Toronto: global epicenter for oppression of sex and gender minorities

zucker-tvo.jpgYou know those reparative therapy "experts" who influenced the homophobic death penalty legislation in Uganda? For sex and gender minorities, that movement is not led by religious zealots, but by a handful of Toronto psychologists like Kenneth Zucker who still get taken seriously in their field.

In 1973, the American Psychiatric Association (APA) decided that gay people were no longer mentally ill, but that changed nothing for trans and gender-variant people. In fact, "experts" led the push to create a new disease called "gender identity disorder," which they successfully got added to the APA's big book of mental illnesses, the Diagnostic and Statistical Manual of Mental Disorders (DSM). Though trans activists have been protesting to get this mental illness removed in the 2012 revision, these Toronto "experts" hold key positions among the people doing the revising.

Even worse is a sub-disease they created called "gender identity disorder in children." They have made a lot of money claiming to "cure" hundreds of children who are "too feminine." While they also treat kids who are "too masculine," in most clinics which have adopted their methods, 5 to 30 times more children assigned as males are treated. The methods? No playing with dolls, no drawing with the "wrong" colors like pink or purple, and no playing with or drawing pictures of girls. The anxious parents who bring their children in to be "cured" are expected to enforce all rules. They are sent home with instructions to make the child go through all their possessions and remove anything "inappropriate," as well as ways to use reinforcement to "correct" their child's thinking and behavior. How did nonconformity become a disease? And how did Toronto become infamous for this? It's a textbook case of pathological science with roots in the 20th-century eugenics movement, and it shows how a few misguided people can have impact all over the world.

(Screenshot: gender reparative therapist Kenneth Zucker appearing on TVO Parents)

provincial-lunatic.jpgThe Centre for Addiction and Mental Health (CAMH, formerly the Provincial Lunatic Asylum) is a sprawling complex that includes what used to be called the Clarke Institute, named after eugenicist Charles Kirk Clarke. During Clarke's tenure as head of Canadian "mental hygiene," foreign-born patients comprised more than 50% of the incarcerated population in Canada's asylums: Bolsheviks, suffragists, degenerates, developmentally disabled, and other "defectives."

Thanks to generous provincial funding, CAMH has become a power base for eugenic ideology, though they started calling it "sociobiology" after that whole Holocaust thing. One of the most notable devices developed at CAMH is the penile plethysmograph, a device hooked up to male genitalia to see what arouses the subject (usually administered involuntarily). Though most courts treat this plethysmograph like a polygraph (lie detector) and deem it scientifically unreliable and inadmissible as evidence in criminal trials, that hasn't stopped the CAMH people from using it to create evidence about all kinds of sex and gender minorities.

One reason these guys have been able to stay in business so long is the politics around "paraphilia," especially attraction to people under the age of consent. Politicians tend to throw money at this issue because no politician wants to deal with an opponent's ad that says they voted against funding for stopping pedophilia. CAMH has capitalized on the moral panic around pedophilia and other sex offenses to generate revenue for all of their programs.

With this job security, they have been able to gather a group of like-minded psychologists under their roof. Ken Zucker and his colleague Susan Bradley have led the movement along with US and UK counterparts like Susan Coates and Richard Green. Remarkably, some of the "experts" advocating this reparative therapy of gender-variant children are gay men who would have been incarcerated at those Toronto facilities in the past, or subjected to "cures" used in the past like castration, shock therapy, etc. Luckily, most of these "experts" are middle aged or near retirement, and there don't seem to be too many younger "experts" lining up to replace them. Most mental health professionals under 40 have a more compassionate and progressive view on gender variance, and they don't want to be on the wrong side of history. To use a movie quote, you either die a hero or you live long enough to see yourself become the villain.

gidreformnow_poster1.jpgWhat can you do?

1. Let your friends and loved ones in Canada know that their taxes are supporting this kind of child abuse. Ask them to contact their legislators. Share this article with them.

2. Tell your friends and loved ones who are psychologists and psychiatrists about this controversy. Ask them to think about the parallels with pathologization of gays and lesbians. Share this article with them.

3. Support non-profits like TransYouth Family Allies, a group of parents and professionals who honor and support gender-variant children. I joined their Board to help stop this child abuse emanating from Toronto. These young people tend to be very bright and creative and outgoing until they start getting psychology-approved aversion therapy at home and on the playground. TYFA seeks to end the shame and fear inflicted on these young people in their formative years.

More info:

Drop the Barbie! (Brain, Child Magazine)

Two Families Grapple with Sons' Gender Preferences (NPR)

Child Gender Identity (TVO Parents)

TransYouth Family Allies

'I'm a Girl' -- Understanding Transgender Children (ABC News)

Gender Madness in American Psychiatry: Essays From the Struggle for Dignity (recommended book)

Gender Shock (recommended book)


  1. Isn’t it the case that most kids w/ markedly atypical gender behavior tend to be gay in later life rather than transgender? IIRC, true transgender people are a splinter of a splinter.

    That being said, I’m not sure what Zucker’s cruel methods can accomplish other than crushing a young person’s soul.

    1. Isn’t it the case that most kids w/ markedly atypical gender behavior tend to be gay in later life rather than transgender? IIRC, true transgender people are a splinter of a splinter.

      You really need to read up on the subject. Being gay and being transgender are quite different things.

      1. What a dismissive and unhelpful comment. Not only did they never say the two were the same thing, they actually asked a serious question and wanted to engage in discussion over it. Instead of addressing it, and maybe educating them, you just acted smugly superior and dismissive.

  2. I find it kind of mean to label the whole city of Toronto as the “epicenter for oppression of sex and gender minorities”…. the whole city?

    I know that’s not what your article intended. I truly am glad you pointed out this is happening here where I live.

    1. I have been to Toronto on many occasions for work and found it to be a lovely city full of amazing people. That’s why I believe most Toronto citizens would be shocked and dismayed to learn that their tax money supported this kind of treatment of children, and that this ideology is being exported globally.

      1. As this kids say, “this”.

        I used to go by CAMH everyday on the streetcar… a little distressed that this is coming out of my city. Doesn’t jive.

        Definitely going to have to look into this more.

    2. The headline is a tad offensive, but it catches the eye. I mean really Toronto did win the bid for World Pride in 2015. We have gay marriage in Canada, business can not discriminate based on sexual orientation etc etc… Unfortunately this is a hurdle we have yet to overcome. Rest assured people (I) will do something about this. Be it canvasing neighborhood’s to inform people, to signing petitions, to protests. I hope we don’t let this news slip under the rug and forget that while we may be progressive in most areas of society, we have a long way to go in others.

  3. What a load of gits. When I was very young I used to like to read girls comics and liked the colour pink, if anyone had suggested this sort of thing I’d hope my parents would have told them to stick their malfunctioning brains up their behinds where they couldn’t cause any harm.

    1. My son loved pink (even got a pink cast when he broke his arm), liked doll houses, loved to color and make crafts. Fast forward 8 months. My son loves to color and make crafts, cars, projectile toys, bikes, and rough housing with other boys. Favorite color now? Khaki.

      Children learn gender roles on their own. At their own speed. There’s no reason to torture them. And for the *very* few that don’t conform to our system of gender polarity…. So f*ing what. The world won’t end if Johnny wears rouge and as long as Johnny gets his part of the work done and doesn’t irritate me he can have a cubicle next to mine.

  4. I didn’t know about this and certainly didn’t know Toronto was the dark heart of it all. Toronto has lots of problems I won’t go into, but it generally is a decent, multicultural and sexually-progressive city.

  5. I was at the GID protest at Moscone. It took place almost a month after I went Full Time. It was a good protest, many psychiatrists who were at Moscone for the conference came up and asked us questions. I think some positives took place that day but much more work needs to be done.

  6. I’m currently in the middle of my dissertation at uni in the UK, looking at the whole evolutionary theory regarding partner preferences. I chose to do this due to having to do a report on such preferences in a 2nd year module.
    The reason it stuck with me? It was all based on heteronormative outlooks on what we like/dislike in potential partners… All relationships are apparently all about the babies and what we women can get out of men and what we pretty young ladies can offer on a plate to guys.

    I had to go to two meetings (not part of the normal approval game) in order to have my diss passed for approval, as apparently, gay relationships don’t count. Well, they don’t according to my senior supervisor. ‘Not very psychological in nature’ was one of her remarks and I thus received a sh*tty mark for the proposal :(

    As a psychology student about to embark on the REAL world, I wholly disagree with much that is made of the DSM series. A lot of peeps make mucho money and reputation, based on backward thinking and prejudice. New Scientist is running a commentary on the whole revised edition, currently undergoing ‘discussion’ and supposed collabaration.

  7. I was at the GID protest at Moscone. It took place almost a month after I went Full Time. It was a good protest, many psychiatrists who were at Moscone for the conference came up and asked us questions. I think some positives took place that day but much more work needs to be done.

  8. I’m not looking to get into a big debate on the subject, nor do I support the idea of “reparative therapies” for persons who are gay, transgender, etc. But, I think the idea that “gender identity disorder” is some sort of terrible, made-up diagnosis to oppress transgender persons is just plain silly. It’s there as a means to diagnose a problem with a common set of symptoms or criteria. I don’t see in any way how it is applicable to anything outside of persons seeking transition.

    I feel it’s different than listing something like homosexuality as a disorder, because homosexuality doesn’t generally result in one seeking medical and psychological assistance to transition. There have to be standards and guidelines, and attempting to relegate all of it to just a variation on the human condition, while quaint, is not likely to result in greater access to the services and care necessary for transition.

