An Alternative To "Gender-Affirming Care": Rigorous Psychotherapy

Radical activists hail this as "conversion therapy," but it works. Full interview with world-leading expert below.

The transgender debate reignites with each tragic mass shooting — most recently the Tumbler Ridge school mass shooting in British Columbia and the attack at a Rhode Island ice hockey rink shortly thereafter — but solutions rarely penetrate the hyper-online cultural zeitgeist.

Far-left activists for transgender rights have refused to explore any connection between mental illness and gender dysphoria, as it would violate the core dogma that gender dysphoria is entirely biological — that people are “born this way.” On the other hand many conservatives have continued to hammer radical gender ideology, which is easier than finding solutions.

The American Society of Plastic Surgeons issued a new position statement last month recommending against breast removal, genital surgery, and facial surgeries for children with gender dysphoria — a clean break from sex changes in childhood, and a dark chapter in medical history. So what to do with a child suffering without defaulting to drugs and surgery on one end, or not doing anything and letting them suffer with anxiety and identity confusion on the other?

Enter Kenneth Zucker, one of the most cited clinical psychologists in this space, who has resisted orthodoxy and taken a science-based approach to treating gender dysphoria for more than four decades at the largest mental health center in Canada.

As gender-affirming care became the inviolable standard for children, Zucker found himself at the center of a harassment campaign that shuttered his clinic, as covered in New York Magazine a decade ago. Now as it recedes, we return to his methods.

In three interviews spanning four hours, Zucker explained to me how gender dysphoria can be understood and treated with clinical psychology rather than adherence to any ideology.

Gender dysphoria is significant distress related to one’s biological sex, according to the American Psychiatric Association.

But adolescence is always a period of profound biological upheaval — when hormones reshape the body and recalibrate mood and desire. It is precisely the developmental window in which many forms of dysphoria, including gender-related distress, can emerge or intensify. For many kids, the solution is simply helping them grow up.

A New Counter-Consensus

“Gender-affirming care” emerged in the early 2000s as an extension of “gay-affirming therapy” depathologizing homosexuality, Zucker said.

The philosophical shift was clear: powerful medical institutions argued that a child’s declared gender identity reflects something immutable, just as being gay was no longer considered a disorder. But the gender-affirming model consisted of invasive biomedical interventions such as puberty blockers, cross-sex hormones and surgeries which cause bone density loss and infertility. The landmark 2024 independent Cass Review in the United Kingdom concluded that the research underpinning puberty blockers and cross-sex hormones for youth is “remarkably weak,” with low-quality studies and insufficient long-term outcome data, and the U.S. Department of Health and Human Services concluded the same last year.

The U.K. has restricted puberty blockers outside of clinical trials. Sweden, Finland, Norway, Denmark, France, and Italy have likewise limited medical transition for minors and prioritized psychological assessment and therapy.

A new rational counter-consensus is emerging, one that relies on well established interventions.

“If the goal is to reduce gender dysphoria, there are many possible ways. For some kids it may involve social transition…but for other kids, that’s not the case,” said Zucker.

He calls his model “exploratory” or “developmentally informed” psychotherapy. It takes into account a kid’s biology, family, personality, life experiences, and social world.

The point is not to force an outcome. It is to explore hypotheses — before intervening irreversibly.

And unlike gender clinics that dispense hormones with few follow-up questions, Zucker’s practice does not use a one-size-fits-all style.

“One could say we were eclectic,” he said. “We would develop a treatment plan that took into account what a particular child or adolescent might most benefit from.”

“Kids who are more introspective and able to reflect on things, maybe they would benefit from a more open-ended psychotherapeutic approach,” he continued.

Others were “more concrete” and dealing with “many day-to-day crises,” in which case treatment would focus more directly on helping them manage these challenges, he said.

The individualized assessment involves evaluating co-occurring mental health conditions.

Depression, anxiety disorders, and obsessive-compulsive symptoms are overrepresented in young people presenting with gender dysphoria. Being on the autistic spectrum might predispose somebody to develop gender dysphoria, maybe for biological reasons, or maybe because of the propensity to think in black and white terms.

“A gender-affirming clinician might say, well, all of these other problems are simply secondary to the gender dysphoria,” he said. “They’re depressed because they have gender dysphoria. They’re depressed because kids are teasing them because of their gender dysphoria.”

Zucker does not deny that dysphoria can cause distress. But he questions whether it is always the primary driver.

Attachment Theory

A central component of Zucker’s developmental approach is attachment theory, the framework pioneered by British psychoanalyst John Bowlby that holds that early relationships with caregivers shape a child’s sense of safety, identity, and perceptions of themselves and others. If parental attachment can shape this much of a person’s personality, it follows that it would also affect issues of gender.

In some young girls, Zucker observed distance from their mothers, what might be clinically classified as an avoidance.

Following that observation, Zucker’s hypothesis was straightforward: if that attachment could be strengthened, the gender dysphoria would lift.

With some boys, the same pattern was observed with fathers. Zucker described one child who, when his father sat at dinner, asked, “who is this man?”

In another case, a boy drew his father and wrote “I hate you” beneath it. If that hostility can be reduced and connection increased, “being a boy” feels less intimidating.

Reviving A Lost Progressive Cause: Breaking Gender Stereotypes

Zucker’s treatment often involves loosening a child’s grip to traditional gender roles — which would’ve been considered a noble, progressive cause circa 20 years ago.

This departs from gender-affirming care, which reifies traditional gender stereotypes.

