When boys would rather not be boys - Macleans.ca

When boys would rather not be boys

Kids are being diagnosed—and identifying themselves—as transgendered younger than ever before

When boys would rather  not be boys

Brian Howell

Cormac O’Dwyer entered Grade 8 in Vancouver as a girl named Amber. All traces of femininity stopped with the name; Amber looked, dressed and acted like a boy. “It was awkward,” admits Cormac, sleeves rolled up to reveal downy, muscular arms, elbows resting on the kitchen table in the family’s immaculate home in upscale Kitsilano. From the other end of the table, Cormac’s mother, Julia, pipes up. “People would use the male pronoun,” she recalls. Usually Julia felt obliged to correct the error, leaving new acquaintances flustered and confused.

But solecisms were the least of Cormac’s worries during the transition from female to male. Becoming a boy involved wearing a breast-flattening binder, changing for phys. ed. in the teachers’ change room, declining invitations to go swimming, and carrying a cellphone to call for help in case of bullying. And then there was the therapy: testosterone injections, counselling and surgery that removed his breasts and contoured what remained into the flat, square planes of a male chest.

Now 16, Cormac is one of a growing number of teenagers in Canada who have been diagnosed with gender identity dysphoria (GID), or transgenderism. These kids feel that they have been born into the wrong bodies, and are actually members of the opposite sex. Cormac recalls his epiphanic moment following a presentation by a peer-counselling group for lesbian, gay, bisexual and transgender youth at Lord Byng Secondary School. “I always sort of knew I wanted to be a guy,” says Cormac. “They explained to me what transgender was and, for the first time ever, I ‘got it’ and went home and told my mom.”

Julia, too, clearly remembers that day, and how difficult it was to reconcile her eldest child’s dramatic declaration. “You don’t know how to answer,” she says. “That’s the one thing for someone who isn’t transgender—it’s very hard to understand what is inside a person to need to make that change.”

Treatment of GID is highly controversial. Some experts believe that the best way to help children and teens is to convince them to accept their bodies and not undergo the therapies that will cause dramatic physical changes. Cormac, however, lives in Vancouver, where pediatric endocrinologist Dr. Daniel Metzger and the B.C. Transgender Care Group are based. The loosely organized group, of which Metzger is a member, is the sole provider of care for transgender youth in B.C. and offers the most extensive suite of medical services for GID adolescents in Canada. Metzger believes that the best course of treatment for teenagers diagnosed with GID is hormone therapy: either blockers to stop puberty or, if post-pubescent, hormones that physically alter the body in a way that reflects their chosen gender. For some teens like Cormac, who are confident, psychologically stable and have family support, this transformation can be complemented further with cosmetic surgery.

Without treatment, Metzger argues, the path to adulthood for GID teens can be torturous, as evidenced by shockingly high attempted suicide rates*: 45 per cent for those aged 18-44, in comparison to the national average of 1.6 per cent, according to the U.S. 2010 National Transgender Discrimination Survey Report on Health and Health Care. Cormac carefully considers what life would be like today if he were still Amber. He pauses for a few seconds then gravely announces, “I think that would push me to be suicidal.” He is much more calm now, he says, free from his obsession with wanting to be a boy. “Before I transitioned I thought about it a lot, like, every minute. Now, I feel like I have so much extra brain space,” says Cormac, who is an honour roll student.

The sense of calm also comes, he adds, from the unburdening of secrets. He is a young man both in body and spirit, rather than a girl trying to pass as a boy. “I have friends that I’ve had for a year or more and I don’t know if they know or not about the transition. It’s not important to where I am right now. I guess I could tell them but I don’t even think about it.”

Transgender experts like Harvard Medical School professor and endocrinologist Dr. Norman Spack, co-director of Boston Children’s Hospital’s clinic for disorders of sexual differentiation, speaks highly of the B.C. Transgender Care Group. In fact, Spack deems the B.C. program one of the more progressive in the world. While progressive, the B.C. Transgender Care Group is not radical. The group’s psychology or psychiatry transgender specialists will ensure that an adolescent who is diagnosed with GID is mentally healthy before referring them to Metzger for hormonal therapy. If a child has GID in combination with depression or anorexia—which can occur in youngsters trying to cope with the stress of GID—then the hormonal cocktail that transforms their sexual development is delayed. For Cormac, who had already finished puberty, a regimen of testosterone injections stopped his period and thickened his jawline. He began shaving and started to speak in the lower registers. During the transition, Cormac also consulted with Vancouver plastic surgeon Dr. Cameron Bowman—one of only three sex-reassignment surgeons in Canada—about getting a mastectomy. After a panel of psychiatric transgender specialists assessed and approved Cormac’s readiness, he had the operation a week after his 15th birthday, making him one of the youngest transgenders in Canada ever to undergo a provincially funded mastectomy and chest contouring. Pronoun confusion was, at last, a moot point.

