In late 2015, the Child and Adolescent Gender Identity Clinic at Toronto’s Centre for Addiction and Mental Health was closed following a review of its practices in the treatment of gender-nonconforming children. The clinic, founded by Dr. Susan Bradley in the 1970s and later directed by her frequent collaborator Dr. Kenneth Zucker, was notable for its use of an approach focused on discouraging children from identifying with or expressing a gender other than the one they were assigned, with the intention of ensuring that they would grow up to be cisgender rather than transgender. This perspective is out of step with contemporary professional consensus that gender-affirming therapy and watchful waiting are the healthiest approaches when treating children who are potentially transgender and gender-questioning.
The allegation that the closure of the Gender Identity Clinic was purely “politically motivated” has received extensive coverage in an investigation by New York magazine, a recent BBC documentary on transgender children, and several articles in the Globe and Mail. However, considerably less attention has been given to Zucker’s and Bradley’s lengthy history of inflammatory and self-promoting rhetoric which irresponsibly plays to popular prejudices. While these researchers have claimed to support transgender adolescents and adults in transitioning, they continue to issue statements which misinform the public about the nature of transgender identity and are scientifically unfounded – in some cases going so far as to offer their tacit approval to religiously-motivated transphobia and long-running myths about queer and trans “recruitment” of children. Their misleading claims in the media do a disservice to transgender youth and adults, as well as the wider public.
Gender deprivation therapy is unproven, unethical, and professionally unsupported
The treatment protocol for gender-questioning children at the Gender Identity Clinic was of a clearly coercive nature, intended to deprive these kids of any gendered apparel, toys, or activities not stereotypically associated with their assigned sex, while encouraging their families to teach them that transitioning is impossible. This approach was described in J. Michael Bailey’s 2003 book, The Man Who Would Be Queen:
First, he thinks that family dynamics play a large role in childhood GID—not necessarily in the origins of cross-gendered behavior, but in their persistence. It is the disordered and chaotic family, according to Zucker, that can’t get its act together to present a consistent and sensible reaction to the child, which would be something like the following: “We love you, but you are a boy, not a girl. Wishing to be a girl will only make you unhappy in the long run, and pretending to be a girl will only make your life around others harder.” . . .
The second prong is therapy for the boy, to help him adjust to the idea that he cannot become a girl, and to help teach him how to minimize social ostracism. . . .
The third prong is key. Zucker says simply: “The Barbies have to go.” He has nothing against Barbie dolls, of course. He means something more general. Feminine toys and accoutrements—including Barbie dolls, girls’ shoes, dresses, purses, and princess gowns—are no longer to be tolerated at home, much less bought for the child. Zucker believes that toleration and encouragement of feminine play and dress prevents the child from accepting his maleness. (Bailey, 2003, pp. 30-31)
Suppose a similar “treatment” were imposed on a cisgender child, denying them the opportunity to engage with any interests that could conceivably be associated with their assigned sex and pushing them to live as a gender with which they don’t identify. It’s obvious that such an attempt at gender conditioning would be not only unsuccessful, but unjustifiable and even traumatic for the child. Those trans and gender-questioning children who were subjected to this coercive protocol were at times very resistant to this as well:
So, to treat Bradley, Zucker explained to Carol that she and her husband would have to radically change their parenting. Bradley would no longer be allowed to spend time with girls. He would no longer be allowed to play with girlish toys or pretend that he was a female character. Zucker said that all of these activities were dangerous to a kid with gender identity disorder. . . .
By the time Bradley started therapy he was almost 6 years old, and Carol had a house full of Barbie dolls and Polly Pockets. She now had to remove them. To cushion the blow, she didn’t take the toys away all at once; she told Bradley that he could choose one or two toys a day.
“In the beginning, he didn’t really care, because he’d picked stuff he didn’t play with,” Carol says. “But then it really got down to the last few.”
As his pile of toys dwindled, Carol realized Bradley was hoarding. She would find female action figures stashed between couch pillows. Rainbow unicorns were hidden in the back of Bradley’s closet. Bradley seemed at a loss, she said. They gave him male toys, but he chose not to play at all. . . .
“He was much more emotional. … He could be very clingy. He didn’t want to go to school anymore,” she says. “Just the smallest thing could, you know, send him into a major crying fit. And … he seemed to feel really heavy and really emotional.”
