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Zucker

Manipulation of Young Feminine Boys

Reprinted by kind permission, Curtis E. Hinkle, from Organisation Intersex International External Link
Article appeared in Polare magazine: July 2008 Last Update: October 2013 Last Reviewed: September 2015

Views expressed in this article are those of Curtis E. Hinkle and references to government action refer to the Canadian Government and not the Australian Government.

When examining the work of Kenneth J. Zucker, we find labels, statistics, and lies.

Older reports ... indicate that feminine behaving boys do not turn out to be transsexual, but largely turn out to be adult homosexual men.

Labels define and labels stick. But, what about statistics? Statistics lie so it is said. Or, is it that people lie? When examining the work of Kenneth J. Zucker, we find labels, statistics, and lies. Although many homosexuals have been described as being masculine in behaviour, an examination of their lives in childhood has found that many were "feminine" in behaviour. [1]

Reports of extreme boyhood "femininity" had also been thought to characterise male-to-female transsexualism. [2] In fact, there had been disagreement as to whether such extreme femininity dating back to age one or two was a representation of what would become "feminine" male homosexuality [3], or true transsexuality, known also as primary transsexualism or total psychosexual inversion. [4] Such extreme boyhood "femininity" had attracted the attention of clinicians and researchers for years. Richard Green of the U.C.L.A. Gender Identity Clinic saw them. Bernard Zuger saw them. Their descriptions were almost uniform. They were already stating they wanted to be girls or they were girls, often at the ages of two or three. They were cross-dressing. They were playing with girls exclusively or almost exclusively and were playing with girl's games exclusively or almost exclusively. Their behaviour was overt. It was very observable and it was obvious. So obvious that many would be brought in to a clinician for evaluation and treatment.

However, others [5] rarely ever saw these same boys later as adult men presenting at sex-change clinics as transsexuals and desiring sex reassignment surgery. Reports of this extreme "feminine" behaviour were conspicuously lacking in those presenting for S.R.S. The lack of such stories in adult sex-change applicants, led Chiland [5] to ask, "Is there such a thing as a transsexual child" (page 55). She had only seen two examples that would fit this description, although her group of adult transsexuals was over 200. Lothstein (see p.c. in ref. 5) had reported three in 1988 and two examples in 1992, and had worked with over 600 transsexuals. Fisk, who coined the term "gender dysphoria", saw a wide representation of clinical histories amongst his group's applicants for sex-change. [6]

If these applicants who were adults seeking sex reassignment did not report extreme feminine behaviour on any consistent basis (when such reports would have most likely impressed the "gatekeepers" and helped convince them of the obviousness of their femininity), then what label could adequately describe the majority of the children who did report extreme feminine behaviour and if such reports were not substantiated by observations from others close to them as children, would such a label stick when they presented for sex reassignment?

We do get some ideas as to what these individuals were like as children. Chiland [5] described the situation as follows:

The disorders that may lead to transsexualism in adults may thus be perfectly silent in childhood as far as an observer, parents, or teachers are concerned ... the child has no clear idea why he feels bad, and will only give his trouble a name on reaching puberty.

This is far from statements that the child wants to be a girl, or says he is a girl. Chiland [5] writes further:

An outside observer may notice that something is wrong with the child, but they cannot imagine, any more than the subject himself, that the child is suffering from a disorder of gender identity.

Again, this is far from what would be seen in the other boys described as already cross-dressing at the age of two or three, who were playing exclusively or almost exclusively girls' games and with girls. The following is more typical of the childhood of those who present at sex-change clinics:

... we see an isolated boy who is ill at ease, does not make friends, and does quite badly at school. But the child has no clear idea why he feels bad, and will only give his trouble a name on reaching puberty. [5]

Furthermore, these adult S.R.S. candidates in adulthood, usually did not show "signs of trouble with their gender identity in childhood that might have attracted attention ... very few were taken to clinics" and; "still fewer were treated". [5] Remarkably, "some were treated in childhood or early adolescence, with whom the question of gender identity never arose either in evaluation or in treatment; they were referred and treated for other reasons." [5] When they thought their therapist would be more intuitive and the therapist wasn't, "they became more and more silent and eventually refused to continue the treatment". [5]

Another group [7], when evaluating adult transsexuals, also found that those without extreme "femininity" in boyhood represented a group which had gender identity as the main motivation for seeking sex reassignment and re-labelled these individuals primary transsexuals. They were typically asexual and did not display homosexual behaviour nor, as mentioned, were they extremely feminine acting in childhood. They write:

In our series of ten primary transsexuals, nine showed no evidence of effeminacy in childhood ... As far as we can make out, they did not engage in girl's activities or play with girls any more than did normal boys ... All ten of our primary transsexuals were socially withdrawn and spent most of their time after school by themselves at home ... In effect, they were childhood loners ... [7]

They further write:

to summarise then, in childhood, the primary transsexual is not effeminate, but he feels either abhorrence or discomfort in boyish activities." [7]

If boys with extreme feminine behaviour in childhood are not the primary transsexuals, then who are these boys studied by Green [8], Zuger [9], and others? If their behaviour is so effeminate in childhood, yet they do not typically request sex-change, what happens to them? It is in the follow-up studies, such as those by Green [8] and Zuger [9], which give us the answer. Green [8] studied forty-four very effeminate boys from childhood into adulthood and found that three quarters of them became homosexual (N=18) or bisexual men (N=14).

Around a quarter of them became heterosexual.

Only 1 out of 44 was stated by Green to be transsexual, and Chiland (page 127) notes:

I felt that Green was pushing him further in transsexualism than the subject himself was going." [5]

The subject was later reported to have said: "I don't feel like a woman. I want to feel like a woman." [5].

What have others found? Have they also found that these extremely feminine boys did not become transsexual, but instead became largely effeminate homosexual adult men? Indeed they have. Zuger [9] studied 55 boys, figures of which could only be accurately obtained for 45 of them in adulthood. Between 35 - 45 boys (77.77%) had a homosexual or bisexual orientation (nearly identical to Greens' findings), three boys were heterosexual, and seven boys (15.55%) were of uncertain outcome. Of the homosexually oriented boys (N=45), only one was deemed transsexual. Thus, Zuger concluded that effeminate behaviour in childhood is the first stage of homosexuality. (page 63 in ref. 5).

When comparing Green [8] and Zuger's [9] findings, the probability that feminine acting boys will become transsexual is only between two to three percent. Cohen-Kettenis [10] reported on follow-up of 74 children who were claimed to have gender identity problems and found that a higher percentage (23 percent) had applied for sex reassignment. However, her study did not state the sex of the child. Older reports by several other authors also indicate that feminine behaving boys do not turn out to be transsexual, but largely turn out to be adult homosexual men [11, 12, 13].

What all of these findings point out is that feminine or effeminate type behaviour in childhood represents behaviour - gender role behaviour and a higher incidence of homosexuality as the outcome. Indeed, feminine behaviour in boyhood does not identify transsexualism or gender identity per se. Gender identity may be defined as "the merging of the concept of gender with the intra-psychic concept of identity" (page 120 in ref.14). Thus, what is observed in these feminine behaving boys, is their gender role. Identity as a construct is a self-image, a sense of belonging to, an intrapsychic self-concept, which can't be labelled by just observing and categorising behaviour. It may only be inferred. It may be inferred from an interpretation of another's behaviour, or from the evaluation of another's self-report. Each is fraught with its own difficulties. First, behaviour need not be in accord with one's sense of self, emotions, or thoughts. Secondly, self-reports need to be believed by others, if one is to claim to be able to accurately gauge them.

In feminine behaving boys, the role behaviour is clearly feminine to some, although it may be argued that typical young girls do not behave as such, and thus that these boys' behaviour is a caricature (i.e., effeminate and not feminine). That they grow up not to think of themselves as women, and not desire sex reassignment, but instead identify as gay men, indicates that although their gender role behaviour may be feminine, and that although their sexual orientation may be pre-homosexual, that their gender identity, is in fact male.

We may observe their role behaviour, (whether it be cross-dressing, attempt at penile removal, a gait, or aggression) and can only infer about its relationship to their identity. And, while we can listen to their self-reports that they are girls, or want to be girls; we do not know what they mean when they say that they are girls or want to be girls. We can only, in error claim that they have a gender identity disorder, when in fact, upon maturity, we see that it is not their gender identity which is affected. Conversely, for the other boys, those who do not behave in a feminine way in childhood, but are timid, withdrawn or shy, and who do not self-report that they think of themselves as girls, again, we can only errantly state that they do not have a gender identity disorder, since they struggle and hide silently, and that on maturity we realise their struggles when they appear at sex-change clinics.