Some specialists question whether such a metamorphosis is appropriate for young patients. Psychologist Kenneth Zucker, who heads Toronto’s Gender Identity Service in the Child, Youth, and Family Program at the Centre for Addiction and Mental Health, leans toward counselling to get his patients—especially the younger ones—to accept their birth sex. He worries that the Internet, which has opened up a world of information for children and teens confused about sexual orientation, may be making “transgenderism fashionable: it’s kind of cool to be transgender, as opposed to being gay or lesbian,” says Zucker, who sees at least 50 new GID cases a year, a “quadrupling compared to 30 years ago.” To illustrate his point, Zucker describes one 15-year-old female patient as a “tomboy” who is attracted to other girls—but interprets the attraction as transgenderism. Such “internalized homophobia” can emerge in homes or cultures that oppose homosexuality, Zucker says. The teen thinks, “It would be easier if I were a boy attracted to girls, because then I wouldn’t be teased for being a lesbian.”

Zucker also cautions that psychological disorders like Asperger syndrome, a form of autism characterized by repetitive patterns of behaviour and interests, can also spark GID. Kids with Asperger’s “can get obsessed with a particular idea, and gender is one.”

Unsurprisingly, given all this, Zucker does not approve sex-reassignment surgery for his adolescent patients at all. And he prefers they wait until they’re at least 13 to take puberty blockers—which are reversible—and especially estrogen or testosterone hormone therapy, the effects of which are not reversible.

Harvard’s Spack is well acquainted with Zucker’s contributions to the study and treatment of GID in children and adolescents. The transgender medical fraternity worldwide, Spack adds, generally supports Zucker’s data showing that about 80 per cent of prepubescent children who identify as the opposite gender will change their minds, while 20 per cent will persist. However, Spack disagrees with Zucker’s counselling methods, which reflect the Toronto psychologist’s fundamental assumption that encouraging a child to play and dress in a way that reflects their biological sex may help them to grow out of their GID. Children who undergo this type of psychological therapy can be devastated by it, Spack believes.

What is the root cause of GID? Clinicians and researchers worldwide are mystified, according to Peggy Cohen-Kettenis, a professor of medical psychology at Free University Medical Center in Amsterdam. Considered one of the world’s foremost experts on transgender adolescents, Cohen-Kettenis believes genetics likely play a strong role; abnormal levels of sex hormones in utero during fetal development may also play a part. Or, brain receptors may be unusually sensitive to developmental hormones, says Cohen-Kettenis. She also points to recent magnetic resonance imaging (MRI) research, which indicates that the brains of those with GID have striking similarities to the brains of the opposite sex with which they identify. For example, according to a study published last year in the Journal of Psychiatric Research, specific regions of female-to-male transsexuals’ brains strongly resemble male brains.

But neither Metzger nor his young patients fret about the cause of a GID diagnosis. The adolescents simply want it dealt with—now. For some male transgenders, Metzger says the prospect of their first period is horrifying, while some female transgenders view their penises as offensive foreign appendages. Anxiety, depression, suicidal thoughts and drug use can follow, he adds. To help patients cope, the B.C. Transgender Care Group follows a “harm reduction” model of medicine. Puberty blockers—which are reversible and can be administered to patients as young as 10—can be initiated before undesired secondary sex characteristics emerge, says Metzger. The treatment not only changes the course of sexual development but also temporarily eliminates patients’ sex drive—a huge relief to kids who need to “focus on their transitioning, school and therapy,” Metzger says. The hormone blockers—usually Lupron, a $400-a-month injectable synthetic hormone—can be stopped at any time, allowing puberty to resume. For individuals like Cormac who have already gone through puberty, hormone therapy is initiated. This is either oral estrogen or, in Cormac’s case, injectable testosterone, replicating the hormones that are normally produced by the ovaries or testes.

