TORONTO -- The former head of a youth gender identity clinic at Canada's largest mental health centre is defending the work he performed at the now-shuttered facility, including encouraging patients to be comfortable with their biological sex and assigned gender at birth.
Dr. Kenneth Zucker defended himself against criticisms of the clinic at the Toronto-based Centre for Addiction and Mental Health, which was the subject of an external review that led to his dismissal in 2015.
The review was sparked by assertions that the clinic, which Zucker led for some 35 years, was practising a form of conversion therapy on transgender youth. The controversial practice, which has been banned in a handful of Canadian provinces, essentially works to forcibly change a person's sexual orientation or gender identity.
Zucker said the clinic actively tried to encourage young patients to accept their biological sex in a bid to "reduce a child's gender dysphoria," but rejected the notion that this approach amounted to conversion therapy.
"The term has been inappropriately expropriated from the way the term was used to critique clinicians who were treating mainly adult homosexual men who didn't want to be gay -- and it was also used coercively in some instances," he said in an interview with The Canadian Press.
"So I object strenuously to using that term when we're talking about young children who have gender dysphoria."
The independent reviewers said in their report that they were unable to ascertain whether the clinic was in fact practising conversion therapy.
Reviewers did find, however, that the clinic focused on intensive assessment and treatment in lieu of more modern approaches. It said today's best practices favour watchful waiting, as well as educating and supporting parents to accept a child's gender expression.
After the review was published, CAMH announced it was "winding down" the clinic's services. Zucker said he was "fired" about an hour before the review was made public.
Years later, the Centre acknowledged errors in its handling of the review.
In a settlement announced last week, CAMH apologized to Zucker and agreed to pay him more than half a million dollars. The centre acknowledged that the external review erroneously described his interactions with patients and noted that the report was made public without his review or comment.
Conversion therapy, sometimes called reparative therapy, has been used by some practitioners to encourage heterosexuality and to discourage those who identify as transgender from embracing the gender they identify with.
Zucker said the method he practised at the clinic attempted to make a child feel comfortable with their sex and gender identity assigned at birth. It included urging the child to form "stronger friendships with same-sex peers" and "play therapy, where one can understand better a child's internal world and why they might feel that it's better to be of the other gender," he said.
Zucker contested the idea that there is a "best practice" approach to treating kids with gender dysphoria, asserting there is limited data and research on the topic -- specifically on whether the dysphoria will persist into adolescence and adulthood.
Several major international medical and human rights bodies, including an arm of the World Health Organization, have said there is considerable evidence to support the notion that conversion therapy is harmful.
Organizations that roundly denounce the practice, such as the Canadian Psychological Association, have decried conversion therapy as an unethical approach that can inflict long-term damage on those who go through it.
"Scientific research does not support the efficacy of conversion or reparative therapy," the association said in its 2015 policy statement on the issue. "(It) can result in negative outcomes such as distress, anxiety, depression, negative self-image, a feeling of personal failure, difficulty sustaining relationships, and sexual dysfunction. There is no evidence that the negative effects of conversion or reparative therapy counterbalance any distress caused by the social stigma and prejudice these individuals may experience."
Canada's approach to conversion therapy has been piecemeal, with laws and regulations varying widely by jurisdiction.
Ontario's 2015 law, for instance, slapped an outright ban on doctors performing such treatments on those under 18 and struck it from the list of insurable services covered for adults.
Nova Scotia's recently tabled bill, meanwhile, allows a provision for "mature minors" between 16 and 18 to consent to conversion therapy. Manitoba is the only other province to have explicit legislation dealing with the issue.
Zucker said that while he tried to encourage children to accept their birth sex, he supports people making the transition to the gender they identify with if they continue to experience gender dysphoria into adolescence.
He said he believes it's best for a patient to start medical treatments, such as hormonal treatments and sex-reassignment surgery, if gender dysphoria continues past childhood.
"I'm supportive, when they're older, of gender-confirming surgery," he said.
Zucker said the clinic also used other approaches with young patients -- aged two to 12 years old -- experiencing gender dysphoria, including watchful waiting and a "social transition" where children changed their names and pronouns.
"There wasn't a one-size-fits-all policy," said Zucker. "I've always accepted where parents are at and what's in the best interest of their child."
