“Intellectual no-platforming”: Ken Zucker pushes back on the latest attempt to discredit desistance-persistence research

by Marie Verite and Brie J

Dr. Kenneth Zucker, recognized as one of the world’s top experts in childhood gender dysphoria, penned the following paper (released today).

Zucker, K. J. (2018). The myth of persistence: Response to “A Critical Commentary on Follow-Up Studies and “Desistance” Theories about Transgender and Gender Non-Conforming Children” by Temple Newhook et al. (2018). International Journal of Transgenderism. https://doi.org/10.1080/15532739.2018.1468293

Dr. Zucker has offered to provide a PDF of the full-text article if readers contact him via email.


Multiple trans-activist journalists and “affirmative” gender clinicians have (rather successfully) propagated the meme that desistance from a trans identity is a “myth”; that Zucker (former director of the Toronto clinic), Thomas Steensma, Peggy Cohen-Kettenis (of the Amsterdam team which pioneered the use of puberty blockers for gender-dysphoric children), and others have wrongly conflated merely gender nonconforming children with “true trans” kids. Therefore, their entire body of research is essentially worthless. These critics have gone further, accusing some clinicians (like Zucker) of forcing harmful reparative therapy on “trans kids.”

Dr. Zucker’s detailed rebuttal to the Temple-Newhook et al article is well worth reading in its entirety.  Be forewarned: The paper is densely argued and referenced, such that understanding it requires a decent working knowledge of the clinical literature on childhood gender dysphoria, the nuances/changes in the DSM diagnostic classifications (e.g., DSM-IV “gender identity disorder” vs. DSM-V “gender dysphoria”), as well as the trans-activist reactions to all of the above.

In a series of tweets today, Dr. Zucker emphasized one of the key points in his paper.

 “…that pre-pubertal gender social transition is itself a psychosocial treatment, which Temple-Newhook et al ignore.”

The context for this tweet can be found on page 7 of Dr. Zucker’s article:

Thus, I would hypothesize that when more follow-up data of children who socially transition prior to puberty become available, the persistence rate will be extremely high. This is not a value judgment – it is simply an empirical prediction. Just like Temple Newhook et al. (2018) argue that some of the children in the four follow-up studies included those who may have received treatment “to lower the odds” of persistence, I would argue that parents who support, implement, or encourage a gender social transition (and clinicians who recommend one) are implementing a psychosocial treatment that will increase the odds of long-term persistence.

And later, on page 10:

Temple Newhook et al. (2018) go on to state that “It is important to acknowledge that discouraging social transition [with reference to the Dutch team’s putative therapeutic approach] is itself an intervention with the potential to impact research findings…” Fair enough. But Temple Newhook et al. (2018) curiously suppress the inverse: encouraging social transition is itself an intervention with the potential to impact findings. I find this omission astonishing.

An astonishing omission, indeed.

As regular readers of this website will know, most parents in the 4thWaveNow community are particularly concerned about the recent increase in teens (particularly females) presenting to gender clinics, with a sudden onset of gender dysphoria around the age of puberty.

Although the characteristics and clinical course of early-onset gender dysphoria (the primary population discussed in Zucker’s paper) are different from that of adolescent-onset, an underlying question pertains to both: Does “affirmative” treatment increase the likelihood that a cross-sex identification will persist?

We must point out here that trans activists consider it “transphobic” for anyone to believe that a child’s desistance from trans-identification would be preferable to persistence. (In fact, this accusation is leveled by Temple Newhook et al in their paper, in so many words. This helps to explain why so many trans activists object to the very idea of studying persistence vs. desistance in the first place.)  Yet, we find it mystifying that a preference for desistance is even controversial.  Surely, if a child can find peace in his or her unaltered body–and happily avoid becoming a sterilized medical patient dependent for life on drugs and surgeries–that is a positive outcome. To leverage an analogy popular with trans activists, many say that “gender affirming” medical treatment is analogous to treatment for children with life-threatening cancers. Yet who would not feel happy for the cancer patient who goes into remission, thus avoiding the ravages of chemo and radiation?

Furthermore, is it not possible to support young people in their gender atypicality,  while at the same time encouraging bodily acceptance?

Central to this discussion is the trans-activist conflation of psychotherapeutic methods with conversion therapy.  Zucker addresses this problem head-on on page 9:

Now, of course, it would not come as a surprise if Temple Newhook et al. (2018) took umbrage at the mere idea of a treatment arm designed to reduce a child’s gender dysphoria via psychotherapeutic methods. They might, for example, offer up the following from the seventh edition of the Standards of Care:

Treatment aimed at trying to change a person’s gender identity…to become more congruent with sex assigned at birth has been attempted in the past without success (Gelder & Marks, 1969; Greenson, 1964)….Such treatment is no longer considered ethical.” (Coleman et al., 2011, p. 175)

Yet, on the very same page of the Standards, one finds the following: “Psychotherapy should focus on reducing a child’s…distress related to the gender dysphoria…” (p. 175) or “Mental health professionals…. should give ample room for clients to explore different options for gender expression” (p. 175). The lack of internal consistency between the first statement and the second and third statements is rather astonishing.