Metzger defends early intervention by arguing that the cessation of undesired—and unmistakable—secondary sex characteristics is key to ensuring that transgender adolescents blend seamlessly into an image-obsessed society when they mature. “I have met lots of adults who transitioned in their 20s and 30s and they look at me like I’m the saviour,” says Metzger, who began treating transgender adolescents 12 years ago—and none of them have regretted their transition. “They say, ‘Oh my God, if there had been someone like you when I was younger, my life would have been totally different. I wouldn’t have spent bazillions of dollars on electrolysis or I wouldn’t have this enormous square jaw.’ They think that the new generation of young transgender kids are so much luckier for being able to do what they knew they wanted to do when they were 12.”

Nonetheless, the mental health experts with the B.C. Transgender Care Group are cautious when it comes to approving the irreversible, final step of GID treatment: sex-reassignment surgery. Cormac O’Dwyer’s surgery was one of only about five that have been approved for adolescents by B.C.’s Medical Services Plan (MSP) in the past 20 years, says Dr. Gail Knudson, one of the group’s psychiatrists. Teens must first complete a full two years of what is called Real Life Experience—engaging with the world at school, work and socially in their chosen gender—in order to be considered for surgery. (Adult transgenders who apply for MSP-funded sex-reassignment surgery only have to make it through one Real Life Experience year.) “It’s better for teens to live two years of Real Life Experience, as their identity as a whole is changing,” says Knudson. “Think of how many times you changed going through adolescence, not only externally but internally: your hairstyle, clothes and beliefs.”

Zucker’s point exactly.

Teenagers, never known for their patience, tend to advocate a swifter process. North Vancouver’s Nikki Buchamer, for one, feels that this conservative approach can cause unnecessary mental anguish. This past spring, Buchamer, a six-foot 17-year-old with blue-black hair and porcelain skin, went before a panel that included Knudson, hoping to be approved for a vaginoplasty, a procedure that is performed at Montreal’s Centre Métropolitain de Chirurgie Plastique, where Canada’s two other sex-reassignment surgeons practise. The complex surgery, which when approved is paid for by B.C.’s MSP, creates female genitalia from penile tissue. Wearing a conservative dress, jacket and leggings, with her hair neatly up, Nikki answered questions from the panel that included queries about her early childhood. In the end, however, the verdict on the surgery was no. “I wanted to bawl my eyes out and walk out,” says the Grade 11 student.

Nikki, whose birth name was Brandon, had only logged 16 months of Real Life Experience as a female, following counselling that crystallized her understanding that she had GID. She estimates that, by the time she is granted another panel hearing, it will be the end of Grade 12 before she is approved for a vaginoplasty.

Matching her physical body to her gender, she says, will lift a crushing weight off her shoulders. “To wake up and not have to think about being trans, to just think about being a person—life will start at this point,” explains Nikki, who has booked surgery this August with Dr. Cameron Bowman to decrease the size of her Adam’s apple.

Michele Buchamer, who accompanied her daughter to the sex-reassignment assessment, which was held in Victoria, was also distraught over the decision. “To a teen, every day is equivalent to three weeks. She just wants to be a normal teenager,” says the interior designer.

Not all parents of teens with GID are as supportive as Nikki’s and Cormac’s. Some oppose their teenager’s transgendering and refuse to give consent for hormone therapy or puberty blockers. Metzger currently has 60 adolescents under his care, the majority referred to him by the psychologist or psychiatrists at the B.C. Transgender Care Group, a few by their family doctors. But some have come to Metzger on their own initiative without their parents’ knowledge after discovering him on the Internet. In B.C., the Infants Act allows Metzger and the B.C. Transgender Group to provide care to these patients without parents’ consent so long as the “young person is capable and the medical treatment is in the young person’s ‘best interests.’ ”

In Canada, common law dictates that a “person under the common law age of majority who is capable of appreciating the nature and consequences of a particular operation or other treatment, whether recommended by the treating physician or chosen by the capable young person, can give an effective consent without anyone else’s approval being required,” David C. Day wrote in 2007 in The Canadian Bar Review. The rub, of course, is that a young patient’s care is limited by what their physician, psychiatrist or endocrinologist will consent to.

