I’m Canada’s first gender medicine whistleblower and started speaking publicly in 2019. I’m an RN with a specialization in psychiatric nursing and had been working as a clinical supervisor at a clinic for youth in Kelowna, BC, Canada when, from about 2017, our clinic saw a rapid increase in youth coming through our doors to ask for hormone prescriptions. One of our physicians had an interest in providing these services but, since we presumed that comprehensive screening, differential diagnosis and whole-person care were the norm, our physician didn’t think she had enough sessional time at our clinic to adequately do the work well. Assessment is one of my clinical strengths so, in addition to my supervisory role, I was tasked with designing a gender program and doing the majority of the front-end screening and information gathering.
I myself have lived as a transman for the last 20 years. I was diagnosed with Gender Identity Disorder (GID) in 2006 and, after months of assessment by a physician and a psychologist to rule out other mental health issues, I was started on testosterone and went on to have a double mastectomy, hysterectomy, and a metoidioplasty. My case was a seemingly uncomplicated, textbook example of the classic, early-onset GID, which persisted into adulthood. I was thirty-three when I decided to medicalize.
I understand GID from a developmental psychology framework and my preference is to continue using the term GID as it was articulated in the Diagnostic and Statistical Manual Version IV (DSM-IV) because it was more specific and limited to a single, well-understood cognitive phenomenon than Gender Dysphoria as outlined in the DSM-5 . (1) Specificity made it clear to me that most of the young people I assessed didn’t fit the diagnostic criteria and had little resemblance to my cohort of women who sought the medical pathway 20 years ago. I’ll explain what GID is and the key differences I saw in this new, novel cohort of young people I assessed. For this new cohort, I will use the term coined by Dr Lisa Littman: Rapid Onset Gender Dysphoria (ROGD). (2)
Childhood Onset Gender Identity Disorder
Unlike the politically motivated definition of “gender identity” being aggressively pushed today, the original meaning of this term illuminates what GID is. When Robert Stoller coined the term in 1964, he’d been studying the identity formation of those with complex Disorders of Sex Development (DSDs). (3) Though I disagree with a great deal of Stoller’s work, I do agree with his understanding of the cognitive process by which each of us comes to understand our sex. It is rooted in a deep, unconscious psychological scaffolding - a process called cognitive categorization. Around age two to three, we begin to develop the capacity to sort things into meaningful categories: male/female, dog/cat, harmful animals/harmless animals, useful information/irrelevant information. This process typically remains flexible through childhood, beginning with the most basic of stereotypes and continuously integrating new information as the child develops and encounters more variables.
Developing an awareness of one’s own sex is achieved through an interaction between three primary variables:
Biological sex
Environmental messages – especially family dynamics
Other biological factors which impact the environmental forces (For example, having a DSD which informs how people interact with the child)
For over 99% of the population, this is an uncomplicated process. Most people accurately understand which sex they are.
For a few, this process is disrupted. If a child has enough traits which cluster towards their own schema of the opposite sex, they may inadvertently place themselves in the opposite sex category. This categorization error is most commonly correlated with proto-homosexuality. In fact, it is so commonly experienced by pre-homosexuals (especially boys) that it’s best understood as a part of the developmental psychology of homosexuality. Thirteen studies have been done, following those children into adolescence and early adulthood, finding that approximately 85% of the time the incongruence corrects itself, and the individuals integrate their sex nonconformity into an understanding of themselves as gay. (4) For this reason, some believe that GID in childhood should be removed from the DSM, asserting that it’s not a mental illness but a common developmental stage of homosexuality. Dr Paul Vasey, who studies male homosexuality in places like Samoa, where the sex-nonconforming dimension of homosexuality is accepted in society, found that few experience distress or identity disruption. (5)
There are several known factors for the persistence of GID into later life: (6)
Comorbid neurodivergence, for example, autism, in which cognitive rigidity seems to prevent the integration of new information into the categorical schemas the child develops
Low economic status and/or familial dysfunction in which the child isn’t adequately supported through the developmental process
Growing up in strictly conservative communities in which gender roles were limited
Childhood sexual abuse or attachment trauma in which the child attaches trauma to their concept of sex
Homophobic trauma, which is internalized
An internalizing psychological disposition
Once a gender identity fully consolidates around late adolescence, it’s more difficult to change, which is why early intervention in childhood is key and psychotherapeutic approaches supporting the entire family were long believed to be best practice.