    I’m familiar with Andrea James and many other trans activists who seek to depathologize transsexuality. I think they’ve done many things that are beneficial to the trans community and likely the LGBT community at large, but in the case of gender identity disorder, I think it’s a lot easier to rail against the system that you feel pathologizes you when you don’t need it anymore.

    1. @alliebean#10: You claim trans people need to be labeled mentally ill in order to get medical services. This idea that psychologists need to be gatekeepers who control my relationship with physicians merely serves the interests of gatekeepers. It’s similar to conservatives who think women require counseling before obtaining an abortion. People have a right to control their own bodies, and to control their relationships with healthcare providers. Why do I have to be labeled mentally ill to receive the same health services many non-trans women receive without such a diagnosis? Furthermore, you operate under the assumption that the “problem” is within the trans person. Some psychologists have proposed that the “disorder” is anxiety caused by living in a society that polices gender norms so rigidly. This moves the locus of the “problem” from inside the trans person. I don’t think there’s anything wrong with someone who is trans. Difference is not disease, despite the best efforts of psychologists to pathologize those who annoy or offend others.

      1. You don’t have to be labeled mentally ill, but if nothing is wrong with you, there’s nothing to treat!

        I don’t have any problem whatsoever with any doctor, surgeon, etc., providing whatever services they want to whomever wants them. There are doctors and surgeons who are more than happy to serve people who want sex reassignment surgery, hormones, etc., without any sort of psychiatric evaluation. However, as you most certainly are aware, we’re not talking about something as simple (and reversible) as something like breast augmentation. Transsexuality can be very complex, psychologically, emotionally, physically, etc. I’m certain you know this.

        Rather, the problem is access to care and affordability. Why would medical insurance companies cover services to treat something that isn’t a problem? I think the idea that transsexuality cannot in any way, shape or form be a problem for the transsexual individual just relegates sex reassignment surgery, hormone replacement therapy, etc., to the realm of cosmetic procedures. Many insurance companies already feel it’s in that realm, and refuse to cover the costs necessary treatments!

        I suppose the way I see it is that if you replace “gender identity disorder” with “depression”, it’s being argued that some people are just sad, it’s a fact of life, and as such nobody should ever be considered depressed or disordered no matter how detrimental it is to their life, but they can have whatever medications they want to make them feel better provided they can afford it.

        1. @alliebean#21: You are conflating two disease models of gender variance: psychopathology and pathology.
          “Gender identity disorder” is a psychopathological model. You could take that off the table and frame it not as a mental problem, but as a medical issue to be dealt with by a physician. The pathology model is just as problematic in my opinion, but that’s outside the scope of this discussion.

          I discussed the distinctions in a paper for Gender Medicine:

          1. There ARE doctors who are willing to prescribe hormones and surgeons who will provide SRS without any sort of psychological evaluation. In places like the US, though, they’re playing with fire, and it’s one of the reasons many practitioners just plain won’t do it.

            Even after reading your post, though, I still have to disagree with you. I still feel that your push to have GID removed is less about access to care and positive outcomes, and more about making it so you and other post-op transsexual women can say, “We have never had anything that could be considered a mental disorder”. Of course, since pretty much nobody but mental health professionals, some doctors and insurance providers actually use the DSM for anything, I don’t think it would have the desired effect.

            You even point out in your post that people who are depressed or anxious can go to a doctor and request medication. This is true. However, doctors are not necessarily mental health professionals, and they may have absolutely no idea what they’re doing. We end up with people who are medicated that may not need to be medicated, exposed to a number of side-effects, some of which can be fatal, with little oversight of their actual mental stability or need in the first place. Yeah, anyone can get pretty much whatever they want, but they STILL require a doctor, there’s still a potential gatekeeper, and the end result is that you have people who are receiving treatments they may not actually need.

            There’s a reason we go to doctors, therapists, psychiatrists, etc. rather than doing these things ourselves.

  9. It’s true that transgender and gayness are quite different, but the fact remains that many or even most gay people are very, very gender atypical in childhood, but do not grow up to want to change their sex. In many cases, they don’t even seem overtly atypical in behavior once they reach adulthood.

    1. Question for Andrea: Do you feel that there is ANY disorder that deals with gender? I mean I can imagine some cases where the behaviour of a child is harmful to themselves and others, but I’m new to these ideas. Clearly the treatments mentioned in the article are abominable.
      In what (if any) circumstances do you feel that psychologists should be involved in gender “stuff”?

      I’m studying to be a high-school teacher in Ontario. I’ve yet to deal with any situation where trans issues come in to play, though I’m certain I will at some point. What do I need to know?

      1. @abstract_reg#62: Gender is a social construct created by people, like religion. I believe that if someone wants to convert to another religious identity, it is usually not called a disorder and doesn’t involve all this nonsense with therapy, etc.

        These kids being “cured” don’t have a problem. They aren’t asking their parents if they can be “cured.” It’s the parents who have the problem, or their teachers or peers. They are the ones who want these children to conform to normative ideologies. All kids experiment with gender roles to greater or lesser degrees, and most decide one suits them better than the other (if they have to choose between two). Sometimes that doesn’t line up with their sex assigned at birth. What’s the harm to themselves or others? The harm usually comes at the hands of bullies and bigots and quacks who want to force them to be something they aren’t.

        1. I will state again that I’m against things like reparative therapy to somehow un-gay or un-trans children. I do think that’s a real problem, but I think it will be a problem regardless of what the diagnostic criteria are, and parents who are looking for a diagnosis will just find a different way to get something to “explain” the “problem”. Yeah, they may not be listed as having gender identity disorder, but perhaps they’re considered delusional or schizophrenic instead.

          However, there’s absolutely no reason that anyone other than a child would need any sort of therapy or counseling for their transgender issues unless 1) it’s causing them distress that is impacting their life and/or 2) they’re seeking transition which usually requires irreversible modifications to one’s body at the hands of trained medical professionals.

          If you’re not fitting into one of those categories, why would a diagnosis of gender identity disorder ever even come up? If you’re not being diagnosed, I find it hard to understand why a potential diagnosis matters, and even so, why it would require any sort of treatment whatsoever.

          I just don’t think it’s a situation where one can have their cake and eat it too, saying there’s nothing wrong with them and there’s no problem, but please give them tens or hundreds of thousands of dollars of surgeries and medical procedures on demand.

  10. If it takes surgery to fix it, it’s a medical problem, isn’t it?

    I’m asking honestly! I had surgery for my myopia, I consider it a genetically transmitted medical disorder that I got fixed. Ditto for melanoma and cancerous polyps; I’ve had warts removed and a lung de-collapsed – these things were all medical problems that society permitted me to pay to have fixed. Nobody cared that I got them because of my parents’ genes, or insisted that I had to keep inherited attributes I was unhappy with.

    If you need more, er, radical surgery to fix your problems, why isn’t that just between you and your surgeon? I just don’t get these people. They’ll let women get breast implants so they can be more successful as hookers, but they don’t want people who are unhappy with their gender to be able to change it?

    I am SO confused.

    1. Try reading again. It’s not about people who want to change their gender identity, it’s about people who make other people think that they want to change THEIR CHILDREN gender identity. No one asked CHILDREN what they think about it.

  11. It’s sad that it’s so hard to be truly scientific about gender issues, as politically charged as they are. It’s bad for any mental abnormality, but gender issues are especially prone to extremism. You have one side pushing for total conformity, and another pushing for total laissez-faire, and very few people collecting real data, establishing real facts and cause-and-effect links.

    We’ve all agreed that homosexuality isn’t pathological, with great certainty, although that’s a vague statement. We all agree that it’s not a personal decision, but rather a drive that works the same way heterosexuality does. But it seems there’s a lot of resistance to looking into potential causes and different types, because of the chance that it’ll turn into a search for the cure. Or maybe someone will invent a gay pill and slip it into the punchbowls at RNC meetings. As soon as it becomes identifiable and manipulable, it will change the landscape of the culture war.

    Or, worse, what if some kinds of gender identity abnormalities are, in fact, pathological? We have neurological illnesses with fancy Greek names for people who can’t recognize faces or colors, people who can recognize faces but believe people to be impostors, people who are blind but think they can still see. Being biologically male but mentally female sounds like it fits this pattern. Indeed, I don’t think much of the examples I’ve mentioned have been cured, though understanding their root causes has allowed people to cope with these conditions.

    In the meantime, we still have the fallacy of gay men’s equivalence to straight women, propagated even in LGBT-friendly media. Look at the sex changes that happened in South Park, or worse, in Hedwig and the Angry Inch. As a straight man, my main concern is getting all this stuff sorted so that I can deal with unusual variations of humanity, and perhaps getting gay pills slipped into punchbowls at RNC meetings.

    1. Or maybe someone will invent a gay pill and slip it into the punchbowls at RNC meetings.

      Are “gay pills” strictly necessary? I should think that alcohol in the punchbowls would suffice — damp down the upper brain, soon enough the raging repressed id will make itself known ….

    2. Or maybe someone will invent a gay pill and slip it into the punchbowls at RNC

      Oh, God, please yes.

      1. Oh, God, please yes.

        I was going to call dibs on a hot Republican politician, but…um….

  12. Well that is… troubling. You know, what is interesting to me is that I have a very old book called Psychopathia Sexualis from the 19th century I think that describes pretty much exactly what these contemporary doctors are talking about as therapies for “deviant” behaviors.

    Amazing that these kinds of ideas are so persistent.

