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Doctors once prescribed long, hard bike rides and testicular transplants to cure gay men of their "sexual abnormality". More than a century on, fear and controversy still dog the secretive world of conversion therapy.

From injections to electric shocks, prayer to rape, myriad methods are peddled by medics, counsellors and moralists to try and change or suppress the sexual desire or gender identity of LGBT+ people.

Interviews with practitioners and people who have been through conversion therapy reveal a deep divergence over practices that dozens of medical associations have condemned as ineffective and harmful.

In Egypt, a young man sought the help of a famous TV doctor on the advice of a friend he came out to. Years later, he remains traumatised by an anal examination.

In post-Soviet Georgia, a teenage lesbian was injected with hormones as a "cure" initiated by her mother.

The prayers of a Mexican pastor persuaded a trans woman to cut off her own hair in a bid to obliterate her identity.

All are examples of modern conversion therapy, which thrives in the shadows even as moves to ban it gather pace globally.

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"Wherever homophobia and transphobia exist, there will be a form of conversion therapy available as well," said Randy Thomas, a former vice president at Exodus International, a U.S-based umbrella organisation of "ex-gay" Christian groups.

In 2013, Exodus was disbanded by its then-president, Alan Chambers, who apologised for promoting "sexual orientation change efforts" and for the "pain and the hurt" it caused.

Conversion therapy did not end with Exodus, though.

Its chief advocates are often religious or conservative groups. Many work in secret, but those who practice it openly say it works, is safe and that adults should be free to undergo it.

"They need to want it, to have decided to do it, and to know they will have a hard time," said Heba Kotb, an Egyptian doctor specialising in sexual medicine who treats gay men.

"The main line of treatment is to replace the programming of this person, who is leaning towards same-sex attraction. We remove this and replace it with heterosexual attraction."

Bans on forms of conversion therapy have been proposed in at least 13 countries, according to research by the Thomson Reuters Foundation.

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Brazil, Ecuador, Malta, Albania and Germany already partially or fully outlaw the practices.

Argentina, Fiji, Nauru, Uruguay, Samoa and Switzerland, as well as Taiwan, all have indirect bans.

But with discrimination against LGBT+ people widespread, conversion therapy remains rife in almost every region of the world.

About 7% of lesbian, gay and bisexual Americans and 13% of transgender Americans have undergone conversion therapy, the Williams Institute, a U.S. think tank, estimated in 2019.

In Britain, a 2018 government survey of more than 108,000 LGBT+ people found 2% had gone through conversion therapy, while a further 5% had been offered it.

A 2020 survey of more than 8,000 LGBT+ people on a male-focused social network, Hornet, received responses from 100 countries; 11% said they had been through conversion therapy.

'Bad dreams'

Taha Metwally was 18 when he revealed his feelings for a friend; the friend suggested he see a doctor who could heal him.

"I just (went) because I loved him," Metwally, now 28, said in a video call from Paris, where he moved from Egypt three years ago.

He recalled his doctor Heba Kotb explaining her method using the metaphor of a cup of dirty water, which would gradually be displaced with clean water until it was "clear and natural".

In their second session, Kotb conducted an anal examination on Metwally without offering any explanation, he said.

READ MORE: LGBT+ conversion therapy: banned on Facebook, but thriving in Arabic

"She took something without speaking with me about my consent," said Metwally, who is now an LGBT+ activist. "I'm very angry with her."

Kotb declined to discuss Metwally's allegations with the Thomson Reuters Foundation, citing patient confidentiality.

She said she only performs anal examinations with patient consent as part of a "sexual assessment".

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Egyptian-born Taha Metwally shares his experience with conversion therapy when living in Egypt. Filmed in Paris, France, June 22, 2021. Thomson Reuters Foundation/Calypso Logel

"I have a 100% cure rate," she said. "I have treated no less than 3,000 cases of gays, all over the Arab world."

Metwally said it took him years to realise that he had been traumatised by his seven months of therapy with Kotb.

"I have so many bad dreams about this," he said.

Kotb put forward three rationales for Metwally's critique.

"Either he never came (to me) and just wants to attack what I'm doing," she said.

"Some people have commitment phobia – (like) people who don't want to get married .... Or third, he's not a fighter, he lost motivation, and decided not to continue something fruitful."

Mental health professional organisations in 22 countries, from Lebanon to the Philippines, Turkey and Australia, have condemned conversion therapy as ineffective and harmful, according to a 2020 report by advocacy group ILGA-World.

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Numerous peer-reviewed studies and large surveys show a correlation between suicide attempts and conversion therapy.

A 2020 U.S. survey by advocacy group The Trevor Project, of almost 35,000 LGBT+ 13 to 24-year-olds, found those who had undergone conversion therapy were over twice as likely to say they had attempted suicide that year as those who had not.

However, others who have had treatment say it works, with some who identify as "ex-gay" or "ex-LGBT" opposing any ban.

   

Transplants

The history of conversion therapy is relatively well documented in the West, much less so in other parts of the world. It was first used in the second half of the 19th century, according to Timothy Murphy of the University of Illinois Chicago.