“Reducing a child’s…distress related to the gender dysphoria” should be the primary goal of all treatment methods. Quite a few 4thWaveNow parents have observed that upon social transition, their children’s dysphoria actually increased. This is another aspect related to the different populations (early-onset vs. adolescent rapid-onset) that needs to be clarified but still remains unknown. Dr. Zucker explains that he “prefers the following summary statements about therapeutics with regard to children with gender dysphoria”:

Different clinical approaches have been advocated for childhood gender discordance….There have been no randomized controlled trials of any treatment….the proposed benefits of treatment to eliminate gender discordance…must be carefully weighed against… possible deleterious effects. (American Academy of Child and Adolescent Psychiatry, 2012, pp. 968–969)

Very few studies have systematically researched any given mode of intervention with respect to an outcome variable in GID and no studies have systematically com- pared results of different interventions….In light of the limited empirical evidence and disagreements…among experts in the field…recommendations supported by the available literature are largely limited to the areas [reviewed] and would be in the form of general suggestions and cautions… (Byne et al., 2012, p. 772)

…because no approach to working with [transgender and gender nonconforming] children has been adequately, empirically validated, consensus does not exist regarding best practice with pre-pubertal children. Lack of consensus about the preferred approach to treatment may be due, in part, to divergent ideas regarding what constitutes optimal treatment outcomes… (American Psychological Association, 2015, p. 842)

Here at 4thWaveNow, we have repeatedly stated that we seek to support—not “eliminate”–our children’s “gender discordance” although we resist the idea that gender atypicality is a sign of bodily incongruence. More than anything, 4thWaveNow parents seek to help our children minimize the discomfort that accompanies their nonconformity to gender norms. Since many of our children only experienced dysphoria upon reaching puberty, we call for (much) more evidence that social and medical transition are better at alleviating dysphoria than psychotherapeutic methods.

And as Dr. Zucker has made clear via his life’s work (and in this paper), the jury is still very much out on that question–despite the many attempts by trans activists to deplatform those who study the matter of persistence and desistance.

zucker intellectual no platforming

 

US conversion therapy laws: Conflating homophobia with helping gender-defiant kids feel whole

One of the many unfortunate consequences of the marriage of transgenderism with the lesbian/gay movement is the wholesale acceptance that “conversion” therapy (also referred to as “reparative” therapy)—rightly condemned as coercive attempts to change a person’s sexual orientation—is equivalent to helping a child or teen feel at home with his or her body.

Why shouldn’t attempts to change “gender identity” be seen as identical to efforts to convince lesbian and gay people to abandon their homosexuality?

Because they are actually polar opposites. Anti-gay conversion therapy tells a healthy human being that they are not ok as they are, in the body they have, with the sexual feelings they have for other humans.  But therapy aimed at helping a young person accept and reconcile with their healthy,  evolution-molded body, as well as their gender nonconformity, actually encourages wholeness and the integration of body and mind.

In an Orwellian twist, the trans activists have hoodwinked the public into believing that these two approaches are one and the same, even though pro-trans “affirmative therapy” leads a young person not only to reject themselves as they are, but to start down a path which can lead to multiple surgeries, lifelong drug injections, and irreversible sterilization—with all the risks and hazards associated with being a permanent medical patient.

lady justice small

Never before in recorded history has every sector of society—political leaders, journalists, medical doctors, psychotherapists, and the legal system—enthusiastically promoted the mutilation, drugging, and sterilization of children’s healthy bodies. Never before have adults conspired to encourage a child in the warped notion that their very own body is a hated, alien monstrosity to be recoiled from in utter disgust.

What’s more, a side effect of this pediatric transition propaganda is the proactive conversion of same-sex attracted young people into surgically and hormonally manufactured heterosexuals. It has been well known for decades that the vast majority of “gender dysphoric” young people resolve those feelings and grow up to be gay and lesbian. We not only have peer reviewed research to back up that assertion. We have the anecdotal life experiences of gay and lesbian adults.  And not only that: Media story after media story reports about the trans men who started off as young lesbians—with no comment or question from the journalists about what happened to that former lesbian identity. And many of these young trans men start testosterone and even have “top surgery” before the typical age when women realize and accept their lesbian orientation—on average, from age 19-early 20s.

That anyone has unthinkingly accepted the false equivalence that anti-gay/lesbian conversion therapy is the same as helping a child avoid self hatred is absurd. That our legal system, from the President of the United States on down, is promulgating this fiction is something I predict will eventually go down in the history books as one of the greatest examples of medical malpractice, homophobia, and mass delusion ever perpetrated by the human race.