  13. I’ve completed most on my clinical psychology training (in NZ), and have yet to find a psychologist who thinks the DSM is the authority on the problems people have. You can find many many problems with every listed disorder in there, but having categories is useful (to a point) in allowing people to communicate a client’s problems slightly more succintly than a unique complex description of each person – which we of course do when we interview the person one on one. In general we make do with what we have, and extend research to make categories more useful. A full clinical formulation of a client is the goal of clinical psychologist (as least how I was taught), not assignments of disorders. We don’t actually have to assign disorders at all, unless there are official orders to do so for compensation reasons.

  14. I know I’m going to piss a bunch of people off with this comment, but I’m serious, I want someone to explain the difference to me.

    So there’s a psychological condition called body integrity identity disorder. People with this are convinced that they’re trapped in the “wrong body.” They were meant to be born without an arm, or legs, or something. They can not be dissuaded from this idea. There is no treatment, and doctors refuse to amputate perfectly healthy limbs of these people.

    Now we also have gender identity issues, for lack of a better term. The transgendered. As I understand it, they also feel like they have been born in to the wrong body. Most frequently, they believe they are a woman in a man’s body. They know this with every part of their being, and can not be convinced otherwise.

    One is a termed a psychological disorder. The second no longer is, but rather simply an “identity.” Now what I want to know is what’s the difference between these two conditions? Because the only difference I see is that one is a guy that wants to cut off his arm, and the other is a guy that wants to cut off his johnson.

    I’ve never heard an argument of how these two situations are different. This can’t be a novel argument, I want to know the retort. Because honestly, I think it’s the baggage of sex that’s the only real difference.

    1. @coaxial#14: The easiest way to explain the difference is to think of it in terms of roles. Trans people reject part or all of their assigned gender role:

      People who wish to remove fingers, limbs, etc. wish to take the sick role:

      Things start to drift into disability theory as you delve deeper into all of this, but that’s the basic difference. Trans people are not disabled by their procedures (unless you want to discuss the legal concept of “perceived disability”). In either case, I believe it’s more useful to look at both situations as social phenomena vs. medical disorders.

    2. Because the only difference I see is that one is a guy that wants to cut off his arm, and the other is a guy that wants to cut off his johnson.

      So you see gender reassignment surgery as just being a penectomy? Very Freudian. Utterly male. Completely simplistic. Breathtakingly inaccurate. Maybe you should read up on the surgery.

    3. Wow. You’re ideas-man from reddit right?

      What more needs to be said? I don’t think they are the same thing at all. I’m not going to lie on the railroad tracks to “cut my johnson off”. Not all trans people undergo surgery either. And besides, its not being cut off, its being rearranged. If anything I’m protecting my “donor tissue” until I am able to see my SRS surgeon, I want to make my surgery is a great success.

      Some desperate trans people do harm themselves, but frequently those people have other issues that they need help with. The same can be said for non-trans people that cut their “johnson” off. Which I am sure there are people without BIID who do this, go look at BME sometime.

      Lets look at it this way. What have I physically done to harm myself because I am a transwoman? Ok, I’ve taken Estradiol and Spironolactone. Now I’m sterile. Not all people view being sterile as harmful, so is it really harm?

      If anything, I’ve hurt myself more socially because of how “normal people” treat me, and I’m not going to say much about the social status of woman vs. man.

      But I am very happy I went down this path. I’ve been through some rough times, but now my positives far outnumber the negative things. I used to be unable to see where I’d be in 5 years, it was always a unknown. Now I can finally see my future, and its a happy one.

    4. Coaxial, I have also wondered about this. It seems related also to body dysmorphic disorder where multiple plastic surgeries are undertaken to repair perceived flaws, or those who do extreme body modifications (piercing and tattoos). On a different note, I get confused by the stereotypical representations that the transgender employ in “dressing the part”. It seems to be a mask that is worn; an idea of what the opposite gender should be by that of an outsider looking in. I am alsoappalled that therapists would use aversion therapy on children to conform to gender stereotypes. As long as gender is seen as a binary system rather than a fluid one, there will be those who try to force this upon kids.

  15. As a Torontonian I am utterly and completely ashamed. I will be contacting my representative immediately.

  16. I’ll take your word that there are bad people working at CAMH, but please don’t tarnish the whole organisation. I’ve always thought that Toronto is actually pretty remarkable for the way that its mental health services are so open and part of the city. CAMH has buildings scattered over the downtown, none of which look like the victorian monstrosity you have pictured. Its main campus is quite close to my house. I went on a tour of the grounds recently and it seemed, to my layperson’s eye, like a pretty progressive place, albeit one that is about to have a few major roads built through it (and with a more dubious, but interesting, history).

  17. A lot of this has to do with the general stigma of mental illness — any mental illness.

    Some people use the term “functional” as an appendation to various types of mental illness. Most of the transgender people that I have met have been “functional.” A tragic few are not and require assistance to survive.

    Rather than fussing over what is and is not to be considered a mental illness in polite society, perhaps we could learn to view mental illness the way we view other non-communicative illness. We could concern ourselves with assistance to the ill, rather than shame, blame and irritation.

  18. coaxial —

    First, it is not true that “most frequently they believe they are a woman in a man’s body.”

    Second, you don’t cut it off. The surgery turns an outie into an innie.

    Third, gender identity is not all about genitals, believe it or not. This is the real answer to your question. Having a penis isn’t what makes you a man, and having a vagina isn’t what makes you a woman. There’s a whole lot more to it than that: how you think and feel, how you act, how others react to you. It might interest you to know that some trans people don’t actually want to have surgery to change their genitals. Some don’t feel like the shape of their genitals is the most important factor in their gender identification, whether they have surgery or not. Some do want surgery and feel that it is very important, of course. But being trans can’t just be boiled down to “I don’t want a penis” or “I do want a penis.”

    Try googling “Trans 101” to learn more.

  19. Dr. Quack: “Mr. and Mrs. Smith, we’ve got good news and bad news.”

    Mr. Smith: “Please tell us, we’re worried sick about our boy’s sissy ways”

    Dr. Quack: “The good news is your boy is cured of his gender disorder. We have forcibly stopped him from playing with dolls, clothes, and the color pink.”

    Mrs. Smith: “What’s the bad news?”

    Dr. Quack: “He killed himself this morning. That won’t affect your prompt payment for services, I hope.”

  20. The amount of ignorance among the comments makes my head hurt.
    Thank goodness for Andrea and Antinous.
    Being straight, gay or bisexual is not the same as being transgendered, since a transgendered person can be either gay, straight or bisexual.
    Sexuality is independent from gender identity and from gender expression.

  21. I have to say I’m kind of with alliebean. I have a close family member who is trans and without some kind of code for a real diagnosis of SOMETHING, would have had to pay for treatment out of pocket. Surgery would still be out of pocket and is totally unaffordable, so for better or worse, it’s a mental health professional that has helped. How else is a person supposed to get support? Some people naturally accept themselves and can transition emotionally on their own but others need help. And unless there’s a mechanism in our health care system to call it something that can be treated, that treatment isn’t going to be accessible to people who need it. I’d love to see total reform and lack of stigmatization, but in the short term, some level of pragmatism seems necessary.

    1. @Anonymous#36: That’s a tautology. The reason a mental health provider helped your relative is because your relative has no choice but to see a mental health provider in order to get help. It’s a self-justifying system maintained by gatekeepers. Any number of countries with nationalized healthcare do not consider gender identity issues a mental illness (France and the UK are top of mind), yet they still provide health services to trans people.

  22. Quite an informative reality check post.Thanks.

    I was thinking, if the “experts” can “define” and “pathologize” other people’s nature and call it a mental problem, I guess they are the ones with a mental problem by power tripping on a need to psycho pathologize their surroundings.

    Just because a bunch of self-called gurus saw something and called it a mental disease, which was put into a book to be read by wanna be experts, doesn’t meant it’s a real mental disease.

    Those people have a problem.

  23. Concentrated/minored in Gender and Women’s Studies for my BA, and for my senior thesis (in 2005), in conjunction with a seminar on gender issues and constitutional law, wrote about transexuality, supreme court case law, medicine, and sexual ideology. I know these aren’t quite the requirements to get on MSNBC as an expert, but hey, I did read a lot of court decisions, the DSM, and Foucault. I also cited my sources, which on the Internet, I guess makes me like the president of knowledge, or something.

    Anyway, in this issue, there’s morality, there’s gender identity, there’s medical science, and then there’s law. They all argue different things for different reasons. Frankly, I don’t care about anything except for what the particular subject wants to label him/herself and his/her body, and don’t think anything else should matter to anyone.

    But what I wrote my paper about, was the effects power structures impose upon those under their jurisdiction. In this arena, this means we’re largely talking about mental health and law affecting poorer people with gender issues. These are not the only people involved in the issue, but these structures and groups butt heads for a reason.

    To cut it short: people with serious gender issues often have mental health issues. Although there are a variety of different issues, and a variety of different treatments, it is not unfair to generalize by saying that sexual reassignment surgery (SRS) often is the treatment of choice in the mind of the subject. Debate the efficacy of SRS and what exactly is transsexualism or GID elsewhere; all diagnostic criteria aside, there are a large number of people who feel without SRS they cannot live a normal life. As I said, I care most about what the person wants.

