Zucker study:A Follow-Up Study of Boys With Gender Identity Disorder

[ItsAllGoingToBeFine]

www.frontiersin.org/articles/10.3389/fpsyt.2021.632784/full (open access)

Abstract:

This study reports follow-up data on the largest sample to date of boys clinic-referred for gender dysphoria (n = 139) with regard to gender identity and sexual orientation. In childhood, the boys were assessed at a mean age of 7.49 years (range, 3.33–12.99) at a mean year of 1989 and followed-up at a mean age of 20.58 years (range, 13.07–39.15) at a mean year of 2002. In childhood, 88 (63.3%) of the boys met the DSM-III, III-R, or IV criteria for gender identity disorder; the remaining 51 (36.7%) boys were subthreshold for the criteria. At follow-up, gender identity/dysphoria was assessed via multiple methods and the participants were classified as either persisters or desisters. Sexual orientation was ascertained for both fantasy and behavior and then dichotomized as either biphilic/androphilic or gynephilic. Of the 139 participants, 17 (12.2%) were classified as persisters and the remaining 122 (87.8%) were classified as desisters. Data on sexual orientation in fantasy were available for 129 participants: 82 (63.6%) were classified as biphilic/androphilic, 43 (33.3%) were classified as gynephilic, and 4 (3.1%) reported no sexual fantasies. For sexual orientation in behavior, data were available for 108 participants: 51 (47.2%) were classified as biphilic/androphilic, 29 (26.9%) were classified as gynephilic, and 28 (25.9%) reported no sexual behaviors. Multinomial logistic regression examined predictors of outcome for the biphilic/androphilic persisters and the gynephilic desisters, with the biphilic/androphilic desisters as the reference group. Compared to the reference group, the biphilic/androphilic persisters tended to be older at the time of the assessment in childhood, were from a lower social class background, and, on a dimensional composite of sex-typed behavior in childhood were more gender-variant. The biphilic/androphilic desisters were more gender-variant compared to the gynephilic desisters. Boys clinic-referred for gender identity concerns in childhood had a high rate of desistance and a high rate of a biphilic/androphilic sexual orientation. The implications of the data for current models of care for the treatment of gender dysphoria in children are discussed.

[PaleBlueMoonlight]

There are a few good long form interviews with Zucker, where he deals with the criticisms of his work.

Here is one:

m.youtube.com/watch?v=tvHxylXOVKg

[PaleBlueMoonlight]

And when I say criticisms, I mean attempts to destroy him.

[FightingTheFoo]

@PaleBlueMoonlight

Isn’t the point though that there aren’t inbuilt differences - the very existence of gender non-confirming behaviour and personalities shows that. So while there may be typical behaviours/personalities and ones that are more common in one sex than another (which may well be broadly based in nature differences connected with different sex roles - nurturing, impregnating) , there will still be people who have the typical characteristics of the opposite sex. In other words, it can be helpful for the purposes of class analysis, but it doesn’t work on the level of the individual.

It is also know that brains are not sexed - is there are no significant differences in things such as spatial awareness etc.

Is that to me? Either way I completely agree re there not being inbuilt sex differences.

One area the article I posted gets extremely muddled is in talking about inherent sex/gender differences (it uses the two words interchangeably so v difficult to work out what she's actually saying) and also including some pseudo sciences about "female brains" (long discredited).

I obviously wholeheartedly disagree with what happened with Zucker in Canada btw and his payout was clearly a vindication. Thanks for posting the link to that interview btw, will definitely give it a watch.

[FightingTheFoo]

*disagree with how Zucker was forced out etc just to be clear

[SmokedDuck]

Anytime I've read Zucker he's quite clear that toys etc aren't inherently gendered. Where he's asked parents to take away some toys or clothing or steer them away it's because the child is being unbalanced/obsessional towards items that the child perceives as being only for one sex.

The problem isn't that the items are wrong it's that the child has developed a really strong identification with toys perceived as being for the other sex. The goal is to encourage a more balanced approach from the child toward the items, and also possibly being more flexible in how they will play with other children who may not share the focus on one type of play.

[FightingTheFoo]

@SmokedDuck

Anytime I've read Zucker he's quite clear that toys etc aren't inherently gendered. Where he's asked parents to take away some toys or clothing or steer them away it's because the child is being unbalanced/obsessional towards items that the child perceives as being only for one sex.

