Dr. Kenneth Zucker has been seeing children with gender-identity disorder in Toronto since the mid-’70s, and has published more on the subject than any other researcher. But lately he has become a pariah to the most-vocal activists in the American transgender community. In 2012, the Diagnostic and Statistical Manual of Mental Disorders—the bible for psychiatric professionals—will be updated. Many in the transgender community see this as their opportunity to remove gender-identity disorder from the book, much the same way homosexuality was delisted in 1973. Zucker is in charge of the committee that will make the recommendation. He seems unlikely to bless the condition as psychologically healthy, especially in young children.
I met Zucker in his office at the Centre for Addiction and Mental Health, where piles of books alternate with the Barbies and superheroes that he uses for play therapy. Zucker has a white mustache and beard, and his manner is somewhat Talmudic. He responds to every question with a methodical three-part answer, often ending by climbing a chair to pull down a research paper he’s written. On one of his file cabinets, he’s tacked up a flyer from a British parents’ advocacy group that reads: “Gender dysphoria is increasingly understood … as having biological origins,” and describes “small parts of the brain” as “progressing along different pathways.” During the interview, he took it down to make a point: “In terms of empirical data, this is not true. It’s just dogma, and I’ve never liked dogma. Biology is not destiny.”
In his case studies and descriptions of patients, Zucker usually explains gender dysphoria in terms of what he calls “family noise”: neglectful parents who caused a boy to overidentify with his domineering older sisters; a mother who expected a daughter and delayed naming her newborn son for eight weeks. Zucker’s belief is that with enough therapy, such children can be made to feel comfortable in their birth sex. Zucker has compared young children who believe they are meant to live as the other sex to people who want to amputate healthy limbs, or who believe they are cats, or those with something called ethnic-identity disorder. “If a 5-year-old black kid came into the clinic and said he wanted to be white, would we endorse that?” he told me. “I don’t think so. What we would want to do is say, ‘What’s going on with this kid that’s making him feel that it would be better to be white?’”
Young children, he explains, have very concrete reasoning; they may believe that if they want to wear dresses, they are girls. But he sees it as his job—and the parents’—to help them think in more-flexible ways. “If a kid has massive separation anxiety and does not want to go to school, one solution would be to let them stay home. That would solve the problem at one level, but not at another. So it is with gender identity.” Allowing a child to switch genders, in other words, would probably not get to the root of the psychological problem, but only offer a superficial fix.
Zucker calls his approach “developmental,” which means that the most important factor is the age of the child. Younger children are more malleable, he believes, and can learn to “be comfortable in their own skin.” Zucker says that in 25 years, not one of the patients who started seeing him by age 6 has switched gender. Adolescents are more fixed in their identity. If a parent brings in, say, a 13-year-old who has never been treated and who has severe gender dysphoria, Zucker will generally recommend hormonal treatment. But he considers that a fraught choice. “One has to think about the long-term developmental path. This kid will go through lifelong hormonal treatment to approximate the phenotype of a male and may require some kind of surgery and then will have to deal with the fact that he doesn’t have a phallus; it’s a tough road, with a lot of pain involved.”
Zucker put me in touch with two of his success stories, a boy and a girl, now both living in the suburbs of Toronto. Meeting them was like moving into a parallel world where every story began the same way as those of the American families I’d met, but then ran in the opposite direction.
When he was 4, the boy, John, had tested at the top of the gender-dysphoria scale. Zucker recalls him as “one of the most anxious kids I ever saw.” He had bins full of Barbies and Disney princess movies, and he dressed in homemade costumes. Once, at a hardware store, he stared up at the glittery chandeliers and wept, “I don’t want to be a daddy! I want to be a mommy!”
His parents, well-educated urbanites, let John grow his hair long and play with whatever toys he preferred. But then a close friend led them to Zucker, and soon they began to see themselves as “in denial,” recalls his mother, Caroline. “Once we came to see his behavior for what it was, it became painfully sad.” Zucker believed John’s behavior resulted from early-childhood medical trauma—he was born with tumors on his kidneys and had had invasive treatments every three months—and from his dependence during that time on his mother, who has a dominant personality.