Despite persistence into adulthood for some people, medicalization wasn’t inevitable. The existence of GID and the reasons some choose to medicalize need to be parsed out. Most of the women of my generation or earlier were motivated to medicalize due to ongoing adversity. In a recorded interview I did with a 69-year-old butch lesbian who took testosterone from 1987-2017, Jessi described her own reasoning for choosing the medical pathway:
“…when I was 21 and that was in 1976 and I didn't know about transitioning anything except for Christine Jorgenson… I had no idea up until 1985 there was even an option for female to male right and I started looking into it because of my background as a separatist lesbian and as a lesbian mother who had a child. My daughter was born in 76 in July and I came out in September of 76, yeah so September October so she was born and I came out period and so I was a brand new mom lesbian mom out of the closet very vocal, very active. I'm a big activist and I always have been and I didn't know about the whole, I mean, it was a rude awakening to find out about the fact that lesbians were unfit mothers, you know, in court and that a lot of the women that were uh, coming out that time were running from their ex-husbands and from Child Services trying to take their kids from them and I ended up being part of that, I got to hide my kid thing and, um, that was very difficult. She ended up living with my parents when she was about seven and through high school because I had to earn a living keep a roof over my head and I had a baby girl and that was all taboo for out lesbians back then in the 70s. So, I was fighting the system and I wasn't the only one, it was a uh um, that was the thing going on back then is lesbian mothers were losing their kids in court. So, I sent my daughter to my parents’ house in order to keep her out of the system and the other pieces to it were that I was already being mistaken as a sir I was being mistaken as a man. Didn't matter. I've always presented as a masculine uh, lesbian and it got in the way a lot… it got in the way of finding work. They wouldn't…I went into a place at one point and they said, “we don't hire dykes here” because they could say that and get away with it, um you know. I got kicked out of a couple of different apartments and houses because they discovered or they didn't let me into their apartment or house because of the lesbianism. So, it was all basically working against me and I just wanted to get on with things you know.” (7)
Jessi’s story is illustrative of the oppressive social forces that motivated most of the butch lesbians I knew, myself included, to masculinize our appearance into male-passing. These were decisions made to leverage what we could at a time when employment, housing and social security was difficult for masculine (butch) lesbians.
Unlike a psychotic delusion, in which one may truly believe they are the opposite sex, those with GID do understand which sex we are, but struggle with cognitive dissonance and social integration. Some experience body dysmorphia. Most transmen of my generation are sex realists.
In alignment with radical feminism, I agree that without gender – that is, without sex-based confinements and oppression - GID and the motivations to medicalize to live as the opposite sex would be eliminated.
Rapid Onset Gender Dysphoria
I assessed fifty-two patients between August 2019 to December 2020. A small sample, but my findings are consistent with what many clinicians are reporting throughout the Western world. 71% of those I saw were girls/young women. Most of those were same-sex attracted (lesbian or bisexual). The boys were all heterosexual or bisexual (none were exclusively same-sex attracted). 19% had an autism diagnosis. 29% had an ADHD diagnosis. 14% were known to be in foster care or were adopted. 15% were known to have severe trauma such as sexual abuse. One patient was in active psychosis. Though I didn’t have data about personality aspects, my clinical impression is that many of the young people I saw had personality disorders like Borderline Personality Disorder.
Most of those I assessed had no childhood history of sex nonconformity or GID. Most came from affluent, middle-class, liberal families. Their trans identity emerged in adolescence often in clusters with their peers.
Many of these youth experienced severe social isolation and rejection, spending most of their time playing video games and limiting social interaction to online spaces like Discord. Few were able to conceptualize who they would be in the future when asked who they might be or what goals they had for themselves as adults.
As illustrated in the table below, what I was seeing in these young patients was starkly different than the GID cohort I was familiar with:
Childhood Onset Gender Identity Disorder | Rapid Onset Gender Dysphoria | |
Age of onset | 2-3 | 11+ |
Economic Status | Lower class | Middle class |
Sex | Mostly boys | Mostly girls |
Political upbringing | Mostly Conservative | Mostly Liberal |
Temperament | Internalizing | Externalizing |
Setting | Rural | Urban |
Sexual Orientation | Vast majority were homosexual | More heterosexuals than previously seen |
Self concept | Sex realist | Focussed on “gender identity” – not sex realists |
Comorbidities | Few. Some autism. Internalizing disorders like depression. | Many comorbidities eg. Autism, personality disorders and externalizing disorders like ADHD |
We know next to nothing about this new cohort, nor the long-term efficacy of medical interventions. Regardless, in a clinical setting, I was discouraged from doing comprehensive assessments by our health authority. Clinical training by the health authority did not include any peer-reviewed evidence about the development of GID or medical outcomes, and I was reprimanded and disciplined for voicing concerns and observations about this dramatic change in cohorts. I withdrew myself from doing hormone readiness assessments and, due to activist pressure (within the health authority and community), I was removed from my role as clinical supervisor at the youth clinic and shuffled off to an adult counselling program. Doxing and smear campaigns were launched by high-profile trans activists. I lost my wife, kids, friends and community, was branded as a “fascist,” and was accused of “gatekeeping” and “conversion therapy”. My profession has completely succumbed to an activist-driven, postmodern political agenda. My understanding of GID, even my self-understanding as biologically female, is no longer welcome. My concerns for the safety and well-being of my clients are seen as bigotry.
