GLR November-December 2022

was seen as practicing something that activists called conver sion therapy for trans kids. So I became interested in this sub ject. I don’t treat children myself, or adolescents before eighteen or nineteen. With my colleague William Byne, we did a special issue of the Journal of Homosexuality in which we invited seven clinics to submit papers telling us what they did. Five of them sent in papers. So here are some interesting facts. Puberty suppression hor mones were approved by the FDA for safe use in 1980. In 1981, they were first used to treat a condition called precocious puberty, an example being a child who starts entering puberty at the age of nine, because there was a belief that if puberty occurred too early, there could be adverse psychological and physical effects. And today, pediatricians are still doing puberty suppression with puberty blockers, and in articles about precocious puberty, they’re calling puberty-blocking the gold standard. In the 1990s, a clinic in Amsterdam noted that children who have what we today would call gender dysphoria were not nec essarily growing up to be transgender after puberty. There are about eleven studies since 1970 of kids who went to these spe cialized gender clinics around the world, and the majority of them, anywhere from fifty to eighty percent, did not grow up to be transgender. They grew up to be gay and cisgender, and a few even grew up to be heterosexual and cisgender. The doctors observed that in some cases gender dysphoria doesn’t go away until after puberty. So, if I’m treating a particu lar child, I don’t know if they’re going to grow up to be trans gender or gay or cisgender. I don’t know, but they’re approaching

puberty, and they’re having panic attacks, because they still are dysphoric, and they don’t want to go through puberty, which will change their secondary sex characteristics in a way that will make it more difficult to transition later on. In the 1990s, they began offering puberty suppression in the Dutch clinic. Their idea was that if the child—who is, say, four teen years old and they’ve been on puberty blockers—changed their mind, they could stop the puberty blockers and they would simply have a late onset puberty. But if they continued to be dysphoric, then they would have an easier transition later on in life, when they were old enough to get all the treatments that are available to transition. So that’s what has been going on for more than twenty years. You would hardly call that experimental. The debates in the old days, ten years ago, when I got into this subject, were not about whether to give kids puberty blockers but what to do with the child before that happened—whether you should try to change their mind, help them to transition them socially, or just let them evolve naturally. Well, the debate has shifted in an extraordinary way, to include people who think that nobody should get treatment at all. That’s what you’re see ing in these laws that are being passed in red states. They want to make offering treatment a crime. The people who are pass ing these laws believe that no child should have any treat ment—other than talking about their feelings—before they’re eighteen at least. G&LR: My guess is that you would advocate a case-by-case approach, correct? JD: Yes, of course. There are two kinds of children. There are children who will benefit from treatment and children who might not, and the goal for anybody treating these kids is to know as much as they can on an individualized basis, what to do for this particular child. But when you pass laws that say no one should get the treatment, what you’re saying is you’re going to privilege the care of the children who grow up to be cisgen der at the expense of the kids who might grow up to be trans gender. And that to me is a very serious ethical problem. G&LR: Wrapping up: here we are fifty years after the big de cision and the DSM revision, and the whole field of psychia try is so radically different now from what it was back then. So, looking forward, is it possible to see any trends within psy chiatry as a discipline or its involvement with LGBT-related concerns? JD: Well, first of all, it’s a truism among psychiatrists that we are notoriously bad at predicting the future. So I’ll start with that. Like many disciplines, psychiatry is dealing with issues related to diversity, equity, and inclusion. The recently elected president of APA is an openly gay man, Petros Levounis, who’s a Harvard graduate. Larry Hartmann was president of APA, but not everybody knew he was gay when he was running. I ran as an openly gay man in 2005, but I didn’t win. But I wasn’t really a viable candidate. And now I’m actually on the faculty of a psychoanalytic institute that wouldn’t accept me back in the ‘80s, and I was elected a director at large of the American Psy choanalytic Association a few months ago. G&LR: Congratulations! And thanks so much for sharing your time and wisdom.

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Highly recommended. —Diane Donovan, Midwest Book Review

A gripping read from beginning to end. —Priscilla Long, author of The riter s Portable Mentor [An] enter taining and ($'()!%&" l nove . — C. Robert Jones, author of The Mystery of &!"))$' &%($ ’ W

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