In 1892, a U.S. doctor prescribed "severe and fatiguing bike riding" to a man he diagnosed with "sexual abnormality", Murphy said in a 1992 research paper.

'The Origins of Organ Transplantation', a book by Thomas Schlich, a medical historian at Canada's McGill University,  details how German and Austrian surgeons tried testicular transplants in the 1910s and '20s to make gay men straight.

In the 1930s and '40s, Nazi doctors experimented with castration as a gay "cure"; one inserted testosterone glands into gay men's penises in 1944, according to a 2004 book by University of Lille historian Florence Tamagne.

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Electroshock therapy was used on trans women and gay and bisexual men in the 1960s in Britain and by South Africa's apartheid army, according to ILGA-World.

Doctors have reportedly used electroshock therapy on LGBT+ people in the past decade in China, Iran and India, according to OutRight Action International, another LGBT+ advocacy group.

Injection of hormones also remains relatively common.

Mariam, whose name has been changed to protect her identity, said she realised she liked girls when she was in kindergarten in rural western Georgia in the Caucasus.

WATCH: Mariam's story

She believes her mother became suspicious after finding a letter from a girl in her bag when she was 13 or 14.

"She already realised she was probably more than a friend," Mariam, now 25, said in an interview in Tbilisi, the Georgian capital.

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A woman, who wished to remain anonymous, talks about her experience going through conversion therapy in Georgia. Filmed in Tbilisi, Georgia, August 14, 2021. Thomson Reuters Foundation/Teona Chakvetadze

Mariam's mother thought her daughter's periods were late to start and sent her to a gynaecologist, who diagnosed high levels of a "male hormone" and prescribed hormonal injections to help.

Mariam soon grew suspicious about the treatment's true aim.

"The gynaecologist was ... telling me that just because I had more male hormones it did not mean I was a lesbian or interested in women," Mariam said.

A year into the hormone treatment, she refused to go back. Now she wants to leave Georgia with her partner.

"The trauma I experienced then will haunt me for the rest of my life," said Mariam. "I still cannot forgive my mother."

'Corrective rape'

Lesbians and bisexual women have also been raped by men who want to force them into heterosexuality, researchers say.

So-called "corrective rape" is "pervasive ... in all regions of the world", the United Nations independent expert on sexual orientation and gender identity said in a 2020 report.

"It is caused by ignorance, homophobia and our churches," said Nomandla, a South African activist whose name has been changed for her protection.

"Sometimes it is caused by jealousy that we do not want to be with them and sometimes it is culture playing a role - men thinking that women need to do what they say."

In 1999, Nomandla was the victim of a brutal sexual attack; this spurred her to help other women and she has since counselled about 50 survivors of "corrective rape" in West Rand, a municipality to the west of the city of Johannesburg.

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Lesbians have also reported "corrective rape", beatings and solitary confinement in drug rehabilitation clinics in Ecuador, despite a 2012 ban.

Talking therapy is also commonly used, though many counsellors who work with patients on what they call "unwanted same-sex attraction" deny this amounts to conversion therapy.

"What people like myself offer is psychological therapy that is identical in method to therapy to help people with addictions or to affirm a sexual identity, it is just the aim that is different," said Phelim McIntyre, a British-based counsellor.

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Yet many conversion therapy bans specifically prohibit mental health or medical professionals from helping anyone to try to change their sexual orientation or gender identity.

The world's first ban on using counselling this way was in 1999 in Brazil. It took another 13 years for California to become the first U.S. state to ban medical and mental health professionals from carrying out conversion therapy on minors.

Now 20 U.S. states ban it - but also only for minors treated by healthcare professionals, bypassing adult patients and other practitioners.

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In 2020, Albania's national psychologists' body barred members from practising conversion therapy, similar to Brazil's ban. LGBT+ activists are now campaigning to legally classify it as violence against children, but are not doing so for adults.

Anyone carrying out conversion therapy on under-18s in Germany, or coercing, deceiving or threatening adults into it, risks a year in prison. Advertising or offering conversion therapy carries a 30,000 euro ($35,535) fine.

'Cruel optimism'

Laws to ban conversion therapy are currently working their way through seven parliaments, including New Zealand, Canada and Spain. Dutch and Austrian MPs have voted for a bill to be introduced.

In Finland, a petition calling for a ban has more than 50,000 signatures so must now be considered by its parliament.

Joe Biden said he would outlaw conversion therapy when running for U.S. president but has yet to act. The leaders of Britain and Norway have made similar pledges, again with no result yet.

Britain renewed its pledge in May but also said it would not criminalise "appropriate pastoral support (including prayer)".

Lecturer Lucas Wilson chose to undergo Christian counselling for four years as an undergraduate, but now backs a ban.

"Conversion therapy is violence, conversion therapy is harm being done to others," Wilson said from Toronto.

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Wilson knew from a young age he was attracted to men but could not come out. He recalled his Baptist mother saying "just how gross and how disgusting these folks are".

Wilson looked around Liberty University, a private Christian institution in the U.S. state of Virginia, and saw an advert in the chapel aimed at men "struggling with same-sex attraction", which became part of his motivation for going there.

Counsellor Dane Emerick read Bible passages in sessions and was also "very pseudo Freudian in his approach," Wilson said.