    It is a fact that since the DSM has lightened up on “transsexualism” as a disorder, it is near impossible for a person to receive SRS if the state is paying for it. G.B. v. Jerome Lackner (1978) and Pinneke v. Preisser (1980) both found that since transsexualism was a “disorder”, the state was obligated to pay for it under Medicaid. This precedent was binding for 20 years, until Smith v. Rassmussen (2001). The DSM had been changed since 1980, and now GID had several other less invasive treatment procedures. Furthermore, because now the DSM specified that there was no specific “cure” for GID, the state was not obligated to pay for SRS. This case law had been binding precedent ever since, and to this day no state medical insurance will pay for SRS. Most private insurances also have followed suit, attaching themselves to this ruling.

    So, yes, in a perfect world, everybody’s gender and body is a fluid confluence of definition and practice, and we are all happy sex cyborgs. But in the meantime, because the State as an Institution ties its responsibility to the pathology of Medicine as an Institution, poor people cannot receive SRS if they choose, and instead look forward to lives of longing and therapy. Foucault’s medical-madness panopticon was working for them, giving them aid they needed, but now like the rest of us, are waiting in line at the State-Clinic, trying to see how these Institutions weasel their way out of helping us. Perhaps in the 1970s it seemed like Institutions were trying to get into people’s heads to control us; but now in the 21st century, it seems like they can’t wait to ignore us.

    Anyway, my two cents. For fun, I uploaded my full paper to my web site. I knew there was a reason I saved all those college papers! Check it out if you like: (licensed Creative Commons, bitches!)

    and feel free to email me any comments on the paper, because I probably won’t watch this thread: adam.rothstein (at)

  24. Why is it that so called “normal” people find “abnormal” anything that is not in their learned parameter of normality ?

    1. Why is it that so called “normal” people find “abnormal” anything that is not in their learned parameter of normality ?

      Isn’t that the definition of “abnormal?”

  25. Anonymous at 35, could you answer a question for me then? Please treat this as a genuinely ‘stupid’ question, not as some kind of ignorant provocation. :-) Please? I ask, because the labels shift depending on where the label started, it seems.

    1) If an MtoF transgendered person, who as a male expressed heterosexually, now as a woman, remains interested in women, was hetero, now she is gay? Or, does she, as she may still have the original equipment, be considered still hetero?

    2) If an MtoF transgendered person, who as a male expressed homosexually, now as a woman remains interested in men, was gay, now is hetero? Or does she, as she may still have the original equipment, be considered gay?

    1. #41: Gay. Straight.

      More importantly, however they choose to identify with respect to sexual orientation.

    2. dougrogers #41: I suggest you ask the transperson in question. See what they identify as. Honestly, they’re the only ones who can answer that question. WE certainly can’t assign them what should be a self label.

    3. maybe a restate of #35 will help you –

      Gender identity is about how you define yourself within the spectrum of male, female, neuter, two-spirited, etc.

      Sexual orientation is about your attraction to other people, gay, lesbian, bisexual, asexual, etc.

      These labels are not static for everyone and they don’t need to be.

      Some trans folk remain interested in partners of specific gender regardless, others change during transition. Some simply adopt a queer identity that embraces the complexity of living in a culture where questions like yours must be asked.

      Why does it matter to you whether someone would be gay or straight after transition? There are trans folk that desire a hetero-normative identity post-transition, but this kind of thinking is what the identity disorder gatekeepers enforce. It isn’t really a puzzle for you to solve, there is no paradox here, and no one answer.

      One of the “mother-may-I” bunches that I encountered in Chicago would not work with you if you told them your orientation would be gay when you finished transition. Getting services often means keeping your mouth shut and blending in as best you can, whether you want to or not. And this is still true whether you are in Canada or the States.

  26. Even though you’re making important points I agree with for the most part (especially about trying to link psychological effects to physiological traits!), the sensationalist tone you’re taking makes it difficult for me to support them.

    Making a blanket statement about all of Toronto, or, indeed, all of this very large institution strikes me as wrong even when I have no connection to either place. Generalizations are nearly always wrong. It makes you seem much more ignorant than I am sure you are.

    Then, the argument for the removal of transgendered-themed disorders from the DSM can be made for many other ridiculous disorders like mathematics disorder which is essentially you are slower than your age level at math in school. Its inclusion was pushed for by parents who wanted, as some other commenters have noted, insurance companies to pay for their children’s difficulty with mathematics. Is it a real disorder? Well, how the hell do you define a disorder? Do disorders actually exist, or are there just a collection of symptoms? A continuum? This argument goes on every day among psychologists. It’s an argument worth having. But it’s not just an argument about transsexuality.

    I appreciate that this is something you have an intimate connection with and so obviously you’re dedicated to it more, but the problem isn’t just a conspiracy authored by a small group of psychologists, but a wider systematic problem within the field, one that isn’t being ignored.

    1. That is a really good point entropyred! There is the general question of how psychiatry in general operates and this makes the issue much broader than the CAMH.

  27. Firstly, the DSM is so broad and vague in some of the “diseases and disorders” that none of us would qualify as normal. I took a sociology course on sex and gender and the professor discussed exactly opposite to what psychologists like Kenneth Zucker argue. We were told there are five different genders instead of two. And that being gay, transgendered, or transsexual was heavily dependent on biological & societal determinations. It wasn’t a disorder rather an evolution of sorts. I’d let the experts workout the details before I jump to any conclusions. For now, I’m content with the defining gender as a socio-evolutionary construct.

  28. @dougrogers

    I’m not #35, but I’d like to give an answer.

    Firstly, the terms “gay” and “straight” themselves are relative to the gender of the person, and it’s easy to get caught in a mess of meaningless terminologies if there’s ambiguity in that area.

    The easiest way to deal with this is, IMO, to simply say that a transperson is “into men” or “into women”.

    However, #35’s point remains. The gender you feel you are is a factor that’s completely independent of the gender you are sexually interested in.

  29. dougrogers @ 41:

    A woman who’s attracted to other women is lesbian (to state the obvious).

    Where it becomes vexed is if she’s also Intersexed, so may have genitalia that’s unconventional. For example, only 10% of 46,XX-chromosomed people identify as men, the rest are women with tomboyish behaviour when young, and somewhat masculinised genitalia, varying from imperceptibly so to grossly so.

    The evidence is that Transsexuality is a particularly extreme form of Intersex. Most of the body conforms to one stereotype, but crucial parts – ones that are involved in the crystallisation of sex identity (often mis-named “gender identity”) conforms strongly to the other.

    So a woman – someone with a female sex/gender identity – who is attracted to other women is lesbian, *even if she looks normally male* to the casual observer. Yes, the old joke about “Help, I’m a lesbian trapped in a man’s body!” is distinctly unfunny for such women. They really are.

    “Female Brain in Male Body” is a good soundbyte. It’s true in essence. Not in detail though, and we have to be careful here. It’s only necessary that certain parts of the brain conform to a cross-sexed stereotype to cause transsexuality. Other parts may be feminised, masculined, some even hyper-masculinised, or anywhere in between.

    That appears to be why so many Trans people have unusual talents, creativity, high IQ etc. The number with PhDs is ridiculous. They also tend to go off on tangents….

    Bottom line: a Trans woman attracted to other women is lesbian, no matter whether she’s pre- or post- op. A Trans man attracted to other men is Gay, whether he’s pre- or post- op.

    1. “Bottom line: a Trans woman attracted to other women is lesbian, no matter whether she’s pre- or post- op. A Trans man attracted to other men is Gay, whether he’s pre- or post- op.”

      You can add non-op to that explanation too.

  30. I think an important part of this issue is that under current definitions, MtF spectrum transsexuals are either homosexual males who’s only hope in sexually attracting heterosexual men is by becoming a women, or else heterosexual males who are so extremely aroused by the thought of themselves having vaginas and breasts that they simply must become women in order to experience sexual thrill.

    I agree that there should be some sort of diagnosis so I can get health care coverage (I live in Toronto, so I have OHIP), but do I need to be reduced to a sex-obsessed deranged person to do it? Can’t I be recognized as an individual who’s physical and mental sexes simply don’t match? That can be taken care of as a medical condition alone which, depending on the severity of the condition, would have varying degrees of treatment based on the individual’s needs.

    As for disorders, I could see diagnosing associated depression and/or dysfunctionality as a result of or response to various pressures (both external and internal) related to an incongruous gender identity or non-conforming gender expression. Such disorders would likely ease with transition, but may need further care, such as antidepressants or reduction of stress in a person’s life, etc. But those would be more tangential to transsexuality and transition rather than implicit.

    Just my thoughts,

    Sarah from Toronto

    1. The ideas you’re discussing are not “current definitions”, they’re some of the Blanchard, Bailey and Lawrence proposed changes that view all transsexual women as either homosexual men or autogynephiles. The ideas are very controversial, and I’ve yet to meet a decent therapist or surgeon who thought they had any validity. I’m sure there are some doctors out there who would agree with these ideas, but there are all kinds of bad doctors out there that do all kinds of stupid things.

      Regarding being “recognized as an individual who’s physical and mental sexes simply don’t match”, that’s pretty much what gender identity disorder is. It doesn’t say you’re crazy, that you’re some sort of fetishist, that you’re sex obsessed or anything like that. It gives a few symptoms/characteristics that are pretty common among people who are transsexual and tries to explain what the condition is. As I see it, the reason it’s not just a purely physical issue is because there’s no conclusive physical evidence of transsexuality. It’s all based on what the transsexual person says they feel. Considering the other mental disorders that can result in gender dysphoria as well (some types of schizophrenia, for example), it’s prudent to have support and evaluation from both the mental health and medical perspectives.

