‘We were wrong’: Pioneer of child sex change experiments ADMITS
“The long and short of it is that the decision was made at a time when these kids were just too young to really know how they were going to make this work. And that’s not fair.”
A Canadian psychiatrist who was one of the early pioneers of the pediatric sex change medical experiment has spoken out against gender-affirming care and the use of puberty blockers and hormones for minors in an interview with the Daily Caller.
Dr. Debra Soh with Dr. Susan Bradley
Dr. Susan Bradley: Autism and Gender
Canadian psychiatrist Dr. Susan Bradley was the chair of the DSM-IV Subcommittee on Gender Disorders. She served as the Head of the Division of Child Psychiatry and was Psychiatrist-in-Chief at the Hospital for Sick Children, a major teaching hospital affiliated with the University of Toronto, where she is a Professor Emerita in the Department of Psychiatry. Dr. Bradley founded the Child and Adolescent Gender Identity Clinic at the Clarke Institute of Psychiatry, where over the course of her career she saw over 400 cases of children and adolescents with gender identity disorder and related issues. She has published books and articles, including over 50 articles in peer-reviewed journals.
Understanding Vulnerability in Girls and Young Women with High Functioning Autism Spectrum Disorder
Dr. Susan Bradley, formerly of Toronto’s Clarke Institute, brought puberty blockers to Canada in 2005 when the treatment protocol was still in its experimental phase. Bradley had been running a pediatric gender clinic in the city since 1975, but prior to embarking on this reckless medical experiment, the clinic had only offered talk therapy to the minuscule number of youth it treated for gender-related issues.
Bradley, who is now retired and in her eighties, said she feels regret that the clinic participated in the puberty blockers experiment because she now believes the drugs help to cement a child’s gender confusion into the mind making it unlikely that the child will outgrow it. She is also concerned about the side effects of the drugs.
“We were wrong,” she told the Daily Caller. “They’re not as reversible as we always thought, and they have longer term effects on kids’ growth and development, including making them sterile and quite a number of things affecting their bone growth.”
“We thought that it was relatively safe, and endocrinologists said they’re reversible, and that we didn’t have to worry about it. I had this skepticism in the back of my mind all the time that maybe we were actually colluding and not helping them. And I think that’s proven correct in that, once these kids get started at any age on puberty blockers, nearly all of them continue to want to go to cross sex hormones,” said Bradley.
This phenomenon has been observed all over the world. In the past, most children would desist and become comfortable with their birth sex after puberty, but since the medical world adopted the affirmation approach, involving social transition, puberty blockers and cross-sex hormones, almost all children continue to identify as transgender as they grow. Proponents of child sex changes argue that this is proof that the treatment pathway is necessary, but others, like Bradley, suggest that it is the treatment pathway itself that is causing the persistence in the transgender identity.
At their conception, puberty blockers were marketed as a fully reversible pause to give the child time to figure things out, but experts have since argued that they are a start switch for further medical transition, and the list of side effects is growing. From bone density and cognitive developments issues, to a rare but serious swelling of the brain, the drugs are no longer considered to be safe and fully reversible.
Before her retirement, Bradley had a long and distinguished career in the field of gender medicine. She opened the Clarke Institute of Toronto’s Child Youth and Family Gender Identity Clinic (GIC) in 1975, and she went on to become the head of Child Psychiatry at the Hospital for Sick Children and the psychiatrist-in-chief and head of the Division of Child Psychiatry at the University of Toronto.
According to Joseph Burgo, vice director of Genspect, Bradley’s opinion has the potential to change minds on this controversial politicised medical treatment.
“An opinion from someone like Dr. Bradley has enormous potential to influence debate because she is what Cass Sunstein has called a ‘surprising validator,’” Burgo told the Daily Caller. “It’s human nature to dismiss even well-reasoned arguments and credible evidence from those who are readily identified as on the other side, as ‘them’ — say, Republicans, or well-known ‘transphobes.’ But Dr. Bradley is a pioneer in the field and politically unaligned.”
“She does not argue that puberty blockers are never appropriate. Instead, she urges a cautious exploratory approach to gender distress based upon her decades of experience,” Burgo added. “When a professional who might have been expected to align with one side (affirmative care) issues a nuanced opinion and urges caution, it can help members of the public not to takes side against her, to polarize and dismiss her opinions, but instead to open their minds to alternative points of view. Surprising validators like Dr. Bradley can soften divisions and promote dialog even more than well-balanced presentations with arguments from both sides can do.”
