Recently the CBC withdrew the BBC documentary “Transgender Kids: Who knows best?” from its scheduled programming in response to pressure from trans activists. As a child psychiatrist, founder of the Gender Identity Clinic (GIC) at Toronto’s Centre for Addiction and Mental health and, currently, Professor Emerita at the University of Toronto, I found this decision quite troubling.
The documentary, in my opinion, is highly informative, offering a balanced exploration of both sides of the transgender debate: on the one hand the “affirmation” model which takes gender dysphoria at face value, with transitioning as the solution to a child or adolescent’s distress, on the other hand the “mental health model,” which concerns itself with underlying or accompanying symptoms, and which takes into consideration the extremely high post-adolescence desistance rate of up to 90%.
Dr. Kenneth Zucker, until 2015 head of the GIC, is interviewed in the documentary.
Dr. Zucker, whose position at CAMH was terminated under pressure from trans activists, has been a special target for demonization. A proponent of the mental-health model in dealing with gender dysphoria, he resists uncritical affirmation of gender dysphoria in very young children, offering support for parents’ right to encourage their children’s identification with their biological sex, and guidance in strategies to achieve that end (often successfully). Where dissuasion is futile, however, he supports prudent transitioning.
Dr. Zucker also counsels caution for vulnerable older children, whose dysphoric persistence is likely more attributable to autism or failure to understand their gay tendencies than a true desire to “be” of the opposite gender. His appearance in the documentary as a credible expert is doubtless in itself the main reason activists were so eager to see it suppressed.
As a specialist in both Autism Spectrum Disorder (ASD) and gender discomfort, I am firmly in the mental-health model camp, and support Dr. Zucker’s reasonable and ethical position.
In my own practice, I have seen a good many young women displaying the phenomenon known as “rapid onset gender dysphoria,” or ROGD, which overwhelmingly affects girls.
Typically, the ROGD teenage girls I see have, wittingly or not, begun to experience homoerotic feelings about which they are conflicted. They tend to be socially isolated, and somewhere “on the spectrum.” They may have histories of eating or self-harm disorders.
They have found companions with the same attributes on Internet sites, which diminishes such adolescents’ sadness over their social isolation, but which can also lead to foreclosure of reflective thinking about their own feelings and situation. Some of these girls are depressed, afflicted with suicidal ideation. Because of the initial euphoria they experience in finally “belonging” to a well-defined kinship group, they tend to embrace the idea of transitioning wholeheartedly as the solution to their other problems.
Parents of ROGD girls find themselves in uncharted or even hostile territory if they resist the affirmative model, which is now the default position in schools, social service programs and gender-focused clinics. As they are often told their daughters may commit suicide if they are not affirmed and encouraged, these parents struggle to find an approach that is safe for their daughters without compromising their own well-founded skepticism and protective instincts. They are rightly alarmed by the speed with which gender professionals glide from near-instant or even self diagnosis to recommendations for off-label and lightly studied hormone blockers or cross-sex hormones (which cause infertility).
At the CAMH clinic, we carried out thorough assessments of dysphoric teens to ensure all factors had been taken into account and that the teenager was fully conscious of the enormity of the choice she was making, not an easy task with ASD teens hampered by limited executive function and difficulty with abstract thinking.
We did not deny hormone treatments, prescribed by informed endocrinologists, where no other option seemed likely or safe, but continued to monitor their progress for safety, inasmuch as we could, given the lack of scientific knowledge regarding long-term impacts. Still, we favoured postponement of irreversible treatment until it was absolutely clear there was no chance of desistance. For observing this cautionary principle, we are often vilified as “transphobic” by activists and ill-informed sympathizers in the general population.
Activists have branded gender fluidity as normative and detached from biological sex. Credulous establishment figures have bought into this narrative, which is now firmly ensconced in our educational, medical, social service and legal institutions. The reality is, however, that there is no credible evidence that the affirmative approach is effective or safe, a key construct in accepting interventions in medical practice today; nor is there a scientific marker for a ‘true” trans or for a desistor. As was noted in the BBC documentary by GIC researcher Dr. Devita Singh, in a study of 100 boys who attended the GIC, 88 desisted post-puberty, even though their childhood certainty had been as intense as those who persisted.
The BBC documentary opens an informative window on both sides of this debate, allowing viewers to draw their own conclusions. As Canada’s public broadcaster, with a mandate to offer the public balanced reportage on important cultural matters, the CBC made the wrong judgment call.
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