When they reversed course, they dedicated themselves to the project with a thoroughness most parents would find exhausting and off-putting. They boxed up all of John’s girl-toys and videos and replaced them with neutral ones. Whenever John cried for his girl-toys, they would ask him, “Do you think playing with those would make you feel better about being a boy?” and then would distract him with an offer to ride bikes or take a walk. They turned their house into a 1950s kitchen-sink drama, intended to inculcate respect for patriarchy, in the crudest and simplest terms: “Boys don’t wear pink, they wear blue,” they would tell him, or “Daddy is smarter than Mommy—ask him.” If John called for Mommy in the middle of the night, Daddy went, every time.
When I visited the family, John was lazing around with his older brother, idly watching TV and playing video games, dressed in a polo shirt and Abercrombie & Fitch shorts. He said he was glad he’d been through the therapy, “because it made me feel happy,” but that’s about all he would say; for the most part, his mother spoke for him. Recently, John was in the basement watching the Grammys. When Caroline walked downstairs to say good night, she found him draped in a blanket, vamping. He looked up at her, mortified. She held his face and said, “You never have to be embarrassed of the things you say or do around me.” Her position now is that the treatment is “not a cure; this will always be with him”—but also that he has nothing to be ashamed of. About a year ago, John carefully broke the news to his parents that he is gay. “You’d have to carefully break the news to me that you were straight,” his dad told him. “He’ll be a man who loves men,” says his mother. “But I want him to be a happy man who loves men.”
The girl’s case was even more extreme in some ways. She insisted on peeing standing up and playing only with boys. When her mother bought her Barbies, she’d pop their heads off. Once, when she was 6, her father, Mike, said out of the blue: “Chris, you’re a girl.” In response, he recalls, she “started screaming and freaking out,” closing her hand into a fist and punching herself between the legs, over and over. After that, her parents took her to see Zucker. He connected Chris’s behavior to the early years of her parents’ marriage; her mother had gotten pregnant and Mike had been resentful of having to marry her, and verbally abusive. Chris, Zucker told them, saw her mother as weak and couldn’t identify with her. For four years, they saw no progress. When Chris turned 11 and other girls in school started getting their periods, her mother found her on the bed one night, weeping. She “said she wanted to kill herself,” her mother told me. “She said, ‘In my head, I’ve always been a boy.’”
But about a month after that, everything began to change. Chris had joined a softball team and made some female friends; her mother figured she had cottoned to the idea that girls could be tough and competitive. Then one day, Chris went to her mother and said, “Mom, I need to talk to you. We need to go shopping.” She bought clothes that were tighter and had her ears pierced. She let her hair grow out. Eventually she gave her boys’ clothes away.
Now Chris wears her hair in a ponytail, walks like a girl, and spends hours on the phone, talking to girlfriends about boys. Her mother recently watched her through a bedroom window as she was jumping on their trampoline, looking slyly at her own reflection and tossing her hair around. At her parents’ insistence, Chris has never been to a support group or a conference, never talked to another girl who wanted to be a boy. For all she knew, she was the only person in the world who felt as she once had felt.
The week before I arrived in Toronto, the Barbara Walters special about Jazz had been re-aired, and both sets of parents had seen it. “I was aghast,” said John’s mother. “It really affected us to see this poor little peanut, and her parents just going to the teacher and saying ‘He is a “she” now.’ Why would you assume a 4-year-old would understand the ramifications of that?”
“We were shocked,” Chris’s father said. “They gave up on their kid too early. Regardless of our beliefs and our values, you look at Chris, and you look at these kids, and they have to go through a sex-change operation and they’ll never look right and they’ll never have a normal life. Look at Chris’s chance for a happy, decent life, and look at theirs. Seeing those kids, it just broke our hearts.”