While Bradley believes undergoing a medical sex change can be beneficial for some people, she questions how success is measured. She gave the example of a female patient who transitioned to live as a male, married and seemed happy and satisfied, but who later pursued the very risky and costly phalloplasty surgery, which involves a surgeon stripping the skin and flesh from a patient’s forearm or thigh and using it to create a non-functional appendage resembling a penis.
Bradley feels this was an indication that her patient, who seemed content and appeared very masculine, was never fully satisfied and was instead always pursuing further bodily improvements.
Bradley spoke of another patient who had transtioned to live as a woman only to transition back after starting a relationship with another man. Bradley says this caused her to reflect upon whether transition is really just about seeking acceptance for some patients.
“It made me realize that what we’re really talking about is acceptance that they need; we all need somebody who loves us,” she said. “And so it’s very complicated. There are people who make this work. But there are an awful lot of people who end up feeling that this hasn’t solved their problems with who they are and what they are … the long and short of it is that the decision was made at a time when these kids were just too young to really know how they were going to make this work. And that’s not fair.”
Bradley co-authored research showing that 87.8 percent of the boys referred to her clinic for gender-related distress eventually found comfort and desisted, meaning they stopped identifying as girls and accepted their male bodies.
Bradley has come to believe that most children who experience gender dysphoria are actually on the autism spectrum or suffering from borderline personality disorder, which she believes should be classified as part of the autism spectrum.
Autistic adolescents are prone to rigid and obsessive thinking and are more likely to experience body image issues. This puts them at particular risk of being seduced by gender identity ideology and more vulnerable to becoming convinced that they are members of the opposite sex and that a medical sex change will solve all their problems.
“You have to put yourself in the place of a 12 year old or a 13 year old, who is thinking, ‘This is my way to get normal,’” Bradley said. “These kids are not faring well with the current affirmative approach. I don’t know that any kids actually could, given the capacity of a 10 or 12, or even 14 or 15 year old to understand the complexity of the decision that they’re making on their long term sexual and life function. It just doesn’t make sense.”
After Bradley’s retirement, the Gender Identity Clinic was shut down after pressure from trans activists who accused the service of being transphobic for not affirming the transgender identities of the children it treated.
Stella O’Malley, a psychotherapist and founder of Genspect, is one of many experts to voice grave concerns about the gender-affirming model of care pushed by trans activists.
“Blocking the sexual development of children is a highly authoritarian intervention. Children are asexual, and so they can’t understand the impact of impaired sexual functioning,” O’Malley told the Daily Caller. “We are roughly 10 years into this large-scale experiment and already we have reports on issues with cognitive development, bone mineral density, and fertility. All the up-to-date evidence shows that puberty blockers are neither safe nor reversible.”
Commentary
Understanding Vulnerability in Girls and Young Women with High-Functioning Autism Spectrum Disorder
Susan Jane Bradley
Professor Emerita Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A1, Canada;
susan.bradley589@gmail.com
Abstract: There is a population of young women with autism spectrum disorder (ASD) who function relatively well so that their disorder is not easily recognized. If their difficulties with emotion regulation in childhood continue into adolescence they are vulnerable to the development of a number of mental disorders, treatment of which can be difficult if the presence of ASD is not understood. In this commentary, I use the example of gender dysphoria to illustrate the issues.
Keywords: autism spectrum disorder; gender dysphoria; adolescence
Check For Updates:
https://www.mdpi.com/article/10.3390/women2010007?type=check_update&version=4
Citation: Bradley, S.J. Understanding
Vulnerability in Girls and Young
Women with High-Functioning
Autism Spectrum Disorder. Women
2022, 2, 64–67. https://doi.org/
10.3390/women2010007
Academic Editors: Mary V. Seeman
and Domenico De Berardis
Received: 22 September 2021
Accepted: 23 February 2022
Published: 27 February 2022
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4.0/).