Even though parents can’t legally prevent Metzger from initiating hormone therapy for his young patients, he will counsel them to postpone such treatment if it will put them at risk or alienate family members. “If they are going to get kicked out of the house and have nowhere to live, then we might come up with an alternative plan or try to encourage the kid to wait a little longer for therapy, just for their safety,” Metzger says. One of his transgender patients, Karina, who asked that her last name not be used, says that her conservative Korean family opposed her transition when she started estrogen therapy at age 17. Her mother sent angry emails to Karina’s psychiatrist and lashed out at her daughter. “She tells me that I’m ugly and I sound funny and that I’m screwing up my life,” says the petite, long-haired 19-year-old, who is looking for work so she can afford to leave home.

Metzger sighs as he ponders how difficult it is for parents to accept that their child has GID. “I always tell the kids that they are running faster than their parents and the parents are a little bit behind.” Some, however, do catch up. “I’ve seen some super hyper-resistant dads who have come around amazingly.”

When Nikki Buchamer thinks back to her childhood, she realizes there were early signs of GID. She was mesmerized, for example, by any TV show, cartoon or book where a character changed gender. GID, indeed, often begins in early childhood, experts say. And many transgenders say that they knew as young as four or five that they were born in the wrong body. Again, however, the most efficacious treatment for young children is cause for debate.

In Toronto, Kenneth Zucker treats children as young as five who exhibit early signs of GID. These include, he says, unconventional play behaviour: a little boy might prefer dolls instead of Bionicles and tiaras instead of hockey helmets. Such cross-gender play should be discouraged, says Zucker, or it might become permanent in adolescence. “They just have an easier life—they don’t have to go on lifelong therapy or have these incredibly invasive surgeries,” he reasons. About 80 per cent of his preadolescent patients outgrow their cross-gender behaviour by puberty, he claims, which supports the rationale for a highly conservative approach to therapy.

In Vancouver, however, Gail Knudson argues that stymying cross-gender play can cause kids to become secretive and hide their behaviour. “It’s okay for children to explore their gender at home in a safe way. If they want to dress differently or do different types of activities, that should be encouraged—if not, it goes underground,” Knudson says. “Practising different gender roles decreases their dysphoria.”

With evidence such as the MRI research pointing toward GID as a physical condition, Knudson questions the notion that it is a mental disorder at all. “If it was a mental disorder and you gave people psychotherapy, it would go away—and it doesn’t. If you give people an antipsychotic or antidepressant, it would go away—and it doesn’t,” she says.

But teens like Cormac care little about the cause of their dysphoria, being more focused on the present. Cormac points out that he can now concentrate on his budding acting career and maintaining honour roll grades at Lord Byng Secondary, rather than obsessing “every minute” about his chromosomal infelicity. Looking to the future, he muses that he might consider undergoing a phalloplasty—the creation of a neo-penis—to complete his transgender journey. But for now, he is simply content in his own skin, happy to be just a normal teenage boy.

*A previous version of this article incorrectly made reference to suicide rates rather than rates of attempted suicide.


When boys would rather not be boys

  1. Thanks for this thorough article on the very important medical options available to assist trans youth.  While there may not be a one size fits all therapy for trans youth, the benefits of early individualized assessment and treatment can have a dramatically positive effect.  Puberty blockers can provide a person with additional time, if necessary, to consider their options without undergoing physical development that can cause both irreversible incongruity between gender identity and morphology as well as greater vulnerability to the transphobic discrimination and harassment the remains all to common in our society,  (Of course, for many trans folks, gender assimilation is not a goal and a non-binary identity, experience and/or appearance is something to be celebrated).  

    To clarify a couple of points in the article, the suicide figure mentioned in the article represents the percentage of trans people who have ever attempted suicide (43% according to Ontario’s Trans PULSE Project).  It’s difficult to know how many attempts are successful.  Also, trans people tend to like being referred to as trans people, and not transgenders, and what is referred to in the article as transgendering is more properly called transitioning. 

    Thank you again for a very good piece on an important topic.

  2. Transgender, not transgenders, is an umbrella term which also encompasses those born with transsexualism(the medical term not transgederism) Not only does transgender include those born with transsexualism but includes all those who transgress the societal idea of what normal gender behaviour is. This of course will also include “tom boys” drag performers, cross dressing people, gender queer people, even can include those who are bisexual since they are attracted to box sexes as well as people attracted to the same sex as themselves.
    That said it’s stupid and irresponsible to deny these youth the medical support they need based on some antiquated idea that youth change their minds all the time. What this does is force the youth towards using black market drugs and even head towards less scrupulis “medical professionals” as we see with so called pumping parties.
    Zucker’s idea of forcing these children and youth in the direction opposite of that which they know themselves to be is called aversion therapy, similar to that used towards homosexuality for many years before.. It only causes these children/youth to live in more pain never mind not being able to go forward in their lives without even more complications. To not be able to correct their bodies before leaving highschool means they are less likely to want to attend colleges and universities until they have been able to live as their true selves.

