder to be cured rather than a normal component of some people's identity.
Our field has fallen into a similar trap when it comes to treating young patients with gender dysphoria. The medical establishment is refusing to acknowledge that the evidence casts serious doubt on our approach to treating gender dysphoria in young people. We are continuing to provide invasive, irreversible medical interventions to large numbers of minors and young adults, believing that this will cure their affliction.
The evidence base for adolescent gender-affirming medical interventions is weak. It is mostly based on two Dutch studies -- both of which contain glaring problems. For instance, the first of those studies, which looked at the effects of puberty-blockers, selected only participants that had successfully undergone this intervention -- while excluding those who had responded poorly or discontinued treatment. The second study suffers from severe methodological flaws that make it difficult to determine whether medical interventions actually decreased feelings of gender
In my own practice, I have long advocated for sensitive, detailed and nuanced psychotherapy as the primary strategy for working with patients experiencing gender dysphoria.
Therapists can help patients work through their internal struggles and find relief from distress, including often becoming more comfortable in their own bodies. Crucially, psychotherapy helps young people find ways to be themselves, before they consider a potentially irreversible medical intervention.
When voices challenging prevailing theories are silenced, and treatments are based on ideology and not the scientific method, patients suffer.
Psychiatrists and psychoanalysts owe it to our patients -- and our profession -- not to repeat the worst mistakes of the past.
Dr. Roberto D'Angelo is a psychiatrist, psychoanalyst, and president of the Society for Evidence-Based Gender Medicine. This piece originally ran in Physician's Weekly.