So just where do we stand in the United States vis-à-vis “conversion” therapy laws, as they apply to “gender identity”?

Before I provide summaries of existing US legislation, let’s take a peek behind the curtain to see which organizations are behind the conflation of LGB with T in the legislative arena.

Powerful, well-funded activist groups often write “model legislation” that is then cloned and heavily lobbied for in US state legislatures. Two of the pressure groups involved in the conversion therapy effort are the Human Rights Campaign, a major player in trans activism, and the absurdly named National Center for Lesbian Rights (NCLR). A recent post on 4thWaveNow highlighted the role of NCLR in helping to push trans activist-crafted policy in US public schools. NCLR was also an original signatory to a damaging boycott-petition targeting the now-defunct Michigan Women’s Music Festival (a private event held for 40 years on private land whose only crime was politely requesting that only biological women attend).

So once again, we find NCLR involved in actually harming young same-sex attracted girls by working to prevent concerned clinicians from helping these girls come to terms with their lesbianism. Could it be any more Orwellian?

As you’ll no doubt notice in the excerpts from US state laws below, the wording of the “model legislation” peddled by the NCLR and HRC is strikingly similar to that in the actual conversion therapy laws on the books. Staff attorneys at NCLR and HRC know what they’re doing. Reading the profile for NCLR staff attorney Samantha Ames (the attorney listed as contact person in the model bill PDF), it’s clear her social justice heart is in the right place. But what will it take for women like Ames to have an epiphany: that the trans’ing of young same-sex attracted girls is actually homophobic conversion therapy perpetrated on minors who are being denied the possibility to even find out if they could enjoy a life free of medical intervention as happy lesbians?

So far, four states, the District of Columbia, and the city of Cincinnati, Ohio have passed legislation that has tacked “gender identity” onto the definition of what constitutes conversion therapy. Summaries/excerpts from the pertinent sections of the laws are below, with links to the full legislation for each.

While the wording is vague and undefined—with the terms “transgender,” “gender expression,” “gender identity” and the like seemingly hastily appended to the language about sexual orientation—we should all be asking what, exactly, is meant by conversion therapy in regards to gender identity.

In a recent guest post by a psychotherapist whose preteen daughter has been questioning her gender identity, a lively discussion ensued in the comments regarding what is and isn’t conversion therapy. Does it mean (as more and more seems to be the case, in my own personal experience and in that of many other parents who contribute to 4thWaveNow) that a therapist dare not even ask why? when a young client announces they are transgender? Is it now verboten to explore a child’s mental health history, social media habits, or other possible contributing factors? What about social contagion? And what about the experiences and opinions of the child’s parents? If a mother says her daughter showed no signs until a month ago of any discomfort with her body, is the parent simply to be dismissed as a transphobe in need of reeducation (a type of conversion therapy in itself)?

The signs are not good, but ethical therapists owe it to themselves—and above all, their young clients—not to place anyone at unnecessary risk of the irreversible changes that will be induced by hormones and surgical treatments.

As grim as it seems right now, there is a glimmer of hope. The conflation of anti-gay reparative therapy with efforts to help children feel comfortable in their own skin is something new, and the legislation has yet to be tested in courts of law by intrepid lawyers who know better. The language in the bills is vague and open to challenge and judicial interpretation. There is a window of opportunity, for clinicians as well as for lawyers.

Note/caveat: Regular readers of this blog know that everyone at 4thWaveNow strongly supports “gender nonconformity” and rejects the enforcement and policing of stereotyped “feminine” or “masculine” behaviors or activities. To the extent that these laws protect young people from attempts to enforce such stereotypes, we applaud them. The problem is that gender identity and gender expression, while actually two very different things, are blurred and undefined in the legislation. So, for example, support for “gender expression” could protect a girl who wants a short haircut and “boys'” clothes; but how very harmful it would be to prohibit therapy that helps that same gender-defiant girl realize she is still 100% female, with a body perfect just as it is, even as she rejects gender stereotypes.

Thanks to overwhelmed for summaries and research assistance on this US legislation. The specific language varies somewhat from state-to-state, and it’s worth a close reading to parse the actual intent of each law. Click the name of each bill to access full text for the legislation.

 

California

SB-1172 Sexual orientation change efforts

“California has a compelling interest in protecting the physical and psychological well-being of minors, including lesbian, gay, bisexual, and transgender youth, and in protecting its minors against exposure to serious harms caused by sexual orientation change efforts.”

(b) (1) “Sexual orientation change efforts” means any practices by mental health providers that seek to change an individual’s sexual orientation. This includes efforts to change behaviors or gender expressions, or to eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same sex.