    I’m also bothered by the idea that the youth should wait just because their parents might not be ready or wanting it. Do they also suggest the same for those they treat who are also homosexual or bisexual? I suggest that they do not, meaning a double standard in treatment.

    • Oh God. I couldn’t read past your very first sentence. Transgender is no umbrella term. It has been redefined in order to mean so but I can assure you any professional would disagree.

      • I agree with you completely (as a trans boy myself). Every day I feel trapped in my body, and some of the time I’m completely disconnected from it. It could be a different entity to me. And saying that BISEXUALS could identify as trans is one one the most idiotic things I have heard for a while. However, the argument that it is stupid to deny us treatment, aversion (which this person makes later on) is quite correct. I also liked the points he made on the fact that Zucker is using aversion therapy.

  3. It would appear that Kenneth Zucker practises aversion type of therapy. He seems to think that the adolescent will grow out of it. The current research shows that GID is a physical disorder at least as much as a pshychological disorder. He is suprised that he sees more GID cases now than 30 years ago. Both society and medicine has changed in 30 years and perhaps Kenneth Zucker should re-evaluate his position. More trans people are wanting to transition because they see that there is a place for them in today’s society. Denying trans patients access to hormones and surgery  will only increase the daily pain they feel. As Ms. Nussbaum points out, 43% will attempt suicide. Dr Zucker’s go slow approach has to be balanced with the knowledge that many trans folk will attempt suicide if they see no way to progress in their transition. Let’s give teens some credit. The 15 year old he refers to is well aware that transitioning is not going to be easy and that as a Trans Man he will have to deal with more serious societal pressure than “teasing”. Transitioning is not for the faint at heart. It takes guts.  We should absolutely take the time to diagnose and require therapy for our trans youth.  However, once the diagnosis is made, postponing treatment and allowing youth to go through puberty will make their transition that much more difficult. What other medical condition is treated by suggesting the individual will “grow out of it” knowing that they may take their own life to end their pain?  I applaud the B.C. Transgender Group for their approach, it is sad that CAMH is stuck with ideas from 30 years ago.

  4. I agree that there needs to be somewhat of a cautious approach with adolescents, but what the Zucker method does is cause the repression of who these young people are. It forces them to become good actors, presenting to the world as the person they are expected to be, while repressing who they really are. It is really mean and wrong to allow the onset of puberty when there is cause to stall it. Breasts for male and facial hair for female identifying adolescents create huge anxiety, and are very costly and painful to undo.

    It is very unfortunate that there isn’t a more enlightened approach towards GID in Toronto, since this has been a problem for years for both adolescents and adult trans people. And parents who refuse to acknowledge and accept the inevitable can do so much psychological damage to their children. It would seem that those closest to trans people have the greatest chance of being the most harmful, whether it be parents, siblings or children. Hopefully, with there being a greater awareness of this condition, there will be far fewer individuals who end up going as far as marrying and having children while trying to be the person that society expects them to be, and not who they really are.

  5. If 80% (or 50%, or 20%) of adolescents who think of themselves as transgendered later discover that they’re in fact gay, then a conservative approach to treatment is the humane thing to do. You don’t get a kidney transplant because you *might* need one.

  6. “Treatment of GID is highly controversial” – no, it’s not. Every single legitimate medical and psychogical / psychatric body has stated that treatment is necessary.

    Resolution 122 from the American Medical Association clearly states that this condition
    must be dealt with. Specifically – ” GID, if left untreated, can result in clinically significant psychological distress, dysfunction, debilitating depression and, for some people without access to appropriate medical care and treatment, suicidality and death”

    Treatment is NOT controversial. It’s odd to see this in an otherwise semi decent article. Birth names are also irrelevant.

