Episode 6

6 - Gender Intervention: Treatment or Experiments?

Published on: 15th January, 2021

Quick Notes 

A whistle-stop tour through the history of psychological and medical approaches to sex and gender in the 20th century. This episode gives background and context to the formation of WPATH (World Professional Association for Transgender Health) and today’s “affirmative model of care” for gender issues. 

Extended Notes

  • A little bit of history about gender transitions over the decades.
  • The medical and psychological theories behind gender transition have always been controversial.
  • Why would someone struggle with their gender?
  • Which gender roles should you raise your children in? Sasha shares a case that happened with twin boys, and one transitioned into a girl in 1965.
  • The outcome was not great. People played God on a child.
  • In 1965, only 3% of surgeons took sex change requests seriously. However, by the 70s, these surgeries were commonplace.
  • People pushed for experimental interventions too soon without having long-term data.
  • Instead of saying “should we do this?” doctors said, “can we do this?”
  • No one knows why a trans person exists. A psychologist would be asking questions to figure out this key piece.
  • It wasn’t until the 2010s that you’d see a huge uptick in gender dysphoria.
  • Both Stella and Sasha break down why they like Dr. Zucker and the research he’s conducted on child gender issues.
  • There are so many variables. It’s hard to know or pinpoint what makes a child want to transition.
  • Objectively, it may be better to have people come to terms with their biology vs. going through a very risky medical path.
  • There is a heavy medical burden when you try to transition. It is not an easy thing to do. Even certain trans people admit that, if you can avoid it, you would be better.
  • Sasha shares a gender study that used hormone blockers on children for two years and the reports they found.
  • What is the psychological impact of puberty blockers?
  • The criteria to see if you have gender dysphoria in the DSM, 5 out of 8 of them use outdated and stereotypical gender roles. Like if the boy or girl likes playing with the opposite sex toys.
  • There is such a thing as a placebo effect.
  • Sasha shares another study where 4.5% of males ended up dying from the gender intervention.
  • What’s crazy is a lot of these studies are deemed to be successful. Someone dying is not a success. It’s a tragedy.
  • From a medical and psychological perspective, there is a big difference between how you treat gay or lesbian people vs. how you treat a trans person.
  • The treatment for a trans person is to take drugs till the day you die. The treatment for being gay is to live your life.
  • How young is too young to get a child to transition?
  • How do you talk to young people about their gender? It can be quite troubling the different doctors’ approaches on the matter.
  • There doesn’t seem to be any studies showcasing why intervening early is going to be good for the long term wellbeing of a gender dysphoric child.
  • You’re halting the development of a young person, we should take that seriously.
  • Feeling distressed about your body? There might be something else going on and it might not just be strictly gender, to begin with.


About John Money & David Reimer 



Harry Benjamin: The Transsexual Phenomenon, Human Outreach & Achievement Institute, (1966) 

Robert Stoller: Sex and Gender: On the Development of Masculinity and Femininity, Science House, (1968) 

Juno Dawson: The Gender Games, p.5, Hachette (2017)  

Diane Ehrensaft: Gender Creative Child, The: Pathways for Nurturing and Supporting Children Who Live Outside Gender Boxes (2016) 


Donald Winnicott: "Ego Distortion in Terms of True and false self ', in The Maturational Process and the Facilitating Environment (London 1965) p. 121 



Criteria for Gender Dysphoria in the DSM 5:  




Standards of Care 

WPATH Standards of Care (Version 7), 2012: https://www.wpath.org/publications/soc  


Harry Benjamin Standards of Care (Version 6), 2001: http://www.genderpsychology.org/transsexual/hbsoc_2001.html 




Louis Theroux documentary: Transgender Kids: https://vimeo.com/264094716  


Norman Spack Ted talk: https://www.ted.com/talks/norman_spack_how_i_help_transgender_teens_become_who_they_want_to_be  





Zucker, K.; Bradley, S. (1995). Gender Identity Disorder and Psychosexual Problems in Children and Adolescents. Canadian Journal of Psychiatry. 35. Guilford Press. pp. 477–86.  

Zucker, K., Wood, H., Singh, D. & Bradley, S. (2012) A Developmental, Biopsychosocial Model for the Treatment of Children with Gender Identity Disorder, Journal of Homosexuality, 59:3, 369-397, DOI: 10.1080/00918369.2012.653309 

Zucker, K. (2016). Persistence and desistence in children and adults with gender variance: a comparative-developmental perspective. J Am Acad Child Adolesc Psychiatry, 55(10):S80 


The Dutch studies  

de Vries AL, Steensma TD, Doreleijers TA, Cohen-Kettenis PT. (2011). Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med. 8(8):2276-83.  

de Vries, A.L. & Cohen-Kettenis, P. (2012): Clinical Management of Gender Dysphoria in Children and Adolescents: The Dutch Approach, Journal of Homosexuality, 59:3, 301-320 