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Canadian Lucas Wilson talks about his experience with conversion therapy at Liberty University in Lynchburg, Virginia. Filmed in Toronto, Canada, June 15, 2021. Thomson Reuters Foundation/Kyle Laurin

The 31-year-old said Emerick, who retired this year, had promised him he would one day find a woman he could love and marry.

"It instilled this very cruel optimism," said Wilson, who is no longer religious.

"I felt that I wasn't praying enough, I felt that I wasn't reading my Bible enough... I thought that I was messed up, I thought that I was gross, I thought that I was dirty."

Liberty University did not respond to repeated requests for comment by email and phone, while Emerick did not reply to requests sent by email and via Facebook.

The 'Student Honor Code' says "sexual relations outside of a biblically-ordained marriage between a natural-born man and a natural-born woman are not permissible at Liberty University".

Same-sex relations and LGBT+ identities are not mentioned.   

Flaming torches

Islamic conversion therapy can involve casting out jinns, a type of spirit.

In Malaysia, state-run 'Mukhayyam' residential programmes target trans women, according to a 2020 report by the Asia Pacific Transgender Network, a regional advocacy group.

Farah went on one three-day programme in 2018 after being promised Islamic teaching at a paid-for resort.

The programmes mainly recruit trans women over 40, said the 51-year-old activist, whose name has been changed to protect her identity, drawn in by the promise of payment and being taught new employment skills such as sewing.

Farah recalled how she and some 40 other trans women were told "you were born as a man and you should die as a man".

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Jazz Bustamante, a trans woman from the port city of Veracruz, shares her experience going through conversion therapy on a Mexican ranch. Filmed in Mexico, August 3, 2021. Thomson Reuters Foundation/Cinthya Chavez

Her limbs were hit lightly with a tree branch by a religious figure seeking jinns hidden within.

She found it funny. But trans women who attended other programmes say they were pepper sprayed in the eyes and pushed into gruelling physical activity.

Some Christian conversion therapy also involves casting out demons or exorcisms.

Jazz Bustamante, a 30-year-old activist from Veracruz, a coastal city east of Mexico City, joined a Pentecostal church aged about 16, after she told her family she felt she was a woman and was kicked out of her home church.

At first she felt accepted, but when she became a regular about three years later, the pastor began praying over her, asking God to rid her of "the demons of homosexuality".

"There came a stage at about 8-9 months in that I started to believe I was sick,"  Bustamante said in an interview, after fleeing Veracruz to escape threats prompted by her activism.

"I arrived home one night, I looked at myself in front of the mirror, I saw myself and I cut my hair."

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Bustamante became depressed and resentful and left the church when she was aged about 20.

Her second experience of conversion therapy was in her early 20s, when a client at her salon invited her to what she thought was a long weekend at a "spiritual retreat".

She arrived at midnight on a Friday, to a scene of flaming torches. Over three sleepless nights, participants were told to write their life stories on pieces of paper.

On the final night, someone identified as a "godfather" took her aside and she was told to burn every page and that she would die of AIDS if she had sex with men again.

Conversion therapy had caused her panic attacks and should be banned, she said, adding: "I am still in therapy."

Taking stock

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ARCHIVE PHOTO: Members of the Mormon church march in a gay Pride parade in Salt Lake City, Utah, June 2, 2013. Both Mormons and members of the Boy Scouts marched with members of LGBT+ community and their supporters as part of the Utah Pride Festival. REUTERS/Jim Urquhart

Not all people who have undergone conversion therapy agree.

Randy Thomas, the former executive at "ex-gay" Christian organisation Exodus, had treatment when he was 24, after converting to Christianity and giving up the drugs and alcohol he had been using since his mother kicked him out aged 16.

He felt accepted by a sober community at a "hipster church". There, he was encouraged to go to a support group for gay men, where his sexuality was blamed on emotional dependency.

"It was the first time (I) felt safe as an adult. They looked normal, so why wouldn't I try to fit in," Thomas explained in a video call from his home in Florida, a photo of him kissing his fiance in the background.

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"Looking back on it, we thought what we were doing was so good and that was what God was telling us to do," said Thomas, now 53. "And that's the way cults work."

Thomas, who came out as gay for the second time in 2015, said that bisexual people were often incorrectly held up as examples of "ex-gay" success.

Yet Thomas does not back a ban on what he went through.

"Maybe it's just my American sensibilities, but I can't - it would be very hard for me to support something that would tell an adult that they couldn't choose something."

"I would be glad to get in their faces," said Thomas, of adults opting for conversion therapy. "I mean, not confrontationally, but in a way of trying to convince them to not give up 22 years of their life like I did."

Reporter: Rachel Savage
Additional reporting: Umberto Bacchi, Christine Murray, Megan Davies, Kim Harrisberg, Maya Gebeily, and Enrique Anarte

Text editing: Lyndsay Griffiths and Hugo Greenhalgh
Video editing: Morgane Mounier
Videography: Kyle Laurin, Calypso Logel, Cinthya Chavez, Teona Chakvetadze
Graphics: Nura Ali
Producer: Amber Milne

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