We have no way to state that they have a gender identity disorder of childhood. It is because of these factors, that we can state that the diagnosis of gender identity of childhood in the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.) is fallacious. It is the misrepresentation by so-called professionals of some very basic tenets of human understanding. When G.I.D. of childhood was placed in the D.S.M. in 1980 [15] and in the D.S.M. - R. in 1987 [16], the outcome of extreme boyhood femininity was not well known. (Green's work [8] and Zuger's [9] work were in progress). Thus, these professionals' misrepresentation of these boys may be justified. However, with subsequent revisions of G.I.D. in childhood diagnoses, as found in the 1994 updated D.S.M. IV [17] and the 2000 updated D.S.M.IV T.R. [18], we still find that boys who are largely pre-homosexual and who have gender role behaviour which is highly unusual are mis-labelled as having a gender identity disorder, despite no evidence to support that gender identity per se as involved and despite evidence to the contrary.

We also see that maintaining this erroneous classification has a unifying thread and that those who are the most vocal representatives defending this erroneous classification work for the Canadian government, specifically the Province of Ontario - in particular, Kenneth J. Zucker who was on the 1994 sub-committee (with his colleague from Canada, Susan J. Bradley) and was one of only four on the 2002 sub-committee, and who is currently slated as being head of the current sub-committee for D.S.M. V.. [19]

When we examine the work of Zucker [20], we find, that he knows well that gender identity disorder of childhood represents largely a pre-homosexual clinical picture, that it does not fit in with what he and his colleagues refer to as gender identity, that it instead relates to what his colleagues know to be sexual orientation and gender role behaviour, and that it thus pathologises sexual orientation and gender role behaviour. But we also find that it also serves more primary goals. It only pathologises children who fit this category until they become adults and then they do not have a disorder anymore, due to homosexuality being removed from the D.S.M. in 1973. But to have a category of pre-homosexual boys remain in the D.S.M., under the mis-label of G.I.D., Zucker and his colleagues can make it look as if G.I.D. of adulthood is highly inflated due to the logical expectation that a G.I.D. of childhood will become a G.I.D. of adulthood.

In fact, Zucker's colleague Bailey [21] states: "Zucker thinks that an important goal of treatment is to help the children accept their birth sex and to avoid becoming transsexual. His experience has convinced him that if a boy with G.I.D. becomes an adolescent with G.I.D., the chances that he will become an adult with G.I.D. and seek a sex-change are much higher. And he thinks the kind of therapy he practises helps reduce this risk." (page 30). (It was under Zucker's colleague Susan J. Bradley, that in 1994, transsexualism was omitted from the D.S.M. IV and replaced by G.I.D. of adulthood) [17].

Since as we have discussed, transsexualism cannot be identified in childhood, it's abusive that this change of transsexualism in adulthood to G.I.D. of adulthood uses homosexual boys to pathologise adult transsexuals. Since it uses G.I.D. of childhood which is not about gender identity, one could be led to believe that transsexuality or even intersex (under gender identity disorder not otherwise specified) is also not about gender identity.

In fact, that is what Zucker's colleagues Ray Blanchard [22] and J Michael Bailey [21] are proposing. In all of their research, as well as the contention by Zucker [20] that gender identity is malleable, there have been no studies which have sought to correlate the effects of hormones on gender identity with the known times of differentiation of sexually dimorphic human brain nuclei or regions, or the exploration that transsexuality is the result of neural growth factors which render the brain even "more female or more male" than is found in typical males and females. These are major limitations of the interpretation of the findings of Zucker's [20, 23] as well as other research involving atypical sexual development [24].

In regard to G.I.D. of childhood not being about gender identity, for Zucker, this classification creates additional problems. Although the "inexperienced clinician" may easily be lead to believe that G.I.D. of childhood is about gender identity, and that it does progress to a G.I.D. of adulthood, every time Zucker gives a diagnosis of G.I.D. of childhood on a claim form to the Ontario Government, we should be suspicious.

We know that he knows that it is largely pre-homosexuality which he is diagnosing, despite the fact that homosexuality is not considered a mental disease. We know that he knows that adolescent transsexuals which he diagnoses as having G.I.D. are likely the same - pre-homosexuals.

That would be an incredible amount of billing for diagnoses which he knows fits on paper (to him and his colleagues' D.S.M. efforts), but does not fit in with actual results because they are homosexuals. Thus, we have misdiagnosis in theory, but he is able to bill the taxpayers, because most won't think that G.I.D. is not about G.I.D.. But, that is only the beginning of the problem for Zucker. As his colleagues are quick to say, the D.S.M. diagnosis, does not in and of itself suggest particular types of treatments. This is a red herring because Zucker has his own treatment and can suggest the same treatment to others.

