Conversion therapy significantly associated with adverse cardiovascular effects

Key takeaways:

• Conversion therapy was tied to higher systolic and diastolic BP and systematic inflammation levels.
• Researchers underlined the need to implement interventions and bans against conversion therapy.

Conversion therapy was associated with several adverse cardiovascular outcomes like higher BP in young adults assigned male at birth, according to a study published in JAMA Network Open.

The findings support both “evidence illustrating a deleterious effect” of conversion therapy on psychosocial health and the need to implement bans and enforce existing bans against the practice, researchers wrote.

“It is important to know that efforts to change sexual orientation have been unequivocally denounced by leading medical, psychological and human rights organizations based on their harmful psychological impacts,” Brian Mustanski, PhD, a professor at Northwestern University Feinberg School of Medicine, told Healio. “Providers should discourage parents from pursuing these discredited practices.”

Healio previously reported that conversion therapy increased symptoms of PTSD, depression and suicidality.

However, evidence on the long-term physical health outcomes resulting from this practice, “particularly concerning cardiovascular health and systemic inflammation, remains scant,” Mustanski and colleagues wrote.

In the analysis, the researchers assessed several cardiovascular health outcomes — including diastolic and systolic BP, systemic inflammation and self-reported hypertension or high BP diagnosis — among 703 sexual and gender minority participants aged 16 to 29 years who were assigned male at birth.

Overall, 10.2% of the cohort was exposed to conversion therapy.

Mustanski and colleagues found that participants exposed to conversion therapy, vs. those who were not, had:

• increased diastolic BP (beta = 3.46; 95% CI, 0.6-6.32);
• increased systolic BP (beta = 4.28; 95% CI, 0.68-7.87);
• higher levels of systematic inflammation (beta = 0.83; 95% CI, 0.17-1.49); and
• greater odds of self-reported hypertension or high BP diagnosis (OR = 2.86; 95% CI, 2.19-3.54).

These associations remained significant even after the researchers adjusted for behavioral and sociodemographic covariates.

Mustanski and colleagues wrote that one potential mechanism behind the findings may involve conversion therapy “triggering the hypothalamic-pituitary-adrenal axis, which regulates cortisol secretion, a pivotal steroidal coordinator of the physiologic stress responses. The chronic activation of this axis due to prolonged [conversion therapy] exposure could lead to cortisol dysregulation, which has been linked to increased hypertension, dyslipidemia and type 2 diabetes — all risk factors for CVDs.”

The researchers acknowledged study limitations, including that the cohort may not be representative of the broader sexual and gender minority population, while the use of self-reported data “introduces potential biases.”

There are still several areas that warrant additional research, like the biological pathways through which conversion therapy “gets under the skin to shape physiologic function and the development of adverse cardiometabolic health outcomes in adulthood,” the researchers wrote.

Mustanski told Healio that if a clinician has a patient who was previously exposed to conversion therapy, “they should assess for a traumatic response and be prepared to refer to a mental health professional who can help.”

“Survivors of these experiences say that they benefit from connections to affirming communities that disprove the scare tactics used in many of these practices, therapy that helps with recovery, and support in managing the instigators that had led them to undergo this practice,” he said.

Mustanski added that public health programs aimed at cardiovascular health “should also recognize the stressors faced by LGBTQ+ populations and offer targeted interventions, such as providing access to affirming health services, implementing stress-reduction programs, and facilitating community-based support groups that address mental and physical health.”

For more information:

Brian Mustanski, PhD, can be reached at primarycare@healio.com.