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Stop Trying to “Fix” Trans People

Today's post is from Matt Kailey, the author of Just Add Hormones: An Insider's Guide the Transsexual Experience (Beacon Press, 2005), the editor of Focus on the Fabulous: Colorado GLBT Voices (Johnson Books, 2007), and the managing editor of Out Front Colorado, Colorado's oldest and largest GLBT publication.

Kailey Trans people aren't broken. We aren't looking to be "fixed," and we have no need of a repairman. We have spent decades trying to convince the Western world of this, and forgive us if some in our ranks were starting to feel a little optimistic about our progress – until, maybe, now.

Just when we thought that an end to the tinkering around with our brains might be in sight – at least for those who are very far sighted – along comes a repairman in the form of Dr. Kenneth Zucker, a non-transman who, like so many before him, thinks he knows what's better for us than we do. Dr. Zucker thinks he can "fix" us – whether we want him to or not.

Now Dr. Zucker might be merely an annoying interruption in our otherwise peaceful day – some scam artist who knocks on our door and tells us that our roof or our driveway or our air conditioning is in disrepair and that he can fix it for cheap – and we could easily tell him that we have our own service, thank you very much, and close the door in his face. Unfortunately, in this case, there's one small catch – Dr. Kenneth Zucker has been appointed by the American Psychiatric Association to serve as the chair for the Sexual and Gender Identities Disorder task force that reviews the new version of the DSM – the Diagnostic and Statistical Manual that is used by psychiatrists, psychologists, and therapists to diagnose mental illness. And, in this regard, Dr. Zucker is no mere annoyance knocking on our door. He is a very dangerous man – and not just to trans people.

Dr. Zucker believes in reparative therapy. Just say the words and shudders go through the gay and lesbian communities as members recall involuntary hospitalizations, forced hormone "treatments," and even electric shock "therapy" designed to "cure" same-sex attraction. Luckily for gay men and lesbians, homosexuality was removed from the DSM in 1973. Same-sex attraction is no longer considered a mental illness, and even though ex-gay programs still exist, the failure rate is high, and most national professional medical and mental health groups – including the American Psychiatric Association – have taken the position that homosexuality is not an illness and cannot be "cured." The American Psychiatric Association even issued a position statement in 1998 saying, in part, that it "opposes any psychiatric treatment, such as reparative or conversion therapy which is based upon the assumption that homosexuality per se is a mental disorder or based upon the a priori assumption that the patient should change his/her sexual homosexual orientation." But, with Dr. Zucker's appointment, those days may be over – and they may be nowhere in sight for trans people.

Consider the case of Bradley, recently featured on a two-part series on transgendered children presented by NPR. Physically a male, Bradley began expressing preferences for "female" toys, clothing, and activities as a toddler. He refused to play with "boy" toys or with male peers. At the age of six, he entered therapy with Dr. Zucker, who insists that the way to treat young children who display signs of gender identity disorder is to immerse them in all things appropriate to their birth gender, so Bradley was forced into boys' clothing and boys' activities. The problem was that, when his "girl" toys were taken away, he refused to play at all – an unfortunate, unhappy, and unhealthy position for a six-year-old to be in.

After eight months of therapy, Bradley's mother says that he has made some "progress." He still can't be exposed to "girl" toys, or he will want to play with them. He panics when he sees the color pink and insists on covering his eyes so he won't be drawn to it. But he has been able to tell his parents that he no longer wants to be a girl, although his mother says that it sounds like a "stock" answer – something that he is saying because it's what she wants to hear. She believes that he still plays only with girls at school – but he then comes home to an entirely different set of expectations. And this is "progress"?

Compare Bradley's situation with that of Jonah (featured in the same NPR segment as Bradley), who was two years old when his parents realized that no amount of persuasion would entice their "son" to play with typical "boy toys," and nothing they could say or do would steer him away from the dresses he was so desperate to wear. Luckily, his parents recognized that Jonah was really a girl – that it was his body, not his identity, that was the problem – and they took steps to allow their daughter to start living the life she was meant to live. Jonah became Jona, and she is now a happy little girl. Jona's therapist, Diane Ehrensaft, has a different view of transgenderism than does Dr. Zucker. In fact, she thinks Zucker's mode of therapy is "unethical," and likens it to the reparative therapy foisted on gay men and lesbians before it was determined that homosexuality was not a mental illness.

Armand, another child profiled in the NPR series, had an experience similar to Jona's. His need to be female also became apparent around the age of two, and his parents tried to seek help for their unhappy "son" until they finally found a therapist who diagnosed gender identity disorder. Armand, now Violet, is undergoing a controversial treatment designed to block male hormones and thus a male puberty, making it easier for her to transition later on if she decides this is what she wants to do. The ramifications of this type of intervention are not fully understood, but with fifty percent of transgendered children ideating suicide, according to Jenn Burleton, the Executive Director of TransActive Education & Advocacy (TEA) and West Region Coordinator and Board Member of PFLAG-Transgender Network (TNET), this type of treatment is probably far better than the potential alternative.

As profiled in the NPR series, both Jona and Violet are much happier and emotionally healthier since being allowed to live in the female gender that matches their internal identity. Bradley, on the other hand, is still struggling with his attempts to remain male and seems, with little joy, to be saying and doing the things that he knows are expected of him. Is he "fixed"? It is unlikely, since even the current DSM says that treatment for childhood gender identity disorder is "likely to be long-term with small gains made on underlying issues as treatment progresses" and that a prognosis for treating the disorder is "mixed" and that "same-sex identification may be very difficult to achieve."

Given all this, it's a strange turn of events indeed that Dr. Zucker has been appointed to serve as the chair for the Sexual and Gender Identities Disorder task force for the new DSM, made even more bizarre by the fact that Zucker believes that there is a relationship between gender identity disorder and homosexuality. Writing for the Child and Adolescent Psychiatric Clinics of North America, Zucker says, "Follow-up studies of boys who have GID that largely is untreated, indicated that homosexuality is the most common long-term psychosexual outcome."

If this is truly the case (and I would be interested in seeing these "studies," because my experience in meeting literally hundreds of male-to-female transsexuals and hundreds of gay men over the last ten years does not bear this out), then it appears that Dr. Zucker's reparative therapy for children with gender identity disorder is aimed at preventing adult homosexuality. And if homosexuality is not a diagnosable mental illness, as per the American Psychiatric Association, then it would follow that attempting to stop it by using reparative therapy with children with gender identity disorder would not be appropriate.  To go even further, it would seem that, combining Dr. Zucker's argument about reparative therapy for gender identity disorder and the American Psychiatric Association's position on homosexuality, gender identity disorder, like homosexuality, should not be a diagnosable mental illness.

I put no stock in Zucker's argument or in his therapeutic methods. While I agree that GID should be removed from the DSM, my reasoning is simplistic and has nothing to do with homosexuality – I don't believe that gender identity issues constitute a mental illness.  But if the American Psychiatric Association supports Zucker's views, and it must, given his appointment on the DSM task force, then it has only two choices for recourse: put homosexuality back in the DSM or take GID out. Oh, wait – there is a third: dump Zucker. Get him off of that task force before he damages – beyond repair – any more lives.

If you agree that Dr. Kenneth Zucker should be removed from the task force, sign this petition. You might also want to read "Drop the Barbie!" by Stephanie Wilkinson from Brain, Child magazine; Matt Kailey's post on pregnant transman Thomas Beatie; and this NPR story about new therapies for transgender adolescents.