Zucker further knows himself that extremely feminine boys usually turn out to be adult gay men and not transsexual. Zucker [20] writes on page 562:

Follow-up studies of boys who have G.I.D. that largely is untreated, indicated that homosexuality is the most common long-term psychosexual outcome.

The key word in Zucker's statement here is the word "untreated". Zucker acknowledges that G.I.D. boys most commonly turn out to be homosexual adult men, not adult transsexuals. This is in striking contrast to his recent documentary statement that "when one engages in psychotherapy" with children and adolescents with gender dysphoria that one may find that many give up the wish for a sex-change and come to an alternative to the "only way I can feel good about myself is with a sex-change." [25]. It also contradicts his colleague's description of Zucker's view that, "Zucker thinks that an important goal of treatment is to help the children accept their birth sex and to avoid becoming transsexual". [21]

With this statement, Zucker's colleague, J Michael Bailey, exposes Zucker's "treatment" as fraudulent, since we have already seen that Zucker knows that most of these boys don't become transsexual, but instead become non-transsexual adult homosexual men. Thus without Zucker's "treatment", they mainly become gay men anyway; and thus, Zucker has no proof of his own fraudulent claims. We are not surprised then, that Bailey again exposes Zucker's "transsexual prevention" treatment of G.I.D. boys as fraudulent and baseless, by this following comment, "Zucker believes that most boys who play with girls' things often enough to earn a diagnosis of G.I.D. would become girls if they could. Failure to intervene increases the chances of transsexualism in adulthood, which Zucker considers a bad outcome. Zucker is the first to acknowledge that no scientific studies currently support the effectiveness of what he does." [21]

We strongly recommend, in the interest of the protection of Canadian taxpayers and the health of Canadian citizens, that investigation into Zucker's and his colleagues' grant applications be carefully evaluated for fraud, that is, to see if Zucker has indeed suggested in grant applications, that any type of treatment he is employing, or requested grant money for, is in fact having an effect on the gender identity outcome of G.I.D. boys.

This is from the research side of things. From direct clinical services, we also suggest, that the Canadian Government, carefully review all claim forms for monetary coverage of children with G.I.D. and related issues whom Zucker has treated, along with those who have co-treated them, in order to see if their G.I.D. diagnosis coexists with services billed to the government for treatment which Zucker has already indicated is non-scientific and which is not substantiated. Such would be a violation and abuse of such childhood victims as well as fraudulent use of health care dollars, since it is reasonable to expect amongst healthcare systems that a treatment for a condition is indeed meritorious and not fraudulent.

The diagnostic manual (D.S.M.) does not suggest treatment. It is only for diagnostic purposes. Zucker's colleagues are well aware of this, but, any treatment thus taken, must have demonstrated its efficacy, and further must indicate whether it is experimental, along with risks to the patient (in this case the patient's parents). Moreover, even if it were found that Zucker has declared the treatments to be experimental, and even if all risks were carefully spelled out to the parents of the children, it would also follow that evidence which is contrary, such as presented here, would need to be told to the parents as well. To not do this, would be to violate certification/licensure regulations and to engage in practice which is unethical and detrimental.

Now that we have shown that Zucker's treatment in fact does not largely prevent adult transsexuality and that Zucker knows that there is no scientific proof for what he does, and that he knows that the vast majority of boys with G.I.D. will develop into homosexual men, we will take four further examinations.

  1. Does Zucker's treatment or therapy have an effect on the sexual orientation outcome of boys with G.I.D. (does it help prevent or cure homosexuality)?
  2. Does the replacement of adult transsexuality with adult G.I.D. and addition of G.I.D. N.O.S. into the D.S.M. IV in 1994 [17], under the direction of C.A.M.H. clinician (and Zucker colleague) Susan J. Bradley, use this replacement term of G.I.D. and its association with pre-homosexual boys, to pathologise adults with transsexuality and intersexed persons? (Note: pre-homosexual boys are removed from pathology categorisation when they become eighteen, due to homosexuality being removed from the D.S.M. in 1973. (Adult transsexuals and intersexed persons with G.I.D. / G.I.D. N.O.S., are pathologised well into adulthood).
  3. No matter what clinical entity boys with childhood G.I.D. represent, is Zucker fudging his data, manipulating statistics, to include more boys in the G.I.D. of childhood category, thus fraudulently inflating its numbers?
  4. If Zucker and colleague Blanchard are studying homosexuality, what happens should they try to remove gender identity as a disorder, and do they even believe in gender identity?

