Historical and ongoing bioessentialism pathologizes queer identities through genetic associations with homosexuality and transgender identities rooted in eugenics.

Bioessentialism, or suggesting that social constructions are inherently biological, has contributed to stigma and discrimination of the queer community (Llorin & Zayhowski, 2023). This perpetuates the narrative that people who do not fit binary categories are “disordered.” Homosexuality was in the DSM-II until 1973 (American Psychiatric Association, 2013) and in the International Classification of Diseases (ICD-10) until 1990 (Cochran et al., 2014). The way that homosexuality has been treated as a “disorder” parallels the way race has been inappropriately pathologized. Racism, not race, leads to the different medical outcomes seen (Newman, 2022; Roberts, 2011), yet race continues to inappropriately guide various aspects of medical care leading to medical mistreatment (Vyas et al., 2020). Similar to the larger medical field, the genetics field has explored queerness as a pathological trait. Research studies looking for genetic associations with homosexuality by Hamer et al. (1993) have been heavily criticized as a tool for pathologization (Petersen, 1999; Schüklenk et al., 1997). Yet, we see an increase in this research (Bentz et al., 2008; Foreman et al., 2019; Ganna et al., 2019; Hamer, 2011; Polderman et al., 2018; Theisen et al., 2019), such as large genome-wide association studies being published to study genes associated with sexual orientations and transgender identities (Ganna et al., 2019; Theisen et al., 2019). While some LGBTQ+ people have expressed that this type of genetic testing could be validating or increase societal acceptance of queer identities, others have expressed concerns about how the testing has serious ethical concerns and could be used with malicious intent, including pathologizing queer identities, undermining reproductive rights, gatekeeping healthcare, and informing eugenic practices (Hammack-Aviran et al., 2022; Rajkovic et al., 2022). Anti-queer bias permeates clinical genetics and the larger medical field. We posit that providing just care for the queer community requires us to examine the anti-queer foundations endemic in genetics practices. Throughout this piece, we will explore how genetics contributes to the perpetuation of pathologization of queer identities and call for systemic changes in the genetics field. 1.1 Cisheteronormative norms embedded into the genetic counseling field Anti-queer biases have been integrated into the genetic counseling field since its inception. The first genetic counseling program was founded by Melissa Richter at Sarah Lawrence College in 1969. Sarah Lawrence College, an all-women's school until 1968, was chosen in order to “appeal to its core constituency, married women in their 30s with two to four children living at home” (Stern, 2009). Over half a century later, the demographic makeup of the field continues to be predominantly white, heterosexual, cisgender women (National Society of Genetic Counselors, 2022). In general, queer communities are underrepresented in the medical field and experience microaggressions and isolation similar to students of racial and ethnic minorities (Marcelin et al., 2019). Queer genetic counseling students have reported cisheteronormative training environments and admissions practices, and a hesitancy to discuss their queer identities with program faculty and peers (Chu et al., 2023; O'Sullivan et al., 2023). One study demonstrated genetic counselors' and genetic counseling students' have an implicit preference for heterosexual over homosexual people (Nathan et al., 2019). Queer patients have reported experiencing discrimination in genetics clinics, despite genetic counselors reporting comfort in working with them (Valentine et al., 2023). Eugenic sentiments were embedded into the conception of genetic counseling. Melissa Richter articulated that the creation of genetic counseling was needed to address “the increase of illnesses by inherited diseases; the sizable proportion of our population suffering from mental or emotional disturbances; and the problems created by overpopulation” (Richter, 1968). These justifications mirror eugenic ideologies which propagandized the need for sterilizations to mitigate overcrowding in institutions, targeting immigrants, Black people, Indigenous people, poor people, and disabled people (Lombardo, 2011). Eugenicists weaponized biology to deem homosexuality and gender nonconformity as traits needing to be fixed. In a speech given in 1970, renowned geneticist H.B. Glass noted the need to end congenital defects including “sex deviation” (Ordover, 2003). Medical practices have attempted to eliminate homosexuality through castration, conversion therapies, brain implants, and lobotomies (Ordover, 2003). The eugenic roots of genetic counseling must be understood in order to examine how practices are still perpetuated within the field today through its focus on eradicating disease.