Recent systematic reviews of evidence, such as the Cass Review have vindicated me, and nothing about my practice is illegal, according to our federal conversion therapy legislation.8 We successfully lobbied during the parliamentary readings of our federal conversion therapy bill to add a clause which protects comprehensive assessment and a therapeutic exploration of identity development. However, activists have been successfully reporting clinicians to our professional regulatory bodies. I know of colleagues in Canada who have been disciplined by their regulators for working psychotherapeutically with clients with gender related distress.
I’m currently working with the Conservative Party of Canada and several Provincial governments to change this activist overreach into clinical practice. We have been successful in ending the medicalization of minors in the Province of Alberta. New Brunswick and Saskatchewan have prohibited schools from socially transitioning minors under the age of sixteen without parental consent and clinical oversight. Our federal conservatives have made a commitment to end pediatric gender medicine if they form our next government. Legal challenges have been launched by activist LGBT non-government organizations against the new corrective policies and laws. I’ve been granted intervenor status in New Brunswick and Saskatchewan and have submitted an affidavit to Alberta’s legal team in anticipation of a legal challenge there.
I support efforts by legislators to intervene and regulate practice since the medical system, ideologically captured as it is, is unable and unwilling to regulate itself.
I also support the project of radical feminism to better resource girls and women, and to eliminate the social confines of what it means to be a girl or woman. Many of the girls I worked with had an overly narrow concept of what they could be. I’m haunted by one case in particular – a teen girl who was set to begin a medical pathway. She had already socially transitioned (using a male name and pronouns) but was unhappy. She told me that she had been happier as a girl, but when asked why she couldn’t accept herself as a girl, she told me that she didn’t want to have to go back to wearing dresses and growing her hair long. She lit up like it was Christmas day when I told her that girls are allowed to have short hair, wear baggy clothes and wear sneakers. She never came back for hormones.
It was that easy. Yet, I could be charged for “conversion therapy” for having that conversation with her - a young butch lesbian who’s now happy. And she’ll stay happy, with her body intact, if she doesn’t experience the systemic homophobic and misogynist oppression that my generation did. Postmodern trans activism, what we call “gender ideology”, is a clear example of homophobia and misogyny. This girl was one visit away from medical conversion into a “straight man”. I make no apologies for my anger about this, nor do I regret my many losses for saying so.
References
American Psychiatric Association. (2013) Gender Identity Disorder. In Diagnostic and statistical manual of mental disorders IV 1994.
Littman L (2019) Correction: Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. PLOS ONE 14(3): e0214157. https://doi.org/10.1371/journal.pone.0214157
Stoller R. Sex and Gender: The Development of Masculinity and Femininity, Routledge. 1968
Singh D, Bradley SJ, Zucker KJ. (2021) A Follow-Up Study of Boys With Gender Identity Disorder. Front Psychiatry. 2021 Mar 29;12:632784. doi: 10.3389/fpsyt.2021.632784. PMID: 33854450; PMCID: PMC8039393.
Vasey PL, Bartlett NH. (2007) What can the Samoan "Fa'afafine" teach us about the Western concept of gender identity disorder in childhood? Perspect Biol Med. Autumn;50(4):481-90. doi: 10.1353/pbm.2007.0056. PMID: 17951883.
Zucker, K. J., & Bradley, S. J. (1995) Gender Identity and Psychosexual Disorders and Children and Adolescents. Gilford Press.
Kimberly, Aaron. Bearded Lesbians Podcast (2025) Jessi: Lesbian Land. Substack https://aaronkimberly.substack.com/publish/posts/detail/154178356?referrer=%2Fpublish%2Fposts
Cass, Hillary (2024) Independent review of gender identity services for children and young people. https://cass.independent-review.uk/home/publications/final-report/
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