      Now, in the end, I know I couldn’t care less if doctors provided SRS and HRT on demand for anyone who wanted it. I think it’s risky, dangerous and stupid, but, I don’t think there’s any reason why doctors shouldn’t be able to provide it if they really want to (and there’s nothing that stops them in the US at least, there are no laws that say the DSM and WPATH guidelines must be followed). But I know if I was a doctor, I most certainly would NOT provide such services without other oversight to ensure the best outcome of the patient.

  31. Perhaps studies and experiments should be done on the parents who dislike their children so much for playing with toy humans.

  32. “and no playing with or drawing pictures of girls.”

    …Holy frack! 99.999% of all comic book artists are gender conbefuddled!?!?! That’s it, I’m selling my collection!

  33. Whew, a lot of discussion to go through. In the interests of not inflating the numbers, I’ll comment on a few items in one go.

    #1: yes, most kids diagnosed with ‘gender identity disorder in children’ turn out as gay; some end up as trans and some as straight. According to the proponents of this type of therapy, it is successful because so many of the kids treated grow up as cisgendered — but it’s at least equally plausible to claim that the diagnostic criteria are just vague enough that most of the children so diagnosed were not trans to start with, and that not all trans children would be diagnosed. This, of course, would mean that the whole system just arbitrarily selects some non-conforming children for legalised abuse.

    #17: The difference between a man who wants to cut off his arm and another one who wants to cut off his penis? At a guess, very little. The difference between both of these and a transsexual woman is that while the guys want to get rid of something that doesn’t match their body image, she wants to change something that doesn’t match to something that does. I don’t want to have my penis cut off, I’d just like to have it reduced in size to roughly the size of a normal clitoris, and moreover I want to have the rest of the equipment — having a male-sized penis is really a rather minor issue compared to the rest. But if the idea of having your penis cut off distresses you, consider that this is what every trans man has to live with at least until they get to the age of legal majority, and even then the surgical options are rather primitive. And they get their lack of penis served with extra oestrogen, something which drove Alan Turing to suicide.

    If I remember correctly (and I’m sure someone here can expand on this either way), there’s been some recent research on how to train the brain of someone who has a body integrity identity disorder disorder to add the extra parts to the body map, but as far as I know, no similar hints of a possibility of eventual success have been reported for transsexuality.

    #47: as a minor point, while gender identity and sexual orientation are completely different issues, having a ‘wrong’ physical sex plays all kinds of hell on one’s sexuality, and quite a few transsexuals are completely asexual before transition. The apparent orientation can change too, so that for instance someone can go from living as a straight man to a straight woman. I have some personal hypotheses on why, but there’s little or no reliable and unbiased research on this. But the bottom line seems to be that while sexual orientation doesn’t change, one’s understanding and expression of it can do so as the genitalia change.

  34. So as an avid anime and manga consumer, I feel the need to point out a series called “Hourou Musuko,” which plays with this sort of transgender issue but rather more lightly. The boy in this story, rather than feeling uncomfortable being a boy, just seems to grow to like dressing as a girl, but still runs into similar social issues. Like why can a girl dress in a boy’s uniform and be reasonably acceptable by the teachers, but a boy in a girl’s uniform becomes disturbing.
    For the most part, anime like most entertainment mediums does sugar coat gay/lesbian/bisexual/transgender issue compared to real terms, especially to articles such as this. And for the majority of its use I see it as more of a comedy gimmick rather than some sort of representation, draw to the appeal of demographics. Girls to guys and guys to girls. Rather this turned out to be my early exposure into this whole issue, which I find as an interesting 6 steps from that to this.

  35. there are nut-jobs and crack-pots everywhere, but don’t tar an entire city with the same brush. Toronto is also home to one of the world’s largest pride celebrations… surely the million people who come to pride every year would stay away if the city were truly the inhospitable disaster you describe as “global epicenter for oppression of sex and gender minorities”. target Zucker, not Toronto.

  36. yes indeed, Zucker’s work makes Toronto look bad internationally. But, weirdly enough, Toronto is also one of the best places on the planet re grass-roots trans activism and access to health care. Sherbourne Health Centre provides cutting edge, compassionate and thoughtful Primary Medical care to over 500 self-identified transgender people with many many more on the waiting list, City of Toronto Youth Services “Pride and Prejudice” group and SOY (“Supporting Our Youth”) at Sherbourne offer imaginative and lively services for gender-questioning and trans youth, the 519 Centre provides excellent community-building for a wide range of trans people from Refugees through Youth, Street-Involved and Sex Workers, our Shelter system has worked hard to radically improve access for both trans men and trans women, “Trans Pulse” is a Community-Based-Research project currently gathering extensive information about trans people in Ontario, next week there is the launch of a campaign for Trans men to get Pap smears — and on and on. Even within the huge hospital, CAMH, where Zucker works, there have just been some very positive changes to the adult Gender Identity Clinic (which also used to be one of the worst internationally). Articles like Andrea’s, and the lively responses, are really helpful in keeping pressure on CAMH to do something about Zucker’s troubling clinic. Keep it coming!

    Hershel Russell

  37. It’s been said a few times in the comments already, and at least partially responded to by the author, but I’ll add my 2 cents too.

    The structure and tone of the piece really looks to paint both Toronto and CAMH in a terrible light. For someone who is so against (rightly so) painting an entire group of people with one brush, you write this in a style that paints a city of 3 million and an organization that has a very broad scope with a single stroke.

    Toronto is one of, if not the most, progressive and accepting cities in the world when it comes to gay/transgender issues and rights. CAMH is THE centre for the addicted and mentally ill in the city. Because a small group of soon-to-retire people stuck in the stone ages work within those walls, within the much larger boundaries of the city, doesn’t warrant “TORONTO IS WHERE THE GAY HATE COMES FROM” type alarmism.

    That said, as a Torontonian, I’m shocked this IS going on, and I’m glad it was brought to my attention. My bi/gay friends who have volunteered and used the services of CAMH (for unrelated issues) should be even more interested in this. Thank you for shining a light on it. Next time, try and be a bit less sensationalist with it.

  38. To be honest, I’m shocked this story isn’t about an institution here in the states; at least I would expect it from them, but Canada? Seriously? Toronto? I guess aging bigots live everywhere, even in Canada. For the sake of the individuals whom seek out the CAMH for serious help, I hope the administration behind this thinking retires/dies soon. It saddens me to see “professionals” touting “cures” to things they even they don’t completely understand, and genuinely concerned parents seeking answers, but only getting lies and misguidance.

  39. Ok, we get it, Toronto is not all bad. Realize that by putting the headline that she did Andrea has successfully gotten you to read the article from top to bottom. I’m certain that most people who are reading this are aware that Toronto is one of the most accepting cities in North America. However, that does not in any circumstance give them licence to allow atrocities to occur within its limits.
    Congrats on creating the right response from your Canadian readers Andrea.

    Heres the really important question I think. How much of the way we categorize the world is really just a construct? I’ve recently started to notice how Western Culture (a so increasingly the rest of the world) has a habit of breaking the universe up into value pairs. Good things and bad things, male things and female things, beautiful things and ugly things, etc. Why do we do this categorization? I know that I’m getting off topic a little, but why do we so often separate everything in our minds? I think this while not evil in itself has caused some wrong approaches. The separation of humanity into male and female for example, or the separation of politics into conservative or liberal ideas. These categories seem to be useful in our language, but they are not actually separate sets of things.
    I think more work needs to be done in analyzing the validity of separate categories.

    1. Yes, my goal was to get the attention of the many progressive citizens of Toronto, to raise awareness about what their tax dollars are doing. For those who feel I was besmirching a whole city (which I wasn’t), please see the first sentence of my new post:

      CAMH turned down 90% of trans applicants in the past, so clearly a mental illness diagnosis does nothing to assist with access to care. It’s just a way to make money while oppressing people.

      1. CAMH is not the whole of transgender care in the world, North America or even Canada as far as I’m aware. As far as the number of trans patients who were “turned down”, turned down in what way? Refused assistance with transition? Told they would not be approved for hormones? SRS? What were the reasons for their being “turned down”? I don’t think that’s a statistic that can stand on its own without additional information.

        1. @alliebean#92: For someone “not looking to get into a big debate on the subject,” you seem to be doing a lot of debating. 9 in 10 were rejected for surgery during the first 15 years they controlled OHIP funding (Toronto Star, November 27, 1984). But then, they were the only game in town.

          I’m sure some people have a great experience in prison, but that does not mean we should dismiss the problems and abuses that occur. CAMH’s regressive policies and ideologies set the tone for treatment throughout Canada and in other parts of the world. Just because a few people have their needs met by navigating their byzantine and humiliating system doesn’t mean it’s a good one.

          If you’d like to have a big debate, maybe email would be better.

          1. I don’t wish to get into a big debate on the subject. However, I do take issue with the types of things you’re saying and the generalizations you make in your arguments that seem to be more sensationalist than substantive.

            In this very reply, you stated earlier that “CAMH turned down 90% of trans applicants in the past”. While you do say “in the past”, it’s a statistic that would appear to be 26 years old. It may have a bearing on what CAMH does now, or it may not. It’s very difficult to know without more information. On top of that, non-approval for SRS does not translate into non-treatment. There ARE people who seek to transition for which transition is not the ideal solution or the necessary treatment. The idea that everyone who, at some point identifies as trans, MUST transition and MUST have SRS just doesn’t sound good to me. You end up with situations like the Australian clinic (I can’t remember the name) where they’ve had tons and tons of people who feel they were forced to transition and have SRS because that was determined to be the optimal outcome.

