NRPLUS MEMBER ARTICLE T he global debate on transgenderism has become toxic for all sides. In the U.S., the Trump administration sparked outrage after its apparent intention to restrict the legal definition of “gender” to one’s sex at birth was leaked to the New York Times. In the U.K., a government-led consultation on whether a person can change his or her legal gender by self-identification alone provoked feminist outcry, while a ComRess poll found that 63 percent of Conservative-party MPs are reluctant to express their views lest they be called “transphobic.” And in Canada, this month, a world-leading psychologist in the field of gender dysphoria has been exonerated at long last after being caught in the crossfire.
Following three years of legal fees and media silence at the request of his ex-boss and the advice of his lawyers, Dr. Kenneth J. Zucker has reached a public settlement with Toronto’s Centre of Addiction and Mental Health (CAMH) for unfair dismissal and libel. The Centre’s $586,000 payout was accompanied by its public apology for, among other things, publishing the false allegation on their website that Dr. Zucker had called a transgender patient “a hairy little vermin.”
John Adair, Dr. Zucker’s lawyer, wrote by email:
The settlement includes a monetary payment that is very large by Canadian standards for a defamation case. We were proud to represent Dr. Zucker in achieving a resounding success that in our view affirms not only his treatment approach but his professional reputation as a world leader in his field.
Dr. Zucker, editor-in-chief of the journal Archives of Sexual Behavior, helped shape the Diagnostic and Statistical Manual’s current definition of “gender dysphoria.” Following complaints local activists made to CAMH in 2014, he was investigated by two independent assessors with little experience in childhood gender issues. After his removal in December 2015, though, more than 500 clinicians and researchers within the field signed an open letter to CAMH’s board of trustees, expressing “dismay” at Dr. Zucker’s dismissal and defending his integrity and his “outstanding” contribution to the field.
Though he will sometimes recommend social and medical transition for his patients, Dr. Zucker is guided by the general principle that congruence between a patient’s gender identity and birth sex is the ideal outcome. This approach is informed by decades of case-by-case clinical practice and a small but substantial body of research — in an uncertain and under-researched area — suggesting that over two-thirds of children with gender dysphoria will realign with their birth sex by the end of adolescence if they have not been exposed to transition-based treatments.
Prior to his ousting, however, political pressure was mounting. One petition to CAMH on Change.org, with 2,203 signers, sought to “eliminate Dr. Kenneth Zucker.” This complaint called his clinical practices “highly outdated and demoralizing” and further claimed, without any substantiation whatsoever, that he is an “alleged sex abuser.”
Broadly speaking, there are three main approaches for youth with gender dysphoria: 1) a range of treatments from psychotherapy to peer relations, which attempt to resolve root causes; 2) an intermediary therapeutic approach known as “watchful waiting”; and 3) gender affirmation (which involves social or medical transition). In recent years, however, activists have been increasing the pressure to make gender-affirming treatment the only treatment.
For example, the American Academy of Pediatrics recently released a policy statement whose lead author is Dr. Jason Rafferty, who, according to the PubMed database, has no published papers on gender issues other than policy statements. Yet the statement — backed by activists and approved by a committee of 24 pediatricians and a maximum of twelve AAP board members (according to an AAP insider), and intended for use by the 67,000 member pediatricians — recommended a strikingly simplistic, one-size-fits-all gender-affirming approach for “transgender” youth.
When Dr. James Cantor of Sexology Today! fact-checked the policy statement, however, he discovered that many of the sources it cited directly contradicted claims made in the document itself. Dr. Zucker, whose work is not cited once despite his authority, also said that the AAP statement was “shockingly bad scholarship” and that it makes bold assertions where the research literature is weak or nonexistent.
“Watchful waiting,” for instance, is dismissed as outdated, even though no randomized control trials have been done in this area. In addition, treatments are labelled as “conversion therapy” if they hesitate to adopt permanent medical and social conversion and instead seek to resolve root causes of gender dysphoria in children. The “conversion therapy” label is disingenuous and coercive, however, given that the real “conversion” would be to try to change a child’s sex through life-altering medical intervention.
Yet media critics often amplify this skewed picture, Dr. Zucker says. He gives the examples of a recent New York Times article by Dr. Perri Klass that endorsed the AAP policy statement and incorrectly asserted that gender dysphoric youth have “triple the rate of suicide.” The Times has now corrected this suicide statistic, admitting it had no basis. Dr. Klass also wrote that “mental health problems in these children arise from stigma and negative experiences.” (Note: not can arise.) Young people with gender dysphoria may indeed have a higher rate of mental-health problems than children without gender dysphoria, Dr. Zucker says, but he adds that it is deeply harmful to parents to assert that the sole cause is an unsupportive environment.
One pediatrician working at a large children’s hospital in the U.S., who prefers to remain anonymous, wrote by email,
If the AAP (and NYT) wishes to help me, a fellow of the AAP and a parent, they would ground their statements in evidence-based research (like vaccines or breast-feeding). They would welcome dissenting opinion when the research isn’t clear. And they would stand up to political pressures that would have them turn a blind eye.
Moreover, while historically gender dysphoria typically affected males, a surge in incidence in girls in a startlingly short period of time has turned this trend on its head. Lisa Littman, M.D., an assistant professor at Brown University, identified this trend in her study published in PLOS-One this year. A possible cause, she suggested in the paper, is “social contagion.” Dr. Littman has been vilified for her study, much as Dr. Zucker has been for his work. Bowing to political pressure, Brown University pulled the paper from its website.
Dr. Littman wrote by email:
Activists appear to follow a very conscious strategy of harassment and intimidation, which I’m sure they feel is justified. They go after the reputations of the people they wish to silence, and they also attack the organizations those people are affiliated with, offering to back off if only those organizations take swift and decisive disciplinary action.
The decision to make a medical transition is a difficult one and people need accurate information about risks, benefits and alternatives to assess whether, in their individual case, it will be beneficial — that is the essence of informed consent. When activists shut down gender dysphoria research about potential risks and contraindications of transition, they are depriving the transgender community of their right to receive accurate information.
Now that he has been vindicated, Dr. Zucker hopes that more clinicians and researchers such as Dr. Littman will be heartened and continue their important work on youth with gender dysphoria — putting evidence before increasingly toxic politics.