  7. Thank you for putting out a well written article that is respectful of the trans community, even though I wouldn’t consider including kenneth zucker as giving both sides equal representation. Putting it bluntly,  Zucker is a incredibly dangerous crackpot, he use widely discredited theories and methods that help no one because they force the children to repress their true nature. And I wish people would get the terminology right “…some oppose their teenager’s transgendering…” should say “…some oppose their teenager’s transition…”

  8. Dr. Zucker’s arguments for inflicting punitive gender-reparative psychotherapies upon gender variant and non-conforming children seem to defy reason and evidence.  For example he describes the need for transition, experienced by a portion of gender variant youth, as both flippant and homophobic:

      * …making “transgenderism fashionable: it’s kind of cool to be transgender, as opposed to being gay or lesbian,”

      * The teen thinks, “It would be easier if I were a boy attracted to girls, because then I wouldn’t be teased for being a lesbian.”

    These statements falsely presume that transitioned individuals possess greater social privilege than our cisgender (not trans) gay and lesbian counterparts. In truth, trans and transsexual people are afforded far less social privilege in North America and much of the world. We suffer disproportionate discrimination in employment, housing, public accommodation, child custody, medical care and civil justice, are afforded fewer legal protections and are more at risk of violence. The issue for trans and questioning youth and adults is not “internalized homophobia.”  The real issue is shame and internalized transphobia that imprison us in the closet.

    Moreover, Dr. Zucker’s statements presume that all trans and transsexual people are straight after transition, in other words, attracted to those opposite their own affirmed, experienced genders. In truth, a great many individuals are gay, lesbian or bisexual after transition and suffer both homophobic and transphobic discrimination.  Dr. Zucker continues, describing closeted transsexual people who are restricted to their birth-assigned roles:

       * “They just have an easier life—they don’t have to go on lifelong therapy or have these incredibly invasive surgeries,”

    Many thousands of us, who have lived both closeted pre-transition and authentic post-transition lives, know better. For those who are painfully distressed by their current or anticipated sex characteristics or their assigned gender roles, there is nothing easy about prolonged suffering. Corrective surgical care, for those who need it, is incredibly effective in relieving this distress. In fact, the medical necessity of these procedures has been affirmed by the American Medical Association, the American Psychological Association and the World Professional Association for Transgender Health (WPATH). 

    Dr. Zucker’s implication that transitioning individuals are mentally ill and require “lifelong therapy” is not factual. The current WPATH standards of care do not specifically require psychotherapy before or after medical transition. Moreover, WPATH issued a policy statement in 2010 that gender expression and identities which differ from birth-assigned sex stereotypes are not inherently pathological.

    Human gender diversity is indeed kind of cool.  Forcing diversity into the closet is not.

  9. I think the differences between the specialists are more apparent than real when it comes to hormones and surgery.

    “Unsurprisingly, given all this, Zucker does not approve sex-reassignment
    surgery for his adolescent patients at all. And he prefers they wait
    until they’re at least 13 to take puberty blockers—which are
    reversible—and especially estrogen or testosterone hormone therapy, the
    effects of which are not reversible.”

    Neither does Spack. Puberty delayers are usually administered around age 13 by him too. The exceptions are for those who begin puberty early, sometimes as early as age 8 or so. It’s standard medical practice to administer puberty delayers to *all* children with precocious puberty, until age 12 or 13 to ensure healthy physical development, so why should “gender dysphoric” children be an exception?

    Where Spack and Zucker differ, is that Zucker uses “reparative therapy”, witholding toys, cutting off friendships, and other coercive techniques in an attempt to move borderline cases towards homosexuality instead of transsexuality. There is little evidence that this has any of the desired effects, and rather a lot that it results in anxiety, depression, even suicidal ideation. While this is not as harmful as his predecessors practice of using physical violence attempting to “beat out the girl” from feminine children assigned male at birth, it is a difference in degree, not kind.

    As for surgery, no surgeon in North America will perform sex reassignment on a patient younger than age 18. Ideally, puberty delayers are used till age 15-16, then hormones, then surgery when the patient can give adult informed consent. If they’ve been through Zucker’s treatment, they may not be deemed competent though due to the psychological damage many have suffered.

  10. I wonder if these confused youth are this way because a majority of kids for years have been growing up without a Father in the picture or without both parents together (Married)

    • Non-cisgender identity and non-heterosexual orientation have existed throughout recorded history, with or without a two-parent household. Try again.

    • Short answer: No.

      Medium answer: There’s no evidence that supports that popularly believed hypothesis. Trans and non-Trans kids have the same rate of growing up without a Father, or with a distant Father etc. The fact that this idea has been throughly disproven hasn’t stopped people believing it on ideological grounds though.