As a Child Psychiatrist who founded the first academic clinic for children and adolescents with Gender Identity Disorder (GID) in Canada at the then Clarke Institute of Psychiatry in 1975, I have become very concerned about the seeming lack of psychological understanding by care providers of young teens presenting with this disorder. Our clinic was led by Dr. Ken Zucker after I moved to the Hospital for Sick Children, where I was Psychiatrist-in-Chief and Head of Child and Adolescent Psychiatry for the University of Toronto for ten years. Under Dr. Zucker’s leadership, the clinic became one of the leading academic programs for these disorders; it became well known and respected by clinicians and scientists around the world because of the numerous authoritative publications that arose from our work. Our book [1], published in 1995, was considered the foremost guide in this area for many years. However, a few years ago, the clinic was shut down because of political pressure.
The pressure came from activist groups that disagreed with our observations about the malleability of GID. A recent report [2] by one of our former students indicates that the majority of the children seen in the clinic, once grown up, relinquished their desire to transition to the opposite sex and instead, as adults, mainly self-identified as lesbian or gay. This finding has been confirmed by other groups who have longitudinally followed young children with GID, both treated and untreated.
Given such findings, current affirmative medical approaches that offer hormonal and surgical treatments to youth when they first present with Recent Onset Gender Dysphoria (ROGD) [3] is a matter of grave concern to practitioners experienced in this area. ROGD, which afflicts mainly young women who appear to be caught up in a cult-like movement and encouraged to radically change their bodies, has effectively shut down the voices of those who counsel a period of waiting and deeper understanding before embarking on a journey that may be profoundly regretted. This commentary is aimed at mental health professionals, including pediatricians, who are consulted by parents when their daughters express concern about their gender identity. Clearly the views expressed in this commentary are not shared by those advocating for the Affirmative Medical approach.
Early on in our clinic’s experience seeing children and teens with GID, we were less aware than we are today of high-functioning autism spectrum disorder (ASD). Despite searching for biological causes for GID and finding nothing specific, (for a more thorough review see Debra Soh’s book [4]), we became more interested in the underlying issues that increase vulnerability in this area. Recently, and particularly with the emerging pandemic of ROGD, we and others have recognized that many of the young women we treated suffered from high-functioning ASD [5–7]. This became clearer for me when I worked as a consultant to a variety of Children’s Mental Health Centers after leaving Sickkids. Most of the girls I saw had not been previously diagnosed with ASD because they melded into the mainstream more easily than boys with ASD. They presented with anxiety, depression suicidal thinking, self-harm behaviors, eating disorders and gender dysphoria. Before my retirement, one of the larger agencies estimated that, over a ten year period, I had seen more than 500 children and teens with undiagnosed ASD. This reflects a possible increasing prevalence of ASD [8] but it also reflects my increasing awareness of this disorder as a risk factor for a variety of psychopathologies in young women.
Clinically, the parents of these girls regularly speak of their daughters’ difficulties regulating their feelings. In the younger children, the presentation often manifests in “meltdowns,” but, in the teens, it more commonly presents as anxiety and depression. In my experience, neither the anxiety nor depression is typical for those diagnoses, often coming and going in reaction to perceived stresses. Suicidal thinking is also commonly seen but it is often fleeting and again related to perceived slights or rejections. Clinicians working with these youth often report a lack of success with such approaches as CBT and they sense that these youth have trouble fully understanding tasks such as analyzing their feelings and related triggers and putting into words how they think about their thoughts. The patients’ difficulty with theory of mind is seen as the underlying cause of the therapeutic impasse. Furthermore, they are described as exhibiting a rigid style of thinking that makes it hard for them to change their thinking, especially if they believe they are right/have found a solution to their distress.
Developmentally, these young girls have typically had trouble making friends and often feel rejected and left out of peer groups. Their interests are often less mature than that of their peers and they do not really understand why peers are not very interested in them as friends. Their self-esteem is usually impacted by this rejection, which becomes particularly acute as they enter adolescence when peer groups become socially very important. They often think of themselves as different in some way that they find hard to explain. Crushes on popular girls are not uncommon in many teens, but, not knowing this, the emotions that are aroused may make these young women feel increasingly “weird”. In the current culture of politically correct affirmation of gender dysphoria, it translates into meaning that you are “trans”, which, for many young women, is less anxiety-provoking than being lesbian. Most have not had a prior history of gender dysphoria but their belief that they have found an answer to their distress, along with their style of rigid thinking, makes it hard to self-reflect in terms of other possible explanations for their feelings. Being welcomed by “trans” advocates acts as the external push. Young women who have gone through this and have subsequently de-transitioned have been very helpful in that they have gained an understanding of their experience and have realized that transitioning did not relieve their original feelings. Most have reported accepting that they are lesbian, especially when they enter into a relationship in which they are accepted for who they are.