            While you continue to rail against the CAMH, BBL, etc., (and I do agree with the majority of your position on BBL and their lunacy), you seem to be throwing out what many consider to be reasonable diagnoses that serve to understand and provide treatment for transgender persons.

            I’m sure you’ve talked to many, many trans people over the years and throughout your life. You’ve probably talked to more than I have. But, I’ve talked and worked with a lot of trans people as well, and while a few have had poor experiences, most are able to get what they need (within cost constraints) with very little difficulty or distress. Some have been denied assistance to transition because they were determined to have a different disorder that led to their gender dysphoria, something that would never be explored if people were simply given treatment on demand with no questions asked and their mental status never examined.

            Anyway. You may be entirely right about how these situations have developed or will play out. However, it’s my opinion that rather than present reasonable arguments, you revert to sensationalism and hyperbole, and people are forced to challenge your assertions than actually consider the topic at hand. I know I’m not the only one here who has felt that way about these posts.

          2. I’m trans and I am extremely unhappy with the way my disease is dissected in the DSM-V, unlike the “many trans people” you’ve talked to. In fact, I would say that most educated trans people hate the system because it puts unnecessary roadblocks in treatment. When I go to get mental health therapy for other reasons, the only thing the therapist sees is my “gender identity disorder” and every problem I’ve ever had stems from my “problem”. Even if you’ve transitioned (which I have) and are happy, you are still considered disordered by the majority of medical practitioners.

            However, most therapists and doctors do not have the training necessary to deal with trans patients and so they go to their standard reference: the DSM-V. Every time I need mental or medical care, I am defined by what’s written in that manual. My whole life leads back to that standard manual and this is why changing the way in which it is classified matters so much to trans people: It will change our lives dramatically.

            A little anecdote for you to understand the ignorance of trans issues by the mental health establishment: I moved to a new town six months ago and needed a new psychiatrist, as I take medicine that cannot be discontinued. I have no health insurance, so I went to the community mental health center in my town. At my first appointment, I told him everything, including that I am trans. Before I tell you the rest, I must tell you that most people read me as an extremely effeminate gay man, which is exactly as I wish to be seen. I am also trans, as in I was assigned female at birth and am now a trans man. Okay, back to that moment when I tell him that I’m trans… He looks at the ground, breathes real slowly for 15 seconds, looks up and asks “So, how long have you felt like a woman?” I practically squealed when he said that, as it made no sense to me, as I usually spend most of my time convincing people I’m not a woman. He immediately assumed many things about me from that one tiny word.

            So everyone who’s not trans and doesn’t see the problem with the system as is, tell me again why my life must be controlled by some entity that probably wants to put me into therapy for not being a proper female-to-male transsexual because I’m too girly. I can’t wait.

          3. “When I go to get mental health therapy for other reasons, the only thing the therapist sees is my “gender identity disorder” and every problem I’ve ever had stems from my “problem”. Even if you’ve transitioned (which I have) and are happy, you are still considered disordered by the majority of medical practitioners.”

            I would contend that these are bad or uneducated practitioners. I also don’t feel that these types of issues would go away simply because there isn’t a diagnosis within the DSM-IV for GID. Yes, the DSM-V has a lot of icky things in it that I hope aren’t going to make it into the final revision, but, it’s not finalized and is not yet used. The DSM-IV is pretty tame when it comes to GID, at least in my own opinion.

            “However, most therapists and doctors do not have the training necessary to deal with trans patients and so they go to their standard reference: the DSM-V. Every time I need mental or medical care, I am defined by what’s written in that manual. My whole life leads back to that standard manual and this is why changing the way in which it is classified matters so much to trans people: It will change our lives dramatically.”

            I agree that there needs to be more training and education among both medical and mental health practitioners. However, I do not feel that removing the diagnosis and diagnostic criteria entirely somehow magically achieves this goal, nor that there’s any particular reason that a mental-oriented diagnosis is somehow worse than a physical-oriented one. That said, I have NEVER had a medical doctor pull out a copy of the DSM-IV (much less the DSM-V, since that one isn’t yet finished) when working on treatment for me, mental or otherwise.

            “Okay, back to that moment when I tell him that I’m trans… He looks at the ground, breathes real slowly for 15 seconds, looks up and asks “So, how long have you felt like a woman?” I practically squealed when he said that, as it made no sense to me, as I usually spend most of my time convincing people I’m not a woman. He immediately assumed many things about me from that one tiny word.”

            Considering that there seem to be more trans women than trans men, I don’t think that at all would come across as unexpected with your appearance as you’ve described. I’ve known both trans men and trans women who have been mistaken to be going the other way, and unfortunately, that’s something that does happen from time to time. It sucks, but it really is a complex issue that many people don’t understand, and many people never knowingly encounter. If anything, it would say to me that you’re passing. So where exactly is the problem? I’d be much more upset with him refusing to treat you for conditions unrelated to your transsexuality, rather than him assuming you were going the opposite direction in your transition.

            “So everyone who’s not trans and doesn’t see the problem with the system as is, tell me again why my life must be controlled by some entity that probably wants to put me into therapy for not being a proper female-to-male transsexual because I’m too girly. I can’t wait.”

            I think very few people want you to be denied treatment or to be coerced to be a certain way. But, when you’re depending on doctors to perform services for you, to assume liability to treat you despite their lack of knowledge on the subject, etc., you’re always going to have to convince someone to do something for you. This is true even when dealing with non-trans issues.

            My point isn’t that there aren’t issues with trans care within the system. My point also isn’t that there are bad doctors like Zucker, BBL, etc., and that there aren’t people who pervert what the DSM says to further their own ideological and religious agendas. Rather, my point is that scrapping diagnostic criteria and diagnoses because some people are offended at the idea that something is “wrong with them”, all while they’re seeking treatment to have their bodies fixed to conform to their gender identities, is just silly. I feel that’s fighting the wrong battle.

            But, as anyone can tell you about the trans community, it’s very fragmented. All trans people are not the same, not all trans people have the same goals and needs, and attempting to treat everyone as a unified, single-minded group is rather futile. I think that’s also one of the reasons so many people take issue with the Standards of Care and a GID diagnosis, but, I do think there has to be some common denominator if there’s any hope of providing acceptable treatment throughout any standardized system.

  40. @ Andrea: Who is touting a “cure”? You say that Zucker’s group < >

    Having listened to Zucker on TVO and read everything I can find from CAMH, I can’t find any such claims. They are instead talking about therapy for gender-related issues that are causing children considerable distress. Did they really make the kind of claims you describe, or are you inserting the words like “cure” and “wrong” into their much more defensible and appropriate descriptions of what they do at their clinic?

    @ Everyone: Remember that DSM disorders ALWAYS come with the caveat that a diagnosis cannot be made unless “the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.”

    Nearly everyone meets all of the criteria for a disorder at one time or another except for that caveat. I, for instance, am almost certainly ADHD, bipolar, and dyslexic EXCEPT for the fact that I have developed enough coping mechanisms to avoid significant distress and impairment of normal functioning.

    Inside the extremely faulty world of psychiatric medicine I don’t think there is any special problem with Gender Identity Disorder. As entropyred(#43) says, these problems span consistently across the entire discipline.

    If we want to challenge the idea of atypical behaviour as illness or disorder, I’m happy to agree. But I don’t see Gender Identity Disorder as oppressing sexual minorities much more than major depressive disorder oppresses sad people or ADHD oppresses me.

    I certainly think the hyperbolic title of this article is the WRONG way go about addressing these issues… as succinctly expressed by Astin(#70).

    1. “…I don’t see Gender Identity Disorder as oppressing sexual minorities much more than major depressive disorder oppresses sad people or ADHD oppresses me.”

      Yes, but there is a problem IMO if someone says “there is something wrong with you because you don’t act the way I think you should.” I think the real problem lies in how the people who have “gender identity disorder” are treated by those around them (kids & adults can be very cruel to those who seem to be the least bit different from them). From birth we are learn behaviors from imitation and learn to identify with what feels most comfortable, most “normal” (if there is such a thing), and trying to change the way someone feels down to the core of their very being is difficult, if not impossible.

      1. I think you’ve brought up a good point. However, this is why I feel it’s silly for people to rail against GID and say that it’s not a legitimate diagnosis or problem.

        I think it’s perfectly natural for there to be depressed people, gay people, manic people, transgender (and transsexual) people, obsessive people, and the list goes on and on. There is nothing wrong from a medical or psychological standpoint in being different UNLESS it’s causing you problems living your life. There is no reason that anyone would have any sort of diagnosis they have one disorder or another unless they’ve sought treatment and that disorder or condition was recognized and seen as potentially contributing to their situation.

        Average people, employers, coworkers, etc., don’t carry around copies of the DSM or ICD-10 and look up possible symptoms of mental problems others may have. These are tools of clinicians and medical and mental health practitioners to help diagnose and treat disorders. I think the greater problem with acceptance of transgender individuals is that it’s a smaller community than the gay and lesbian community, and many people simply do not understand gender dysphoria in a way to which they can relate. I don’t think these people care one bit what any official diagnoses are, and I think this is why this cause is normally taken up by people who have successfully transitioned and feel that having GID in the DSM leaves them with some sort of crazy, mentally ill stigma.

        Anyway. The whole thing just really rubs me the wrong way. The goal should be better access to medical and psychological care, more affordability, and successful treatment outcomes. Turning it into a non-standard, undiagnosable free-for-all would seem to lead to less successful treatment when assistance is desired.