Now that we have seen that there really is no solid scientific evidence that Zucker is preventing transsexualism by treating G.I.D. boys, the next question is, does Zucker's therapy prevent or change homosexual orientation in these boys?

By Zucker's own admission, as we have seen, the majority of untreated G.I.D. boys become adult homosexual men. In Green's [8] study the majority of boys treated became homosexual or bisexual irrespective of whether they were treated or not. Surprisingly, Zucker states that clinical experience (sic) "suggests that psychosocial treatments can be effective in reducing gender dysphoria". [20] Zucker further states, "in considering these various therapeutic approaches, one important ring fact should be contemplated. With the exception of a series of intra subject behaviour therapy case reports from the 1970s, no randomised controlled treatment can be found in the literature". [20] His only reference to these studies of the 1970s is a publication by him and his colleague, Susan J. Bradley. [26]

However, when we look at behavioural treatments from the 1970s for very feminine type boys, we find reports by Rekers. [27, 28] Perhaps Zucker did not wish to cite these directly, as Rekers' treatments seemed to be harmful and to be largely ineffectual. Zucker doesn't define gender dysphoria, although others indicate that gender dysphoria is related more to gender identity/role than it is to sexual orientation. But, it does not necessarily mean transsexualism. Thus we can't know what Zucker means precisely when he speaks here of gender dysphoria. Certainly gender role behaviour may also be interpreted as part of gender dysphoria. Zucker mentions only one follow-up study of one boy at a one year follow-up (which did not make random assignment to different treatment protocols), in which a child was claimed to have had behavioural change. [20] But behaviour is not synonymous with sexual orientation, and again, Zucker made no direct references to the shortcoming of the treatment by Rekers.

For a discussion of one of Rekers failed attempts at turning a G.I.D. boy into a heterosexual, see Zucker's colleague, J Michael Bailey's account, on pages 24-26 in his book. [21] But, more importantly, Zucker's colleague Bailey, again exposes Zucker's belief, that in fact Zucker believes that adult homosexuality in men cannot be prevented or treated by therapy or treatment of G.I.D. boys. Bailey demonstrates this as follows about his colleague (page 29 in (page 29 in ref. 21):

"Zucker thinks that kids with G.I.D. need to be treated with psychotherapy, and that their families do as well ... but Zucker also disagrees with the right's emphasis on preventing homosexuality. Zucker does not consider this an important clinical goal, because he thinks that homosexual people can be as happy as heterosexual people, and regardless, he doubts that therapy to prevent homosexuality works."

Thus, here we have it:

  1. Zucker's therapy is not preventing child transsexuality.
  2. Zucker's treatment is not curing child transsexuality.
  3. It is said by his colleague, that Zucker does not believe that his own treatment prevents homosexuality either, and that it is not even an important goal to do so. [21]

In regard to treating "homosexual" or "pre-homosexual" G.I.D. boys, Zucker nonetheless states the following:

Others have asserted - without direct empiric documentation - that treatment of G.I.D. results in harm to children who are "homosexual" or "pre-homosexual". (pages 562-563 in ref. 20)

Again, we have another attempt at conniving by Zucker. In order to accumulate empiric documentation of the efficacy of such treatments for homosexual or pre-homosexual conditions in G.I.D. boys, one needs to secure grants or acquire funding for treating homosexuality or sexual orientation. But, one cannot do this readily, since homosexuality is not considered a disorder, and has been removed from such in 1973 by the very Association (American Psychiatric Association) which Zucker is now slated to lead as gender identity disorder subcommittee chair. One can only reasonably expect to study the effect of treatment of pre-homosexuality or homosexuality in boys, by calling it another name; in other words by changing the label and claim that G.I.D. in childhood is not about sexual orientation/pre-homosexuality (although we have seen that it is), but falsely claim, as does Zucker, that it is about gender identity. Only when Zucker can pretend to be treating gender identity, by using terminology such as gender identity disorder (G.I.D.) of childhood, can he secure funding for research and more - to treat children for sexual orientation (pre-homosexuality). If he called it what it usually is in fact (but not on paper), that is, gender role and pre-homosexual disorder of childhood, it is likely, that he wouldn't be able to deceive the public so easily. On this score, it is interesting, that adult transsexuality as a diagnosis was omitted from the D.S.M. IV when Zucker's colleague - also at C.A.M.H., Susan J Bradley, was in charge of this committee. [17] Removing adult transsexuality is a clever way to deceive people and bilk them for their money, when it is relabelled as G.I.D. of adulthood, since the less experienced clinician may think that a childhood G.I.D. has a lot in common with an adult G.I.D.. Childhood transsexuals largely are not seen (see above) clinically and usually keep their secret hidden and suffer in silence.

