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Carson’s Missteps on Sexual Orientation

Ben Carson claimed that being gay is “absolutely” a choice, and as proof he said “a lot of people” go into prison and change their sexual orientation while incarcerated. There is no evidence to support these claims.

Though no conclusive answers are available about how people arrive at their sexual orientation, there is general consensus that choice does not play a significant role. Studies have found genetics likely plays a role, as may hormonal exposure while in utero. As for prison inmates changing sexual orientation, very little research has been conducted on the subject. One small, non-representative study that did not follow inmates after release did find some inmates reported shifting their orientation while in prison.

Carson apologized for those comments, but in doing so made another mistake. He said, “We do know, however, that we are always born male and female.” This is not entirely accurate: Disorders of sex development, also known as intersex disorders, occur in about one in 4,500 births and have raised questions about the male-female gender dichotomy.

Choice and Sexual Orientation

Carson, a potential 2016 Republican presidential candidate and a retired pediatric neurosurgeon, spoke with CNN’s Chris Cuomo on March 4. Cuomo asked about the progress toward marriage equality, and compared it to the civil rights battles of the mid-20th century.

Carson, March 4: You can’t just say because it happened that way this time, this is the same situation — it’s not the same situation.

Cuomo: Why not?

Carson: Because people have no control over their race, for instance.

Cuomo: You think they have control over their sexuality?

Carson: Absolutely.

Cuomo: You think being gay is a choice?

Carson: Absolutely.

Cuomo: Why do you say that?

Carson: Because a lot of people who go into prison go into prison straight and when they come out they’re gay. So did something happen while they were in there? Ask yourself that question.

Carson went on to say that his point about prisons “thwarts” the notion that being gay is not a choice. In fact, the scientific community remains unsure of exactly what determines sexual orientation, but choice is not a significant factor.

According to the American Psychological Association: “Although much research has examined the possible genetic, hormonal, developmental, social and cultural influences on sexual orientation, no findings have emerged that permit scientists to conclude that sexual orientation is determined by any particular factor or factors. Many think that nature and nurture both play complex roles; most people experience little or no sense of choice about their sexual orientation.”

SciCHECKinsertClinton Anderson, a psychologist and the director of APA’s Lesbian, Gay, Bisexual, and Transgender Concerns Office, told us in an email that surveys have borne out this notion that very few feel any choice in sexual orientation. He pointed to one such survey that found 88 percent of gay men and 68 percent of lesbians reported having “no choice at all” about their sexual orientation. Combined with those who said they had a “small amount of choice,” those proportions rise to 95 percent and 84 percent.

Anderson said the APA does “not currently take any position on the biological evidence,” but added that there is “substantial” evidence regarding biology and sexual orientation. For example, there is likely a genetic component, based upon studies of the families of homosexual men. In one such study, published in the journal Science in 1993, it was more likely that maternal uncles and male cousins of gay men were also gay; that study found it was more than 99 percent likely “that at least one subtype of male sexual orientation is genetically influenced.”

Another study, published in 2004 in the Proceedings of the Royal Society B, a journal on biological sciences published by the United Kingdom’s national academy of sciences, looked at 98 homosexual and 100 heterosexual men and more than 4,000 of their relatives. The study found that female maternal relatives of homosexual men have higher fecundity — reproductive rate, or a measure of how many children someone has or can have — than female maternal relatives of heterosexuals. This could help explain what has been considered a sort of evolutionary paradox, that a genetic trait for homosexuality could be passed down.

This finding has been confirmed elsewhere, including by a 2012 study in the open-access journal PLoS One. In that paper, the authors wrote that “the total female fecundity was significantly higher in homosexual than heterosexual probands” — essentially the people being studied — “thus compensating for the reduced fecundity of homosexuals.”

Another 2012 study, published in the Quarterly Review of Biology, suggested that “epigenetic” effects occurring while in the womb may determine sexual orientation. This means that it isn’t the genes themselves dictating sexual orientation, but which genes or parts of genes are activated or expressed — something that can change based on levels of hormones to which a fetus is exposed.

Prisons and Sexual Orientation

Carson claimed that “a lot of people” change their sexual orientation in prison. There is no evidence that this is the case.

Very little research has been done specifically on changes to sexual orientation while incarcerated. One relevant study was published in 2013 in the Prison Journal by Lauren Gibson and Christopher Hensley, both of the University of Tennessee at Chattanooga. Their work included 142 male inmates incarcerated in a single maximum-security prison. The inmates were asked to retrospectively characterize their sexual orientation before incarceration, and to characterize it again “today,” along with a variety of other questions on sexual activity and other factors.

Of the 142 inmates, 24 reported a change in sexual orientation from before incarceration to the present. In total, 75 percent of those who changed orientation changed from straight to bisexual, 12.5 percent changed from bisexual to straight, and 4.2 percent each changed from bisexual to gay, from gay to straight, and from gay to bisexual. And again, these represented only 16.9 percent of all the inmates who responded to the survey, and only 18 percent of those asked to participate (800 in total) actually responded.

Hensley, the coauthor of the paper, told us in a phone interview that this was indeed a small sample and should not be considered representative of the larger population. He also said that he has not followed up with these inmates to check what their sexual orientation was after release from prison, and that he is unaware of any studies that have examined sexual orientation before entering and after leaving prison.

Ignoring a Gender Continuum

Carson released an apology for his comments on homosexuality and choice. “I do not pretend to know how every individual came to their sexual orientation,” he said. “I regret that my words to express that concept were hurtful and divisive. For that I apologize unreservedly to all that were offended.”

Within that apology, however, Carson made another mistake. After noting that he is a “doctor trained in multiple fields of medicine,” he said: “We do know, however, that we are always born male and female.” As a doctor, he should know that strict male-female dichotomy does not reflect the current understanding of gender given the approximately one in 4,500 children born with disorders of sex development, also known as intersex disorders.

DSDs represent a number of different congenital abnormalities that can make it difficult or impossible to determine male or female gender at birth. These conditions include syndromes such as 46,XX congenital adrenal hyperplasia, Klinefelter syndrome, epispadias and Turner syndrome.

Much research has gone into understanding and managing DSDs. According to one expert writing in the Journal of Clinical Research in Pediatric Endocrinology, “The psychological and social implications of gender assignment require a multidisciplinary approach” and a team of physicians across a variety of fields. Other authors, writing in Nature Reviews Endocrinology, point out the need for a shift in attitudes on gender: “Most importantly, dealing with DSDs requires acceptance of the fact that deviation from the traditional definitions of gender is not necessarily pathologic.”

Editor’s Note: SciCheck is made possible by a grant from the Stanton Foundation.

– Dave Levitan