Conversion Therapy Exposure and Elevated Cardiovascular Disease Risk

Importance: Sexual orientation and gender identity change efforts (SOGICE), commonly known as conversion therapy, persist across the United States despite having been discredited due to their harmful mental health impact. Understanding the health consequences of SOGICE is critical, particularly for conditions exacerbated by stress, such as cardiovascular disease. Objective: To investigate the association between SOGICE exposure and cardiovascular disease risk. Design, Setting, and Participants: This cohort study draws on data from the observational cohort study RADAR, which included sexual and gender minority (SGM) young adults assigned male at birth (AMAB) in Chicago, Illinois. All data for this analysis were collected cross-sectionally during the same study visit for each participant between December 1, 2023, and October 31, 2024. Participants who completed SOGICE exposure measures and had cardiovascular health data were eligible; participants with incomplete data were excluded. Exposure: SOGICE exposure and duration. Main Outcomes and Measures: Primary outcomes were diastolic blood pressure (DBP) and systolic blood pressure (SBP) measured via automatic monitors, systemic inflammation (SI) assessed through plasma biomarkers, and self-reported hypertension or high blood pressure (HHBP) diagnosis. Regression analyses were adjusted for sociodemographic and behavioral covariates. Results: Among 703 participants (mean SD age, 26.75 4.60 years), 540 (76.8%) identified as cisgender, and 163 (23.2%) identified as transgender or gender diverse. Seventy-two participants (10.2%) reported exposure to SOGICE. Exposed participants had higher SI levels (β = 0.83; 95% CI, 0.17-1.49; P = .02), increased DBP (β = 3.46; 95% CI, 0.60-6.32; P = .02), elevated SBP (β = 4.28; 95% CI, 0.68-7.87; P = .02), and greater odds of self-reported HHBP diagnosis (odds ratio, 2.86; 95% CI, 2.19-3.54; P = .003) compared with nonexposed participants. Associations remained significant after adjusting for covariates. Conclusions and Relevance: In this cohort study of SGM young adults AMAB, exposure to SOGICE was associated with adverse cardiovascular health indicators, including elevated DBP and SBP, increased SI, and higher odds of self-reported HHBP. These findings underscore the need for public health and policy interventions to enforce and strengthen bans on SOGICE practices. Recognizing the cardiovascular health consequences of SOGICE contributes to addressing SGM health disparities and emphasizes the importance of affirmative care approaches that prioritize the well-being of SGM individuals.