        Yes there are problems when parents try to get their “overly” masculine girls and “overly” feminine boys some sort of “treatment” for being the way they are. Sometimes these children are homosexual, sometimes they’re transgender or transsexual, and other times it’s just growth and exploration in figuring out their identities. I do feel it’s wrong when there are people like Zucker who try to do some sort of reparative or aversion therapy for these children, but I still think it’s a fairly rare in occurrence.

        Andrea James and others have been waging a war against CAMH, Zucker, BBL, etc., for a while now. I don’t disagree with them on many of their points, because a lot of the people involved in transgender care at CAMH are rather wonky. But there are people who have gone through the clinic, had successful outcomes, and are happier for it and able to lead normal lives. The wonky nature of some of these clinicians is an exception, rather than the rule, for transgender and transsexual care in both North America and likely the rest of the world.

        So, problems with CAMH? Yes, sometimes. Outdated and possibly dangerous ideas from some of the personnel there? Absolutely. Enough that any mention of transgender or transsexual persons needs to be stricken from the diagnostic materials, all disorders involving these characteristics gone, and everything relegated to on-demand medical procedures and surgery? I think that’s extreme.

        1. Re the GID diagnosis: The next version of the DSM, (the reference book of psychiatric diagnoses mostly used in North America and also influential in the rest of the world) the DSM_V, will come out in 2012. Discussions about what should/should not be in it are happening now. Indeed, the initial discussion papers from the APA committees are just now being distributed.
          The next 2 years are an excellent time for lively, well-informed public discussion! GID is a hot topic within the DSM_V. Though Zucker is the chair of the overall committee re “sexuality and gender identity”, the committee on GID includes some reasonably progressive people and is actually producing some interesting thinking. GID as it stands will probably go. What will replace it is still very much up for discussion and might even be an improvement, though we won’t get my own fave — Ann Vitale’s “Gender Expression Deprivation Disorder”. Let’s both hope and keep pushing, it’s a great time for activism on this topic!
          On the other hand the committee on the “Paraphilias” is headed by Ray Blanchard, another of CAMH’s less palatable researchers. The discussion paper is alarmingly bad. While there seems to be lots of public dialogue about GID, I am hearing nothing about the “Paraphilias” which worries me a lot. There is a strong argument to dump the entire category and replace it with something that primarily draws a distinction between consensual and non-consensual sex rather than ludicrous categories like “fetishism” (yep, bet you didn’t know that your passion for shoes was a mental illness) lumped in with serious criminal behaviour like pedophilia…

    2. @ rsn reminds us that ‘DSM disorders ALWAYS come with the caveat that a diagnosis cannot be made unless “the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.”‘

      I’ve always found this deeply problematic. For example, suppose I live in a deeply transphobic society (as I do), and I find it hard to get a job because I am a transsexual, then by the above definition (‘impairment in occupation functioning’) it’s my mental health that’s to blame, not the transphobia of those around me. This is a blatant piece of victim blaming and social engineering, and not a scientific judgement at all. And, as rsn says, the DSM is riddled with it.

      @Anonymous 77: Rather than tell us about the building works at CAMH, if you want to persuade people that Zucker is a reputable researcher, perhaps you could assure us that Ms James’ account of his cruel and repressive reparative therapies (e.g. asking children of trans girls to deny them access to “female” toys, etc) is untrue. Unless you can do that, news about building renovations has got to win some kind of award for missing the point.

      1. “I’ve always found this deeply problematic. For example, suppose I live in a deeply transphobic society (as I do), and I find it hard to get a job because I am a transsexual, then by the above definition (‘impairment in occupation functioning’) it’s my mental health that’s to blame, not the transphobia of those around me. This is a blatant piece of victim blaming and social engineering, and not a scientific judgement at all. And, as rsn says, the DSM is riddled with it.”

        I don’t think that’s how that’s applied in common practice at all. Having trouble living in your job because other people are mean or don’t like you does not mean you have a mental disorder, but being unable to go to work because you’re uncomfortable in the gender role to which you were assigned at birth WOULD qualify as “impairment in occupation functioning”.

        1. You may well be right that that’s not how it’s generally how its applied, but in that case the DSM editors would be advised to find a different set of words, because that’s certainly what it *says*. And while this may seem like a pernicketiness about usage, I find it a revealing one in relation to the discussion up-thread, about how mental illness can end up being defined by difference from the norm – and hence an inability to fit into normative restrictions.

          1. Reading the DSM-IV’s section on gender identity disorder leaves me with a completely different impression than the one you’re portraying. Perhaps it’s left up to interpretation. In the end, a happy life is the goal, and I don’t think that’s a more likely outcome if any attempt to standardize and provide comprehensive psychological and medical care is defeated.

      2. Given the way Ms. James framed this article, I don’t think pointing out inaccurate representations on her part misses the point.

        She saw fit to mention that CAMH was once called the Provincial Lunatic Asylum, she deemed it important to include a picture of an imposing looking Victorian asylum, she felt the need to point out that Clarke was once a believer in eugenics. If she felt it was important enough to include, why shouldn’t I point out that it is at best incomplete, and at worst deliberately misleading information?

        And with respect to Zucker’s research career, I don’t particularly wish to “persuade” anyone of anything. But if you want an indication of his reknown, look him up on PubMed. I said nothing about his therapeutic methods, I merely pointed out an incorrect statement on Ms. James’ part: she claimed that he held little interest for “experts” under 40. The number of MDs, PhDs, and MD-PhDs who apply to work with him suggests this is not the case.

  41. Toronto is also the home of CAPA – the Coalition Against Psychiatric Assault – a group of activists and psychiatric survivors who advocate against psychiatric oppression by the likes of CAMH, and especially against the widespread use of electroshock therapy (yes, it’s still being used widely, mostly against women and marginalized individuals).

    For those in Toronto, there is a major conference of academics, activists, and survivors happening May 7 and 8, 2010 at the Ontario Institute for Studies in Education at the University of Toronto. CAPA encourages people to register for the conference, to becoming active in organizing it, and to submit proposals for workshops or papers. To learn more, to submit a proposal, or to register, please click here. To join the organizing team, contact Dr. Bonnie Burstow.

    1. you say: “Toronto is also the home of CAPA – the Coalition Against Psychiatric Assault – a group of activists and psychiatric survivors who advocate against psychiatric oppression by the likes of CAMH, and especially against the widespread use of electroshock therapy (yes, it’s still being used widely, mostly against women and marginalized individuals). ”

      Electroshock therapy is mostly used BY (not AGAINST)severely depressed patients on a voluntary/request basis.
      It is not used AGAINST anyone.

      And CAPA have skeletons in their closet too, mostly because they are too single minded to see that sometimes psychiatric patients are too ill to make their own decisions (it’s not always “oppression”). Talk to the mother of a schizophrenic 22 yr-old who, with CAPA’s help, successfully fought to cease medication and leave the hospital. He was found dead behind a dumpster not too long after. Ask her about “oppression”

  42. Dear Ms James,

    This article is woefully misleading. First of all, CAMH is the result of the merging of four mental health and addiction facilities: The Queen Street Mental Health Centre, the Clarke Institute of Psychiatry, the Addiction Research Foundation, and the Donwood Institute. The fact that the former Queen Street Mental Health Centre was called the Provincial Lunatic Asylum when it opened in 1850 has absolutely no bearing on any of its current activities. Similarly, the fact that the former Clarke Institute of Psychiatry is named after CK Clarke, and CK Clarke was a proponent of eugenics approximately 150 years ago (the man died in the 1920s) is equally inflammatory, and equally irrelevant. Although, since you bring up his support of eugenics, why did you not also mention his advocacy against the use of confinement and restraints on the mentally ill? Is it because you feel only his unpalatable beliefs support your rhetoric? Your cherry picking of positions and practices from the 19th century and implied claim that they in any way speak to treatments and mandates practiced now is childish. Moreover, you have posted a picture of the Queen Street site (which, incidently is not where Zucker is based – he works out of the Clarke site) from 150 years ago. Are you even aware of what CAMH’s buildings look like now? Or that they are presently rennovating and updating their main site?

    Second, CAMH is far from a “powerhouse of eugenics”, in fact its mission statement is “Centred on Diversity”. CAMH has been designated a WHO “Centre of Excellence”, in part due to its policies on diversity. Moreover CAMH does not need to “stay in business” – it’s publicly funded because it is a hospital in a country with public health care. So the “generous provincial funding” is not actually, as you seem to believe, a tool of state oppression of the transgendered (or any other group).

    Third, I don’t know where you get the impression that Ken Zucker et al. are some sort of old guard of fossils, but contrary to your assertion that “most of these “experts” are middle aged or near retirement, and there don’t seem to be too many younger “experts” lining up to replace them”, Zucker is a highly regarded and well-reputed researcher. There are actually a lot of younger “experts” (graduate students, post-docs, residents) applying to work with him.

    You may disagree with the notion of gender identity disorder, the DSM, psychiatry in general. That is your right. But this grossly innacurate, shrill, hysterical portrayal of CAMH, and even more bizarrely the city of Toronto does your opinion no service whatsoever.

    1. Got you to leave a nice long comment about it though.
      Remember kids: rhetoric is our friend. We use it incite response and action. Andrea James has been successful in the first part, lets see if we can help her in the second.

  43. “Every time I come to this city, some guy picks me up at the bus station, takes me to a Leaf game, gets me pissed, then tries to blow me.”

  44. “being unable to go to work because you’re uncomfortable in the gender role to which you were assigned at birth WOULD qualify as “impairment in occupation functioning”.”