(2) “Sexual orientation change efforts” does not include psychotherapies that: (A) provide acceptance, support, and understanding of clients or the facilitation of clients’ coping, social support, and identity exploration and development, including sexual orientation-neutral interventions to prevent or address unlawful conduct or unsafe sexual practices; and (B) do not seek to change sexual orientation.

865.1.

Under no circumstances shall a mental health provider engage in sexual orientation change efforts with a patient under 18 years of age.

865.2.

Any sexual orientation change efforts attempted on a patient under 18 years of age by a mental health provider shall be considered unprofessional conduct and shall subject a mental health provider to discipline by the licensing entity for that mental health provider.

Illinois

House Bill 217: Youth Mental Health Protection Act.

 “Sexual orientation change efforts” or “conversion therapy” means any practices or treatments that seek to change an individual’s sexual orientation, as defined by subsection (o-1) of Section 1-103 of the Illinois Human Rights Act, including efforts to change behaviors or gender expressions or to eliminate or reduce sexual or romantic attractions or feelings towards individuals of the same sex. “Sexual orientation change efforts” or “conversion therapy” does not include counseling or mental health services that provide acceptance, support, and understanding of a person without seeking to change sexual orientation or mental health services that facilitate a person’s coping, social support, and gender identity exploration and development, including sexual orientation neutral interventions to prevent or address unlawful conduct or unsafe sexual practices, without seeking to change sexual orientation.

New Jersey

Sexual Orientation Change Efforts

 b.    As used in this section, “sexual orientation change efforts” means the practice of seeking to change a person’s sexual orientation, including, but not limited to, efforts to change behaviors, gender identity, or gender expressions, or to reduce or eliminate sexual or romantic attractions or feelings toward a person of the same gender; except that sexual orientation change efforts shall not include counseling for a person seeking to transition from one gender to another, or counseling that:

(1)   provides acceptance, support, and understanding of a person or facilitates a person’s coping, social support, and identity exploration and development, including sexual orientation-neutral interventions to prevent or address unlawful conduct or unsafe sexual practices; and

(2)   does not seek to change sexual orientation.

 Oregon

House bill 2307

 A mental health care or social health professional may not practice conversion therapy if the recipient of the conversion therapy is under 18 years of age. (2) As used in this section: (a)(A) “Conversion therapy” means providing professional services for the purpose of attempting to change a person’s sexual orientation or gender identity, including attempting to change behaviors or expressions of self or to reduce sexual or romantic attractions or feelings toward individuals of the same gender. (B) “Conversion therapy” does not mean: (i) Counseling that assists a client who is seeking to undergo a gender transition or who is in the process of undergoing a gender transition; or (ii) Counseling that provides a client with acceptance, support and understanding, or counseling that facilitates a client’s coping, social support and identity exploration or development, including counseling in the form of sexual orientation-neutral or gender identity-neutral interventions provided for the purpose of preventing or addressing unlawful conduct or unsafe sexual practices, as long as the counseling is not provided for the purpose of attempting to change the client’s sexual orientation or gender identity.

 Washington, DC

Amendment  to Mental Health Service Delivery Reform Act of 2001

“Sexual orientation change efforts” means a practice by a provider that seeks to change a consumer’s sexual orientation, including efforts to change behaviors, gender identity or expression, or to reduce or eliminate sexual or romantic attractions or feelings toward a person of the same sex or gender; provided, that the term “sexual orientation change efforts” shall not include counseling for a consumer seeking to transition from one gender to another, or counseling that provides acceptance, support, and understanding of a consumer or facilitates a consumer’s coping, social support, and identity exploration and development, including sexual orientation-neutral interventions to prevent or address unlawful conduct or unsafe sexual practices in a manner that does not seek to change a consumer’s sexual orientation.”. (b) A new section 214a is added to read as follows: “Sec. 214a. Prohibition on sexual orientation change efforts for minors.

 Cincinnati, OH

Sexual Orientation or Gender Identity Change Efforts

Prohibits within the geographical boundary of Cincinnati, Ohio, “sexual orientation or gender identity change efforts,” commonly known as conversion therapy, by mental health professionals.  The prohibited therapy is defined as:

conversion therapy, reparative therapy or any other practices by mental health professionals that seek to change an individual’s sexual orientation or to change gender identity to a gender other than that with which the individual personally identifies, including efforts to change behaviors or gender expressions, or to eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same sex.

Excluded from this definition

psychotherapies that provide acceptance, support, and identity exploration and development, including sexual orientation-neutral interventions to prevent or address unlawful conduct or unsafe sexual practices, and psychotherapies that do not seek to change sexual orientation or to change gender identity to a gender other than that with which the individual personally identifies.

The fine for violating the ordinance is $200 per occurrence.  Each day that a violation occurs constitutes a separate violation.