They typically didn't get a diagnosis of transsexuality per se, until well after childhood. So, when C.A.M.H. member Susan J. Bradley as chair of the D.S.M. IV gender identity sub-committee succeeded in removing adult transsexuality as a diagnosis in 1994 [17], the replacement with G.I.D. (adulthood) terminology consistently served to pathologise children, adolescents, and adults, all under the same label, despite their being separate clinical entities.

As a result, pre-homosexual children/adolescents could be pathologised until adulthood, by falsely suggesting their condition was one of gender identity, only to be automatically disorder-free at eighteen (adult), when it was usually found (as was expected) that it was about the child's sexual orientation.

Since there was no way to identify child transsexuality (and no label of childhood transsexuality per se), which would be a true childhood gender identity "disorder", they would only be labelled transsexual per se, in adulthood, when it also found (as expected), that they did not have what is generally regarded as a childhood G.I.D..

Yet their numbers would falsely inflate the G.I.D. of childhood diagnosis to the less experienced clinician, since it would seem unlikely that a transsexual diagnosis would present or manifest only after childhood.

Thus, the pathologisation of sexual orientation and behaviour by Zucker, under the guise of gender identity (G.I.D. disorder of childhood), uses and abuses pre-homosexual boys for a more devious purpose - to pathologise adult transsexuals, and also adults with intersexed conditions who reject their assignment who are also said to have a gender identity disorder not otherwise specified (G.I.D. N.O.S.) in the presence of a physical intersex condition.

But even as G.I.D. of childhood is usually not about gender identity per se, and even if Zucker has no scientific evidence that he is preventing adult transsexualism, is there any evidence that even more people who should not be diagnosed as having childhood G.I.D., indeed are being diagnosed as such? Indeed, when we and others [29] examine Zucker's writings, we see him including further, without evidence, people who don't meet the diagnostic criteria for inclusion. [30] This suggests that Zucker is manipulating data, fabricating data, and engaging in fraudulent misrepresentation of data in the very publications with which he is receiving grant money to do.

When we examine further some of Zucker's research, we find that in fact, he manipulates data to inflate the numbers of boys who receive a diagnosis of G.I.D. of childhood. Again, we have heard that statistics lie. But we think it is not statistics per se which lie, but people who lie. What about Zucker? We suggest that the Canadian government review the following data manipulations by Zucker and decide for themselves.

We will just present the data here, as observed by another group of Zucker's peers from Canada. [29] (We do need to say, that one of the authors [29], Paul Vasey, is being investigated by O.I.I. as to whether he was asked by Zucker's colleague, J. Michael Bailey, to request Bailey's colleague, Alice Dreger, to write a "tabloid style journalism" article for the publication Archives of Sexual Behaviour, which is edited by Zucker to defend a controversial book written by Zucker's colleague, J. Michael Bailey.)

Bartlett et al. [29] brilliantly point out flagrant errors in data compilation and interpretation in Zucker's research. The fact that there are in fact five conflations of the data lead us to suggest that in fact, Zucker may be fudging his data to inflate the numbers of boys who are diagnosed as having a G.I.D. of childhood diagnosis. Consider the following:

"As outlined in the D.S.M. IV, for a diagnosis of G.I.D. in children, there must be a "strong and persistent cross-gender identification." In children, one manifestation of this "disturbance" is the individual's "repeatedly stated desire to be, or insistence that he or she is, the other sex."