Although “trans” advocates argue that they were “born that way,” there is little evidence of a biological factor determining one’s gender identity [9]. As stated earlier, studies following up young children with gender identity disorders with or without therapeutic support find that the majority have relinquished their desire to transition and describe themselves as mainly lesbian or gay. However, we do know that those young women who begin puberty blockers are more likely to continue to seek cross-sex hormones and surgery than do those who are not so exposed [10–12]. These findings have raised issues that, despite our best intentions regarding help for these young women, often in the belief that we are preventing suicide, may reinforce their belief that they should proceed to transition as opposed to buying time for them to consider other options.
Although I am using the example of gender dysphoria here as an example of misdiagnosis of young women with high-functioning ASD, I believe that the distress of these young women can be mislabeled in many different ways. Because they are high functioning, their ASD may not be apparent until they are older. They clearly suffer from high levels of anxiety and depression, but also from eating disorders and body dysphoria. Understanding the developmental origins and style of thinking that may make these young women more resistant to regular psychiatric interventions and, therefore, more vulnerable, is very important to their effective management. Some may question if these young women should also be diagnosed as having Borderline Personality Disorder. This is an ongoing issue in the literature but I believe that evidence of earlier ASD features should suggest that ASD is the simpler and more logical diagnosis.
As the most parsimonious way of understanding difficulties in self-regulation in ASD I have adopted Steve Porges’ theory [13] of vagal nerve dysfunction in ASD as this theory helps to explain the symptoms of “meltdowns” in younger children but also the difficulty in managing stress during the teenage years. Essentially, Porges posits that their parasympathetic nervous system is less able to return the autonomic nervous system to normal after stress than it is in typical individuals. In his book “The PolyVagal Theory”, Porges describes the intricate way in which the myelinated part of the vagus, which oversees the body’s restorative functions including social engagement, works in concert with the sympathetic or mobilizing part of the autonomic nervous system to allow response to danger and recovery from the state of readiness. When vagal tone is low or fails to respond adequately after a danger or a mobilizing signal, the individual has difficulty with self-regulation, feeling in a constant state of “fight or flight”. It is postulated that being more constantly in this state of “fight or flight” can “wear out” their stress system as the vagal nerve connects with the other part of the stress management system, the hypothalamic pituitary adrenal axis (HPA axis). Porges has tested his theory in individuals with ASD, Borderline Personality Disorder and those who have experienced prior abuse and finds evidence for poorer vagal tone in these clinical populations. Another study using different measures has confirmed Porges’ findings of autonomic dysfunction in ASD [14]. From my perspective, both understanding the feelings that make these young women vulnerable but also the physiology that may make it harder for them to use standard therapy or learn to regulate their feelings is crucial to effectively help them manage their distress.
Clearly, this population does not have access to evidence-based treatments that are specific to their problems with emotion regulation (ER). Mazefsky [15] provides a very good overview of factors both general and specific to ER in ASD and makes suggestions for research that may enhance efficacy of treatment interventions in ASD. The results, to date, using modified CBT for ASD, are promising but not yet conclusive [16]. Although vagal nerve stimulation appears possibly helpful it has not yet been adequately tested. This group of young people will remain vulnerable until we have evidence-based treatments and so I welcome this opportunity to encourage readers to think of this target population when designing future research programs.
Funding: This research received no external funding.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement: Not applicable.
Conflicts of Interest: The authors declare no conflict of interest.
References [clickable links on the pdf document below]
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- Soh, D. The End of Gender; Threshold Editions: Toronto, ON, Canada, 2020.
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- Brik, T.; Vrouenraets, L.J.J.J.; De Vries, M.C.; Hannema, S.E. Trajectories of Adolescents Treated with Gonadotropin-Releasing Hormone Analogues for Gender Dysphoria. Arch. Sex. Behav. 2020, 49, 2611–2618. [CrossRef] [PubMed]
- Porges, S. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication and Self-Regulation; Norton: New York, NY, USA, 2011.
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