Bradley has been in therapy now for eight months, and Carol says still, on the rare occasions when she cannot avoid having him exposed to girl toys, like when they visit family, it doesn’t go well.
“It’s really hard for him. He’ll disappear and close a door, and we’ll find him playing with dolls and Polly Pockets and … the stuff that he’s drawn to,” she says.
While this is inflicted on children with the intention of preventing them from growing up to be transgender, there is no clear evidence that this distressing treatment changes the likelihood of that outcome. Zucker and Bradley themselves acknowledge this in their 1995 textbook, Gender Identity Disorder and Psychosexual Problems in Children and Adolescents:
At this point, formal outcome studies of cross-gender-identified children are needed to determine whether some types of treatment are better than others, and whether any type of treatment is significantly better than no treatment. Process studies are also needed to learn why, with or without intensive treatment, the vast majority of cross-gender-identified children eventually relinquish the desire to change sex. (Zucker & Bradley, 1995, p. 288)
Other clinicians working with gender-questioning children have also noted that gender-disaffirming approaches are not supported by evidence (de Vries & Cohen-Kettenis, 2012):
There are, however, no controlled studies that have investigated psychological interventions aimed at influencing certain types of gender dysphoria. It remains for the most part unclear if “treated” children have been “cured” through interventions or just “grew out of” their gender variance.
Even if one were to accept that preventing transgender adults from existing is a valid clinical goal, it remains unclear whether this protocol can be said to achieve even that or provide any benefits that would justify the harm imposed on these children. Instead, professional organizations such as the American Academy of Pediatrics recommend an approach allowing transgender and gender-questioning children to live as their identified gender with the support of their family and community (Dreyer, 2016):
Both families stressed how important it is for home to be a safe and accepting space for the transgender child. When those children walk through the door of their homes at the end of a school day, they should be able to be themselves without any judgment. As one of the fathers passionately said, “I won’t be my child’s first bully!”
The pediatrician’s office, and the entire health care setting, should be a safe, accepting place as well. I was sad to receive an email from one of the parents telling of another family’s encounters with the health care system when they bring their 5-year-old transgender daughter in for care for her serious chronic disease. The doctors refuse to treat her as a girl until she is older, and some have even called child protective services claiming the mother is harming her child for allowing her to live as a girl.
This is done even though a study by Olson and colleagues, published in Pediatrics in March, showed socially transitioned transgender children who are supported in their gender identity have improved mental health outcomes. There appears to be no harm — and possible benefit — from such parent-supported early social transitions.
Contrary to the wide base of professional and scientific support for a gender-affirming approach, much coverage of the CAMH GIC’s closure has misleadingly framed this controversy as a clash between “trans activists” who endorse an affirming approach in implied opposition to scientific evidence, and “researchers” like Zucker and Bradley who have supposedly been unjustly pushed aside by the overwhelming forces of “political correctness”. In reality, this is not a matter of undue influence by antiscientific activists as is commonly depicted – this position is supported by major organizations of medical professionals whose recommendations are counterintuitive to a largely uninformed public, and opposed by a marginal fringe of researchers whose approach is nowhere near as strongly backed by science but is much more heavily backed by the widespread public preference that trans people simply not exist at all. Appeals to the public’s ignorance by Zucker and Bradley are a recurring theme throughout their engagement with the media.
Claims of support for trans people are contradicted by facile and offensive comparisons
Zucker is emphatic in his support of transition for adolescent and adult trans people:
Well, I think that there are good data showing, for adolescents and adults with gender dysphoria, that as they transition they do better psychologically. . . . Nobody who gets the treatment regrets it by and large.
However, this support is rather badly compromised by Zucker’s frequent habit of comparing transitioning to the hypothetical situations of individuals wishing to alter their race or species:
Zucker says the homosexuality metaphor is wrong. He proposes another metaphor: racial identity disorder.
“Suppose you were a clinician and a 4-year-old black kid came into your office and said he wanted to be white. Would you go with that? … I don’t think we would,” Zucker says.
In the 2017 BBC documentary “Transgender Kids: Who Knows Best?”, Zucker offers another such analogy:
A four-year-old might say that he’s a dog – do you go out and buy dog food?