To arrive at the conclusion that the majority (76.1 percent) of gender referred children, including those with a diagnosis of G.I.D., expressed cross-sex wishes, Zucker aggregated the categories "once-in-a-while" and "very rarely" together with "frequently/every day". A more ... diagnostically relevant interpretation of Zucker's (2000) Table 36.2 leads to the conclusion that the minority (23.4 percent) of the boys and girls in his sample expressed what could be considered "repeated" (i.e., "frequently/every day") cross-sex wishes indicative of "strong and persistent" cross-gender identification." Cross-sex wishes that are expressed once-in-a-while" or "very rarely" are, arguably, not indicative of "strong and persistent' cross-gender identification." [29]

Zucker cited Green (1987) to support his position/conclusion that expressing verbally a wish to be the other sex is consistent with Zucker's own data, but again, Zucker did this, "by combining disparate categories, in this case, "occasionally" and "frequently." The authors noted that it is doubtful, that "occasional" wishes and "frequent" wishes are "diagnostically equivalent." [29]

The authors further state that they are "intended to be conceptually distinct." [29]

Zucker inflated his (2000) data [30] as well as that of Green [8] to compare cross-sex wishes by combining boys who were only gender referred with those who were gender diagnosed, and by comparing these two clinical groups, with non-feminine boys or control children. [29]. Furthermore:

... such a comparison has limited relevance to a diagnosis of G.I.D. per se. That either clinical group expressed cross-sex wishes more than control children does not mean that they expressed such wishes to an extent that is of clinical or diagnostic significance." [29]

Zucker [30] also did not define what he meant by his categories "once-in-a-while" and "very rarely" in his data. Thus, there is no objectivity here. This is also confusing for the informant who provided him information "who may have subjective notions regarding the meaning of the categories "frequently", "once in a while", and "very rarely", based on their own experience and tolerance of cross gender/sex behaviours". [30]

In Zucker's work [30] he further combined the categories "frequently" and "every day", but when these categories were presented on the maternal rating scale that he used to gather his data, they were two separate categories. [30]

Finally, Zucker [30], alternately referred to children as "Gender Identity Disorder" group, in his table, but as gender referred in the text. Zucker [30] responded that not all of the children met complete D.S.M. IV criteria for G.I.D.. This of course, limits the value of making specific statements about those children who specifically have G.I.D. per se. Although Zucker stated "that if only the children who met the D.S.M. IV diagnostic criteria for G.I.D. were included in the analysis, the percentage expressing cross-sex wishes would have been higher. Unfortunately, he presented no data to support this statement." (see page 192 in ref. 29).

We have seen that Zucker has very sloppy usage of statistics and labels in this particular report of his. [30] We encourage others to find comparable examples which may exist in his work and suggest that Zucker has manipulated data. Even if not intentional, this does a great injustice to the samples with which he is studying and to the conclusions which he is drawing, as well as its influence on the clinical and research subjects with whom he is dealing, and also with the professionals who would be adversely affected in their understanding of his data, and in their attempt at dealing professionally with comparable issues.

We do suggest that the government inquire in to how so many errors/manipulations of Zucker's data could occur by Zucker, and if, in fact, it represents intentional "fudging" of data, and if so, what Zucker stands to benefit from this, and at whose expense. By conflating gender identity with pre-homosexuality, Zucker is able to victimise many populations. Transsexuals should be outraged that they should be misrepresented in clinical history and in treatment proposals. "Feminine" homosexuals should also be outraged in the use of one type ("feminine" homosexuality) of homosexuality to pathologise "non-feminine" homosexuals as well as themselves. Transsexual and intersexed groups should also be outraged, that pre-homosexuality further pathologises them by extending a childhood diagnosis (G.I.D. of childhood) to include adults (G.I.D. of adulthood) or intersexed persons (G.I.D. N.O.S.).

All others should be outraged at the role of Zucker in oppressing these groups, with its psycho-emotional toll and with doing this at the expense of the Ontario taxpayers and the Provincial Government.