      Long answer: The Abstract from ”

      Sexual Hormones and the Brain: An Essential Alliance for Sexual Identity and Sexual Orientation” Garcia-Falgueras A, Swaab DF Endocr Dev. 2010;17:22-35

      fetal brain develops during the intrauterine period in the male
      direction through a direct action of testosterone on the developing
      nerve cells, or in the female direction through the absence of this
      hormone surge. In this way, our gender identity (the conviction of
      belonging to the male or female gender) and sexual orientation are
      programmed or organized into our brain structures when we are still in
      the womb. However, since sexual differentiation of the genitals takes
      place in the first two months of pregnancy and sexual differentiation of
      the brain starts in the second half of pregnancy, these two processes
      can be influenced independently, which may result in extreme cases in
      trans-sexuality. This also means that in the event of ambiguous sex at
      birth, the degree of masculinization of the genitals may not reflect the
      degree of masculinization of the brain. There is no indication that
      social environment after birth has an effect on gender identity or
      sexual orientation.

  11. As someone who had to hide my homosexuality growing up and who was constantly indoctrinated in the definition of normal behavior, I utterly cringe at the thought of parents taking 12 year-olds to this Zucker fellow to be “deprogrammed” of their opposite-sex play habits.  There are hundreds of thousands of us who grew up in the closet who know first hand what kind of damage these attempts to “make us normal” did to us.  It’s not treatment. It’s child abuse. 

  12. I find it difficult to believe that Zucker has retained his license. As far as I know, he is still refusing to allow reviews of his work or any long term studies. That makes his practice of less value than a witch doctor. He alone says that it works. The horrible consequences of his work are hidden away. Kinda like convincing a blind person that living with blindness when an operation is available is completely normal and good for you. Only much worse. 

  13. It is great to read this article, and the responses to it. When I was a 7-8 y/o child 30somethingyears ago, there was a 4-5 year old family friend that, while we were playing rough outside, he was painting his nails and trying clothes inside. Both his brothers grew up to be hetero, as far as I know he now identifies as gay (I last saw him several years back), but even though his family has always been supportive, I have no doubt that had he had access to early transition, he would have been better off.

  14. Is anyone who is commenting on this actually trans*? I’m reading through these comments and almost every single one of you seems to have gotten something wrong!

  15. Going to comment from a parents perspective.
    I’ve got many many concerns. Example – FTM, introducing male hormones into a female born body. Various cancer risks, possible heightened suicidal thought process due to imbalances created in the brain as a result of hormone therapy. THIS IS VERY CONCERNING TO ME. The reality is that a body was born ie female. No matter what, that body is forever going to try to revert back to the sex it was born. Would appreciate some educated comments on this.

    • The difficulties and risks with transition could never be considered as insignificant, but the satisfaction rate of those who do choose to transition, and even more-so those with strong support, is still exceptionally, stunningly high. When considering this, make sure you put the risks of transition and hormone therapy in perspective and balance with the extreme negative effects of not transitioning or having access to hormone therapy when it is needed. It is hard for many people to understand the cost of just “trying to cope with” gender dysphoria when they do not have personal experience of what this means. I would suggest not only becoming informed on the statistics and science that is available, but listening to the stories and experiences of those who have lived through this. I would venture from the statistics and stories I have seen, that not having access to hormone therapy *when it is desired and needed,* poses a much greater risk of suicidal thought process (and early death, let alone psychological pain and dissatisfaction in life) than hormone treatment. If the case was not compellingly so, this would not have had a snowball’s chance in heck at becoming the increasingly recognized and recommended method of successful treatment that it is. But, as a parent, continue to ask and get all the information you need to be confident about what the best options for your child are. Keep asking when things don’t sit right, because you need to understand in order to be your child’s support and advocate.
      My thoughts are only semi-educated on this topic, but hopefully you will find resources for more substantial information. I am writing as the spouse of a trans individual who has tried to live in their raised gender role and suppress and “cope” with their dysphoria, who is no longer able to do so in silence, and recently “came out” to me. They are perhaps one of the most risk adverse, medically cautious people I know, who has rarely even taken Tylenol, and yet knowing the risks and difficulties involved, would not hesitate if they had the option to have been treated during puberty with hormone replacement therapy. Everyone is individual, but it can help to hear other’s experiences. My best wishes to you and others on their own journeys.