    But this is still putting the problem as being a disturbed mind rather than a physical disorder.

    If being trans and having the desire/need to transition is itself treated as a mental disorder, this implies that the ideal resolution would not be transition, but to ‘fix’ the mind so the person is no longer trans.

    This leads to ‘therapies’ exactly like those described above. The assumption is that if a gender atypical child grows up to transition this is a failed outcome, as the assumed mental disorder has not been eliminated.

    The same scenario you describe, could also be described as a physical condition compounded by social stigma. If one is unable to work because one’s physical state leads to everyone around you assuming you are a man (or a woman) and demanding that you live as such, when you aren’t.

    A cisgender man with gynocomastia or a cisgender woman with male pattern baldness would not be considered mentally ill for being distressed by these traits and by the social stigma associated with them, and wouldn’t have to be “diagnosed” as mentally ill to get medical treatment to fix it. They’re just physical problems, and treated as such.

    Why should we be classified differently? There’s nothing inherently disordered about having a male or a female mind. If one’s physical state makes it difficult to live and work as a man/woman, it’s a physical problem, not a mental one.

    1. I think the problem here is people approaching this situation from some sort of absolute, all-or-nothing position. The goal shouldn’t be encouraging someone to transition or not transition, but to do what they need to do to be happy and live a fulfilling life.

      So, you say it’s wrong to say that people who wish to transition have a mental disorder and instead have a physical disorder. Does that mean they’re deformed? Are all the people out there who are transgender and decide against hormones and surgery just deformed people with perfectly intact minds? Why is this the preferred situation? Why isn’t that offensive as well?

      Regarding your situation about a person’s physical problems causing them distress in their daily life, if that distress is debilitating, then it very may well be diagnosed and treated as a mental condition. It doesn’t mean they don’t have a physical problem, nor does it mean that they are crazy. It means they’re unable to cope with their situation and may need additional assistance to be able to adjust and live their life. This may result in them having medical treatment to fix the physical problem to their satisfaction, but it may not. It’s all up to them and what they want to do.

      I don’t think a seemingly gender variant child is successful if they transition, or successful if they don’t. I think they’re successful if they do what they need to do to be happy and live their life. I do not agree with parents attempting to force their child into any particular role, especially when it’s apparent the child does not want that role. I think that issue is entirely separate to those about whether or not gender identity disorder is, in fact, a disorder.

      Again, though, the disorder is disorder in one’s life and inability to live. And I think that in the case of the example of someone being assumed to be male because of their physical appearance leading to distress, it IS a problem THEY have to tackle. This means either coming to terms with their appearance, their gender dysphoria and learning to cope with the adversity they face, or transitioning and alleviating some of that adversity (though possibly facing other forms along the way). It doesn’t at all mean they’re mentally ill or crazy, it simply means this situation has turned into depression, anxiety, etc., and they will likely need help.

  45. I posted another comment that I think came through anonymously because my session expired. So, sorry about that if it makes things confusing!

  46. It’s ridiculous to state that sociobiology is simply “eugenic ideology.” But then, it’s ridiculous to think that Wikipedia is a reliable source of information.

  47. Read the tragic tale of Bruce-Brenda-David Reimer in a non-fictional book entitled As Nature Made Him: The Boy Who Was Raised As a Girl. Again another horrifying and true account of how twisted psychos end up in a position of authority and are allowed to play out their sick moral science projects on children and their confused and frightened parents.

    The ego of Dr. John Money is astonishing. And a heartbreaking end that does not appear in the book is that Bruce-Brenda-David Reimer committed suicide not two years after his twin brother died of a questionable drug overdose.

    So, Huzzah!! for likes of Dr. John Money and CAMH – clearly they are healing themselves and not their “patients”. I have to ask myself why it matters so much to these so called “Doctors” that there are members of society who differ from what they consider “phenotypically normal” – it’s a lot of judgement from a man who will not publicly discuss his own sexual preferences.

  48. Full disclaimer: I’m American, not Canadian, and have never had any interaction with CAMH.

    Having a handy little DSM diagnosis hasn’t done shit for me as a trans person. In fact, it may have made my life a whole lot harder (well, that and the SOC). Doctors are overly cautious about prescribing hormones for me, which is a problem because I’m not wealthy and have limited mobility. The doctors near me are the only doctors available, and when they refuse, I’m screwed. My insurance covers testosterone, but not for transsexual people, and it specifically bars coverage for SRS. The extra requirement that I get a letter is far beyond my means.

    So thank you, psycho-whatevers, for making rules for us and not listening when we tell you the rules don’t work. Your delightful legacy of patronization can fade into history books as far as I’m concerned.

    1. I’m just curious, but, do you feel patronized when a doctor tells you that you have something other than what you think you have? Do you feel that no doctor should ever be able to refuse you the medications and procedures you want? If so, do you feel we need doctors at all?

      I’d still maintain that the attack against the psychology community is rather misguided, especially as far as it concerns gatekeepers. Of course there will be gatekeepers from time to time, but they will exist in ANY system where one person has authority and you need something from them. The only way to eliminate this is medication and surgery on demand, and I know I feel that would provide for a grim outcome.

      There is nothing in the US that requires a doctor or surgeon to make sure you have a GID diagnosis, therapy letters, etc., before they prescribe things for you. They can give you whatever you want, provided you can convince them to do it, and that it won’t be a huge liability. I think education would better help in those situations, not abolishing diagnoses and diagnostic criteria.

  49. I kind of agree with letting kids wear the clothes they want and certainly with letting them use the colors they want to create art with. Although I’m a male who never wanted to be a female, my favorite color is pink! People like Zucker have a lot of nerve. On the other hand, I don’t know if prepubesents know enough to decide whether they’re trangender or not. It seems to me that it would be an individual’s adult decision to cut off their gentials and do hormone treatments. I support transgender people, and believe it’s a serious issue, but I just don’t think a little kid could possibly have enough information about himself to make such a decision. My natural inclination, although I’ll grant that maybe I’m being patronizing, is kids of a certain age should be more concerned with playing and having fun and getting their school work done, then whether they’re boys or girls. And their parents too.

    1. The idea that seems to be gaining traction nowadays is that young persons who feel they may be transsexual can take medications that block sex hormones and puberty. This can safely be done for several years to give them more time to grow and determine if it’s what they really want. Should they change their minds, the medication is ceased and puberty continues on normally.

      Also, trans people do not “cut off their genitals”, they have reconstructive surgery that restructures tissues to a more acceptable form. Some of those tissues are discarded, but most are preserved to form the new structures. It’s something that is pretty serious surgery, and not all transsexual people opt for the procedures, but they can greatly improve the quality of life when someone has significant dysphoria about their genitalia.

  50. alliebean, if you went to the doctor with a strange pain and were told “you need to see a psychiatrist, because you couldn’t possibly be having a pain there,” how would you feel?

    1. If I disagreed with them, I’d probably get a second opinion. If the second doctor said the same thing, I’d probably consider going to a psychiatrist to see what they had to say too, and would then go from there.

      There are people who have significant pain and other chronic disorders that have little or no way to physically diagnose. I don’t think this is a failing of the system, but rather, a symptom of our difficulty in dealing with things that are some what intangible.

      However, if upon going to the psychiatrist, there’s a disorder that’s criteria describes the strange pain I’m feeling and it proposes a treatment to remedy the problem, why is that a bad thing to explore? Is it better to have an ill-informed medical practitioner guessing and giving you drugs to see if your symptoms go away?

  51. To those who repeat the scaremongering manta “No taking of the corrupt psychiatrist’s shilling means no surgical treatment” – it just ain’t so, it is FUD concocted by wicked people like Kenneth zucker to divide and rule.

    1. In all the history of medicine, proven successful treatments are not abandoned merely because the theory behind the disease is debunked.

    2. Non-trans men with morbidly large breasts get surgery, there is no reason why transmen should not get the same treatment and on the same basis as non-trans men.

    3. What this requires is a simple recognition that scientific sex is not the same as medical sex. Scientific sex is sex which best fits existing understandings of biological science. Medical sex is sex which has a history of best promoting health. This is all because medicine is the art of healing, medicine is not the pseudoscience of abusive sex prurient peter meters.

  52. 4. And what it takes to get the recognition that “scientific sex is not the same thing as medical sex” is for transfolk to loudly and repeatedly ask for such recognition. That is really all it takes – people speaking up. Loudly and repeatedly.

  53. This is a very interesting thread — I was especially intrigued by CoAxial’s #17 question. A few people tried to answer, but i don’t think anyone truly succeeded. Fundamentally, BIID people and trans people share feelings that their physical bodies do not correspond with their mental body image.

    One twist on this that intrigued me (and probably relates to brain-body mapping) is the phenomenon of Phantom Limb Syndrome (PLS), where amputees continue to “feel” limbs that have been surgically removed. This effect has apparently been successfully treated with mirror boxes. On other sites, i’ve read that some trans people do experience varying degrees of PLS after surgery. this made me wonder whether mirror box or (more likely) full immersive virtual reality treatments have been tried by trans people as a treatment. If a trans person could experience themselves with the “correct” gender, I wonder if anything could be learned.

    A number of people here have stated that “Gender is a social construct”. We are often told that “gender is learned” or “gender is performed”. If this is so, then for trans people why was it not learned? Did “society” or “family” fail them do something wrong?

    Personally, i would agree that the “style” of gender is learned, but that at a deeper level, there must be a physiological mechanism that produces masculine and feminine gender. Perhaps the FOXL2 gene (shared by both male and female) has something to do with it;

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