References

  • [1] Bieber, I. et al. Homosexuality: A Psychoanalytic Study of Male Homosexuals. Basic Books, New York, 1962.
  • [2] Stoller, R.J. Sex & Gender. Science House, New York, 1968.
  • [3] Socarides, C.W.. Beyond Sexual Freedom. New York Times/Quadrangle Books, 1975.
  • [4] Pauly, I.B. Male psychosexual inversion: transsexualism: a review of 100 cases. Arch. General Psychiatry 1965, 13:172-181.
  • [5] Chiland, C. Transsexualism: Illusion and Reality. Wesleyan University Press, 2003.
  • [6] Fisk, N.M. Editorial: Gender dysphoria syndrome - the conceptualization that liberalizes indications for total gender reorientation and implies a broadly based multidimensional rehabilitative regimen. Western J. Medicine 1974, 120:386-391.
  • [7] Person , E. & Ovesey, L. The Transsexual Syndrome in Males I. Primary Transsexualism. American J. Psychotherapy 1974, 28:4-20.
  • [8] Green, R. The "sissy boy syndrome" and the development of homosexuality. New Haven (CT.): Yale University Press, 1987
  • [9] Zuger, B. Early effeminate behaviour in boys: Outcome and significance for homosexuality. J. Nervous Mental Disorders. 1984, 172:90-97.
  • [10] Cohen-Kettenis, P.T. Gender identity disorder in D.S.M.? (letter). J. American Academy Child Adolescent Psychiatry 2001, 40:391
  • [11] Bakwin, H. Deviant gender role behaviour in children: relation to homosexuality. paediatrics 1968, 41:620-629.
  • [12] Liebovitz, P.S. Feminine behaviour in boys: aspects of its outcome. American J. Psychiatry 1972, 128:1283-1289.
  • [13] Davenport, C.W. A follow-up study of 10 feminine boys. Archives Sexual behaviour 1986, 15:511-517.
  • [14] Money, J. Sin, Science, and the Sex Police. Prometheus Books, Amherst, New York, 1998.
  • [15] Diagnostic and Statistical Manual of Mental Disorders, (3rd edition), American Psychiatric Association, Washington, D.C.
  • [16] Diagnostic and Statistical Manual of Mental Disorders, (3rd edition-revised), American Psychiatric Association, Washington, D.C.
  • [17] Diagnostic and Statistical Manual of Mental Disorders,(4th edition), American Psychiatric Association, Washington, D.C.
  • [18] Diagnostic and Statistical Manual of Mental Disorders, (4th edition-Text Revision), American Psychiatric Association, Washington, D.C.
  • [19] Diagnostic and Statistical Manual of Mental Disorders, (5th edition-forthcoming), Washington, D.C.
  • [20] Zucker, K.J. Gender identity development and issues. Child Adolescent Psychiatric Clinics North America 2004, 13:551-568.
  • [21] Bailey, J.M. The Man Who Would Be Queen: The Science of Gender Bending and Transsexualism. Joseph Henry Press, Washington, D.C., 2003.
  • [22] Blanchard, R. Deconstructing the Feminine Essence Narrative. Archives of Sexual behaviour 2008, (in press).
  • [23] Bradley, S., et al. Experiment of nurture: Ablatio penis at two months, sex reassignment at seven months, and a psychosexual follow-up in young adulthood. paediatrics 1998, 102:E91 External Link
  • [24] (For review of psychosexual outcomes in various intersex conditions, see Archives of Sexual behaviour 2005, 34, August.)
  • [25] Trapped. Discovery Health Documentary, 2004 Public Broadcasting Service, U.S.A.
  • [26] Zucker, K.J. & Bradley, S.J. Gender identity disorder and psychosexual problems in children and adolescents. New York, Guilford, 1995.
  • [27] Rekers, G.A. Sex-role behaviour change: intra subject studies of boyhood gender disturbance. J Psychology 1979, 103:255-269.
  • [28] Rekers, G.A., et al. Assessment of childhood gender behavioural change. J. Child Psychology and Psychiatry 1977, 18:53-65.
  • [29] Bartlett, N.H., et al. Cross-Sex Wishes and Gender Identity Disorder in Children: A Reply to Zucker (2002). Sex Roles 2003, 49:191-192.
  • [30] Zucker, K.J. Gender identity disorder. In A. Sameroff, M. Lewis, & S.M. Miller (Eds.), Handbook of developmental psychopathology (2nd Ed.), pages 671-686), New York: Kluwer Academic / Plenum Publishers, 2000.
  • [31] Zucker, K.J. A factual correction to Bartlett, Vasey, and Bukowski's (2000) "Is gender identity disorder in children a mental disorder?" Sex Roles 46:263-264.

Polare Magazine is published quarterly in Australia by The Gender Centre Inc. which is funded by the Department of Family & Community Services under the S.A.A.P. program and supported by the N.S.W. Health Department through the AIDS and Infectious Diseases Branch. Polare provides a forum for discussion and debate on gender issues. Unsolicited contributions are welcome, the editor reserves the right to edit such contributions without notification. Any submission which appears in Polare may be published on our internet site. Opinions expressed in this publication do not necessarily reflect those of the Editor, The Gender Centre Inc., the Department of Family & Community Services or the N.S.W. Department of Health.

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