Conversion Therapy Tied to Worse CV Risk Factors in Sexual, Gender Minorities

Gay men, transgender women, and nonbinary people who’ve undergone efforts change their sexual orientation and/or gender identity show signs of worse cardiovascular health in young adulthood, according to data from the RADAR cohort study.

Specifically, conversion therapy in this study of individuals assigned male at birth was associated with increased blood pressure and systemic inflammation by the time they reached their 20s, as well as a higher likelihood of being formally diagnosed with hypertension.

Such programs, despite falling out of favor due to their harmful effects on mental health, persist to this day in some parts of the United States, researchers led by James K. Gibb, MSc, MA (Northwestern University, Evanston, IL), note in their paper published online this week in JAMA Network Open. “Understanding the health consequences of [conversion therapy] is critical,” they say, “particularly for conditions exacerbated by stress, such as cardiovascular disease.”

Brian Mustanski, PhD (Northwestern University, Chicago, IL), senior author of the new report, told TCTMD that while there’s been a history of studies looking at outcomes like depression, anxiety, and suicidal ideation, “this is the first to really look at any medical-related [or] physician health outcome that we’re aware of.”

The fact that RADAR participants who’d had conversion therapy were showing signs of worse CV health at such a young age is a reminder “to look at the risk factors in early adulthood, so that we can intervene while we could still change the trajectory of someone’s risk for future cardiovascular disease,” he said.

More broadly, sexual and gender minority people have a heightened risk of CVD, especially when they also belong to other marginalized groups. Some of the association is explained by HIV risk, said Mustanski, “but HIV doesn’t explain the entire pattern.”

Billy A. Caceres, PhD, RN (Columbia University School of Nursing, New York, NY), commenting on the new study for TCTMD, said it makes sense that conversion therapy—known to have a strong impact on mental health—“would also then have a negative impact on physical health outcomes that are so highly related to mental health. We know depression and anxiety are risk factors for heart disease.”

The problem may even be more severe than what’s captured by RADAR, he added, since databases haven’t tracked the relevant details for very long and because it can take decades for cardiovascular disease to manifest.

More Exposure, More Risk

Gibb, Mustanski, and colleagues turned to the RADAR observational cohort study, launched in 2014, for insights into conversion therapy’s influence on CV health. The study, which tracks HIV risks, substance use, relationship and sexual partner characteristics, and social and psychological measures, enrolled young adults ages 16 to 29 years who were assigned male at birth and who self-identify as belonging to a sexual or gender minority group (men who have sex with men, transgender women, and nonbinary people). All data in the current paper were collected at single office visits between December 2023 and October 2024.

A total of 703 RADAR participants (mean age 26.75 years) were included. Three-quarters (76.8%) were cisgender and 23.2% transgender or gender-diverse. Nearly 60% were gay, 23.0% were bisexual or pansexual, and 17.6% had other sexual identities. One-third were Hispanic or Latinx, 27.7% Black or African American, 27.3% white, and 11.2% other race/ethnicity.

One in 10 reported having been exposed to efforts to change their sexual orientation and/or gender identity. Mean age was 12.79 years at the time of the first exposure and 16.51 years at the time of the last exposure. Most participants (58.3%) experienced conversion attempts for less than a year, with 54.2% saying that exposure was due to a parent. For 37.5%, conversion therapy was their own choice, while 5.6% cited another person (such as a grandparent), 1.4% a counselor, and 1.4% a community leader.

Systemic inflammation, calculated as an index based on levels of C-reactive protein, interleukin (IL)-6, IL-10, and tumor necrosis factor-alpha, was increased among people who’d had conversion therapy after adjusting for sociodemographic factors, body mass index, HIV status, and tobacco use.

With adjustment for these confounders, both diastolic and systolic blood pressure were significantly increased (+4.11 and +5.34 mm Hg) among patients who did versus did not receive conversion therapy. People who’d experienced attempts at identity change were nearly three times more likely to report having been diagnosed with hypertension (OR 2.86; 95% CI 2.19-3.54).

Exposure to more than 1 year of conversion therapy, compared with shorter durations or none, was linked to significantly higher diastolic blood pressure (+6.36 mm Hg) and systolic blood pressure (+4.57 mm Hg). Compared with individuals who did not undergo efforts to change their sexuality and/or gender, those exposed for 1 year or less still had higher diastolic and systolic blood pressure (+4.63 and +3.79 mm Hg, respectively). The same patterns were seen for hypertension diagnosis. Inflammatory markers, on the other hand, were increased with more than 1 year of exposure but not at durations of 1 year or less.

Look at the risk factors in early adulthood, so that we can intervene while we could still change the trajectory of someone’s risk for future cardiovascular disease. Brian Mustanski

“These findings underscore the need for public health and policy interventions to enforce and strengthen bans on [conversion therapy] practices,” the investigators conclude, pointing out that knowledge of the adverse consequences for CV health also should encourage work to address health disparities and provide affirmative care to sexual and gender minority individuals.

With any observational study, confounding can be an issue. Here, “we were able to measure in rigorous ways many of the potential confounders and make sure that we statistically controlled for them, so that we could really try to get a precise estimate of the effect of conversion therapy,” Mustanski explained. “The other thing that I think gives confidence to the findings is the fact that we see this dose-response effect: the longer the exposure to conversion therapy, the larger the effects were, including on biomarkers of cardiovascular disease.”

Conversion therapy, he said, is unique among the many stressors faced by LGBTQ+ people because it involves being pressured by others to reject “this core aspect of who they are” and perhaps playing active roles in that process. For most of the RADAR participants, these efforts to change occurred “in their teenage years around the time of puberty,” a time that overlaps with the insecurity and confusion that all people experience irrespective of sexuality and gender, said Mustanski.

Cardiologists treating these patients today can help by understanding conversion therapy’s contribution as a risk factor for chronic disease, especially for older LGBTQ+ individuals who grew up when these conversion efforts were more widespread, he advised.

The conversation can begin by simply “raising that question: ‘Did this ever happen to you?’ Maybe the patient isn’t even aware of the fact that it might be an insidious factor for them,” said Mustanski.

Caceres, for his part, doubts that additional data showing conversion therapy’s impact on physical health will sway policymakers, given that the already-strong evidence on mental health hasn’t done so. Healthcare professionals, however, can take steps to apply the knowledge in practice. Both he and Mustanski suggested referring people who’ve experienced conversion therapy to mental health services.

The idea is to provide “preventive mental health and primary care services to people that have been exposed to these therapies,” he said, as a way to “offset or reduce the chances that they will then develop things like hypertension.”

Mustanski said that investigators hope to dig into other health effects of conversion therapy, including the consequences of inflammation, epigenetic signatures of accelerated aging, and changes in endothelial function.

That may prove challenging in the current US political climate—just last month, the RADAR researchers got word the study was terminated, he said. In the wake of that decision, “we’re trying to work with donors and do fundraising to continue to follow this cohort.”