The problem isn't that the items are wrong it's that the child has developed a really strong identification with toys perceived as being for the other sex. The goal is to encourage a more balanced approach from the child toward the items, and also possibly being more flexible in how they will play with other children who may not share the focus on one type of play.

Interesting - that makes more sense. An obsession with any one thing isn't great, especially for young kids.

I actually realized I'd already watched the Zucker video before and certainly don't recall hearing anything at the time that seemed particularly alarming.

[SmokedDuck]

@PaleBlueMoonlight

Isn’t the point though that there aren’t inbuilt differences - the very existence of gender non-confirming behaviour and personalities shows that. So while there may be typical behaviours/personalities and ones that are more common in one sex than another (which may well be broadly based in nature differences connected with different sex roles - nurturing, impregnating) , there will still be people who have the typical characteristics of the opposite sex. In other words, it can be helpful for the purposes of class analysis, but it doesn’t work on the level of the individual.

It is also know that brains are not sexed - is there are no significant differences in things such as spatial awareness etc.

No, I don't think you can say that the fact that there are GHC behaviours shows that on a population level there are not biologically based behavioural differences between men and women.

Any more than you could say the existence of very tall women and very short men shows there is no biologically based height difference on a population level between men and women.

[PaleBlueMoonlight]

I agree with you, I think there almost certainly are biologically based behavioural differences between men and women as a class (though very very difficult to unpick nature from nurture), but these are at class level and say nothing about an individual.

[PaleBlueMoonlight]

In other words, you can identify traits/behaviours that are typical of one sex or the other (to a greater or lesser extent) but there will always be people of that sex who do not share that trait/behaviour.

[SmokedDuck]

Yes, I think that is true.

It's an important distinction though, some people tend to want to deny or underplay the class element but it potentially has some important effects when you are looking at data sets.

[OldCrone]

@SmokedDuck

Anytime I've read Zucker he's quite clear that toys etc aren't inherently gendered. Where he's asked parents to take away some toys or clothing or steer them away it's because the child is being unbalanced/obsessional towards items that the child perceives as being only for one sex.

The problem isn't that the items are wrong it's that the child has developed a really strong identification with toys perceived as being for the other sex. The goal is to encourage a more balanced approach from the child toward the items, and also possibly being more flexible in how they will play with other children who may not share the focus on one type of play.

In this paper (from 2012), there doesn't seem to be a focus on taking away opposite sex toys and clothes, quite the opposite.
www.researchgate.net/profile/Kenneth-Zucker/publication/223135175_A_Developmental_Biopsychosocial_Model_for_the_Treatment_of_Children_with_Gender_Identity_Disorder/links/56c39b7008ae8a6fab5a1885/A-Developmental-Biopsychosocial-Model-for-the-Treatment-of-Children-with-Gender-Identity-Disorder.pdf

In general, our approach with parents is to make the point that the surface behaviors of GID are, in effect, “symptoms” and that symptoms can best be helped if the underlying mechanisms are better understood. As an example, we might explain to parents of girls that forcing them to wear dresses or other feminine clothing (which creates severe anxiety in many girls with GID) should not be the focus of treatment and that it would likely be unhelpful. Instead, it would be more helpful to focus on the underlying gender dysphoria.

But the Atlantic article from 2008 suggests that he is really keen on children conforming to stereotypes:

Zucker put me in touch with two of his success stories, a boy and a girl, now both living in the suburbs of Toronto.
...
When he was 4, the boy, John, had tested at the top of the gender-dysphoria scale. Zucker recalls him as “one of the most anxious kids I ever saw.” He had bins full of Barbies and Disney princess movies, and he dressed in homemade costumes. Once, at a hardware store, he stared up at the glittery chandeliers and wept, “I don’t want to be a daddy! I want to be a mommy!”
...
When they reversed course, they dedicated themselves to the project with a thoroughness most parents would find exhausting and off-putting. They boxed up all of John’s girl-toys and videos and replaced them with neutral ones. Whenever John cried for his girl-toys, they would ask him, “Do you think playing with those would make you feel better about being a boy?” and then would distract him with an offer to ride bikes or take a walk. They turned their house into a 1950s kitchen-sink drama, intended to inculcate respect for patriarchy, in the crudest and simplest terms: “Boys don’t wear pink, they wear blue,” they would tell him, or “Daddy is smarter than Mommy—ask him.”

I asked Hibari for a link to one of Zucker's own papers which indicated this preference for reinforcing gender stereotypes because I'd found that the articles about him seem to say something different about this from the ones he has actually written himself. I'm not convinced that a paper from 1990 is particularly relevant to what he is doing today - I'd limited my own search to what he has published in the last 10 or 15 years.