Wagenaar, T., Doreleijers, A., Cohen-Kettenis, P., de Vries, A., McGuire, J., Steensma, T., Eva C.F. (2014). Young Adult Psychological Outcome After Puberty Suppression and Gender Reassignment. Pediatrics; 134;696 


de Vries A.L (2020) Challenges in Timing Puberty Suppression for Gender-Nonconforming Adolescents. Pediatrics. 2020;146(4):e2020010611 

This podcast is partially sponsored by ReIME, Rethink Identity Medicine Ethics:


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About the Podcast

Gender: A Wider Lens Podcast
Two therapists explore the expanding concept of "gender" from a psychological depth perspective.
Gender dysphoria has become a minefield for public discussion, with many afraid to express their views or question the narrative. Our mission is to examine this important and complex topic from a range of perspectives, but always through a psychological lens. By openly considering and examining gender identity, transition, and the transgender umbrella, we hope to give all interested parties permission to engage these fascinating topics with less fear and more honesty. Interviews and discussions will involve clinicians, medical professionals, academics, transgender people, parents, detransitioners and other interesting individuals whose lives have been touched by the concept of gender.

Conversations between two practicing therapists give listeners an opportunity to contemplate gender from a depth perspective not currently taken up in most of today’s accessible debates. As a result of their work with gender dysphoric therapy clients as well as their personal divergent experiences with gender, Stella and Sasha hold a refreshing and informed perspective.

Is gender identity a facilitation of development and expression of creativity, or can it be a defense against painful existential realities of living in a human body? What can we discover about masculinity, femininity, identity, gender performance, and sexuality when we peer beneath the surface and dive into a deeper psychological exploration? What is the relationship between body, mind, identity, culture, and psyche?

This podcast engages listeners in an intimate and fascinating behind-the-scenes inquiry about a topic as taboo as it is salient today.

Thank you to our sponsors:
Genspect - an international organization which offers an alternative to WPATH. Providing a range of education, resources and supports to anyone impacted by gender distress, Genspect unites many different organizations globally, and gives voice to 1,000s of previously untold stories. For more info, visit genspect.org.

GETA - an association of therapists who believe that individuals experiencing gender related concerns ought to be treated using a whole person approach. GETA connects like minded clinicians, provides educational resources and trainings, and helps people with gender dysphoria find support. For more info, visit genderexploratory.com.
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About your hosts

Stella O'Malley

Profile picture for Stella O'Malley
Stella O’Malley is a psychotherapist and author who works in private practice in Ireland. Her work focuses on parenting, family dynamics and working with teenagers.

Much of Stella’s counselling and writing focuses on mental health and the importance of well-being and she is a regular contributor to the media. She is also the resident psychotherapist for the current TV series, Raised by the Village, a family programme that helps troubled teenagers reconnect with themselves and their families.

Stella's first book, Cotton Wool Kids, was released in 2015 while Bully-Proof Kids: Practical tools to help kids grow up confident, resilient and strong was released in 2017. Stella’s latest book Fragile, was released in 2019 and focuses on overcoming anxiety and stress.

Stella was the presenter of the documentary Trans - Kids: It’s Time To Talk broadcast on Channel 4 in November 2018 and she contributed a chapter to the 2019 book, Inventing Transgender Children and Young People.

The Jungian analyst, Lisa Marchiano, and Stella launched Secrets of the Motherworld in September 2019, offering thoughtful exploration of the most intimate aspects of motherhood in a bid to help mothers feel less alone.

Stella is a Clinical Advisor for the Society for Evidence-based Gender Medicine and a founding member of the International Association of Therapists for Desisters and Detransitioners. She is also the lead facilitator for the Gender Dysphoria Support Network.

Stella holds a B.A. in Counselling and Psychotherapy and a M.A. in Cognitive Behavioural Therapy.

Sasha Ayad

Profile picture for Sasha Ayad
Sasha Ayad is a Licensed Professional Counselor who works in private practice, and has treated adolescents for over 10 years. Her work focuses on teens and young adults struggling with issues of gender dysphoria and gender identity.

She became interested in the sharp rise in teenagers who declare a trans identity for the first time during adolescence. She discovered, through working with hundreds of families, that many teens were developing gender dysphoria only after adopting a transgender identity. She questions the practice of medical transition for children and teenagers, and her clinical work focuses on developmentally appropriate, least-invasive-first talk therapy.

Sasha is also a founding member and Clinical Advisor in the Society for Evidence-based Gender Medicine and a founding member of the International Association of Therapists for Desisters and Detransitioners.

Sasha’s previous work experience includes:
- School counselor for middle and high school students at a charter school for underserved communities

- Behavioral therapy with children on the autism spectrum

- Individual and group counseling for women and children impacted by domestic abuse and sexual violence

- Developed and ran the first counseling program at a large state supported living facility for adults with intellectual disability

Sasha holds a B.S. in Psychology and an M.Ed. in Counseling Psychology.