Under an archaic worldview, a boy who likes dolls, fashion, or reading often gets interpreted as “really” being a girl. A tomboy who prefers rough-and-tumble play gets nudged toward identifying as a boy. The model collapses personality into sex — and in doing so, relies on exactly the crude gender stereotypes that liberal culture has spent 50 years trying to retire.

“Kids can be pretty black and white when it comes to gender when they’re quite young,” Zucker said.

One 12-year-old boy wanted to be a girl because he didn’t like to sweat. He believed that “only boys perspired, girls didn’t.” The same child thought “girls like to read but boys don’t.” Zucker called these “clear distortions.”

He persuaded the child that there are some girls who do sweat and there are some boys who do like to read.

Another pattern he described repeatedly: boys whose internal logic was that “all boys are mean and rough and they swear and I don’t like that so I want to be a girl.”

Perhaps the most striking example he shared involved a young girl whose classmates were debating whether she was a boy or a girl. The resolution came not from hormones or a new pronoun, but from a kindergarten teacher who stepped in and said, “Sally is a tomboy. She’s a girl who likes boy things.”

“For the kid, that apparently was a real epiphany,” Zucker recalled.

Over the next couple of years, “the gender dysphoria, the wish to be a boy dissipated entirely.”

For decades, progressives fought to expand the meaning of masculinity and femininity. In our zeal to affirm, they may have reintroduced rigidity again, causing psychological distress in children in the process.

The Results

What are the long-term outcomes of children treated this way? Some data suggests between 63 to 73 percent likelihood of gender dysphoria “desistance” — a term that refers to kids recovering from the condition after puberty.

In his own clinic’s follow-up peer reviewed study, published in 2021 in Frontiers In Psychiatry, the findings were even more pronounced.

“In our own follow-up in Toronto, the desistance rate was 88 percent for both girls and boys,” he said. These were children first seen at an average age of 7 and were followed into early adulthood.

In other words, gender dysphoria appeared to be a mostly temporary phenomenon confined to adolescence, rather than one which persists for decades post-pubescence.

This aligns with what we broadly understand about pubescence: a period of life when nature radically reshapes the body and young people grapple with belonging, identity, sexuality, and autonomy.

Medicalizing Homosexuality

Activists have been slow to acknowledge the possibility that gender-affirming care medicalizes children who might have otherwise grown up to be gay.

“The vast majority of prepubertal kids who were not socially transitioned in childhood appear to grow up to be gay,” he said.

He estimates that these cases account for 75 to 80 percent of gender dysphoric kids.

Zucker said that kids who socially transitioned before puberty are also often attracted to members of their own birth sex, even when they stick with transgender identity, which research suggests occurs as often as 90 percent of the time.

“Because these kids are identifying as the other gender, they might say that they’re straight, but in relation to their birth sex, we would say that they’re same-sex attracted,” Zucker said.

Clinic Shut Down Following Bogus ‘Conversion Therapy’ Allegations

In 2015, activists accused Zucker of practicing conversion therapy, triggering a formal review and shutdown of his Child Youth and Family Gender Identity Clinic by the research hospital it was housed by, the Center for Addiction and Mental Health (CAMH).

“Next to being accused of racism, being accused of being a conversion therapist is probably the worst charge that can be leveled against any practicing clinician,” he said.

“Changing a kid’s sexual orientation was not a goal of the clinic,” he continued. “As if anybody would know how to do that anyways,” he added incredulously.

His approach is explicitly exploratory, not coercive.

“That’s what all reasonable, well-trained clinicians do with these kids. We explore things. We don’t try to impose anything on them,” he said.

In the publicized external review of his clinic, the investigating psychologists characterized the “intensive assessment and treatment” in Zucker’s approach as problematic and noted it differs from the “accepted” practice of merely “educating and supporting parents to accept a child’s gender expression.”

Zucker has argued that the review process was deeply flawed and that he was not given a fair opportunity to respond before the shutdown.

In 2018, he was vindicated. He sued and reached a settlement with CAMH for defamation and wrongful dismissal. The mental health center issued a formal apology and he was awarded more than $500,000.

Therapy Culture’s Gender Dysphoria Blindspot

The smear campaign against Zucker for the crime of providing intensive psychotherapy seems completely incongruous with modern therapy culture that saturates TikTok and Instagram and Hollywood.

For some progressive-minded people, therapy culture as secular religion has displaced older moral vocabularies with “trauma responses” and “healing journeys.” Pop stars like Madonna to The Weeknd have built entire albums and films around their psychotherapeutic self-discovery. To be in therapy, to be “doing the work,” is a mark of seriousness.

Modern psychotherapy rests on a simple principle: feelings are real, but the stories we tell about those feelings are worth examining. A teenager with social anxiety who believes “everyone secretly hates me” is not affirmed in that belief by a competent therapist — the belief is gently explored, questioned, and where appropriate, challenged.

A patient with body dysmorphia who feels profoundly disfigured despite evidence to the contrary is not told their self-perception is accurate. The suffering is validated; the underlying interpretation is held up to the light.

Yet in the case of pediatric gender dysphoria, the prevailing clinical posture has inverted this logic entirely.

In a culture that urges young people to unpack unconscious narratives, sit with complex emotions, and examine painful traumas — trans identity has become the one diagnosis in which it is taboo to receive sustained psychological examination.

Zucker’s work challenges this hypocrisy. Tending to children’s anxiety in puberty may be the most compassionate service we can provide them.

Rav Arora is an independent journalist based in Vancouver. His reporting on Covid mandates, mental health, FDA, and inner-city crime has appeared on The Joe Rogan Experience, Jordan B. Peterson podcast, Megyn Kelly Show, and DarkHorse podcast, among other alternative media platforms.