I'm still not totally sure whether he thinks everyone should conform to the stereotypes for their sex or if he just thinks that physical transition might not be in the best interests of some people with gender dysphoria, although the Atlantic article says "He seems unlikely to bless the condition as psychologically healthy, especially in young children." Which no doubt makes him unpopular with the advocates of 'everyone is whatever 'gender' they say they are'.

[NotBadConsidering]

Why are we playing the man, not the ball? It’s typical. Someone publishes something TRAs don’t like and mud is slung at one - of several -author of the paper. Zucker could publish a paper saying the sky is blue and certain people would claim he’s trying to force everyone into gendered thinking about the range of sky colours.

What does this paper say? What does the evidence in this paper say? The data say if you leave boys alone and don’t adulterate their bodies then they will be fine as adults.

Again, this is an essential component of consent for children. Will children and their parents be told of these finding from today? Even if there isn’t agreement on the findings, will parents and children be told that this paper exists and that it adds to the overall understanding? Because if not, it’s irresponsible to continue to believe a child is consented to puberty blockers.

[SmokedDuck]

In general with clinical psychology I think there is not a one size fits all approach that is going to work. So while one child might respond best to having a real obsessional object removed, in another it would be better to just encourage other things. Or something else.

So I'd tend to be wary of assuming what is suggested with one kid means the practitioner would do the same with all kids. And sometimes what they try doesn't work and they have to try something else.

I don't think Zucker is actually looking to create a perfect indifference to social gender norms in anyone though, which is maybe what some GC people would think best. More that certain gender norms exist and it adaptive to be able to function within those where they aren't actually damaging. So if it's unusual for boys out of preschool to wear dresses, and leads to some social problems, for the patient it's often (not always) most adaptive to be comfortable with wearing something like jeans and a t-shirt, which after all aren't horrific items of clothing. No one has an innate gender identity but they don't have an innate need to wear dresses either. These things should be at the level of a preference, which a person may indulge or not if it meets their wider goals - not a necessity for mental comfort.

Clinical practitioners usually aren't looking at radically changing social norms, they are looking for a stable outcome for the patient.

[OldCrone]

Why are we playing the man, not the ball? It’s typical. Someone publishes something TRAs don’t like and mud is slung at one - of several -author of the paper. Zucker could publish a paper saying the sky is blue and certain people would claim he’s trying to force everyone into gendered thinking about the range of sky colours.

Apologies for my part in the derail. As I said earlier, I had asked Hibari for a link to some of Zucker's work about his 'methodology' because I'd asked about this on another thread and Hibari had failed to respond. Having finally got a response I'd forgotten what this thread was really about.

[Scepticaltank]

Zucker is a man of his time of course, as is Blanchard. Neither are free of their own socialisation in the time they matured. Alice Dreger writes of US clinicians surgically treating children with DSDs according to social norms of their time. The problem is no one has manged to unravel the complex interplay in real time treatment as perfectly demonstrated by the Tavistock mess of demand led confusion.

There are very few people trying to establish an actual healthcare protocol that is focussed entirely on a stable outcome and not overly influenced by the dogma of the day.

Hopefully the Cass enquiry will have a good go at it but I suspect it will be a huge struggle.

[WarriorN]

@SmokedDuck

Anytime I've read Zucker he's quite clear that toys etc aren't inherently gendered. Where he's asked parents to take away some toys or clothing or steer them away it's because the child is being unbalanced/obsessional towards items that the child perceives as being only for one sex.

The problem isn't that the items are wrong it's that the child has developed a really strong identification with toys perceived as being for the other sex. The goal is to encourage a more balanced approach from the child toward the items, and also possibly being more flexible in how they will play with other children who may not share the focus on one type of play.

I get this.

It's very nuanced.

I taught a child, Sen, asd. He became so single minded about only doing "girls things" that he outright refused to consider doing anything he'd picked up as being "for boys."

So I approached it exactly as I would a girl who would be refusing to do anything she labelled boyish. Or a boy who refused to do anything girlish.

Eg. Refused to play football in pe. So we looked at some images of women's football teams and also some male teams playing in pink. Played football happily after that.

Also had a boy with asd who refused to read a Cinderella reading book as it "was for girls." He wasn't allowed not to read it.

This is different to denying any interaction with items "gendered," which I would say is inherently sexist and going to have the opposite effect.