Why Therapists Trans Away the Gay

Looking back on 60 years of support and affirmation

Imagine if breast or penis amputations were disproportionately inflicted on black people – progressives would rightly throw a fit. Today I'm going to bring that same sense of urgency to the question of why therapists help gay people degrade their bodies. 

Gender medicine has severe physical side effects. It’s objectively harmful. Therapists are complicit in the harm when they formally endorse patients for surgery and when they affirm trans identities. While some argue the harm is necessary to avert suicide, no reliable evidence supports the claim.

This post examines over a dozen influential therapists and three major psych institutions: the American Psychiatric Association, the American Psychological Association, and the UK’s Gender Identity Development Service. I diagnose them at the end.

The Patients

Lesbians make up only about 2% of the female population, yet in the 20th century almost all FTMs were lesbians. The mid-century Danish gender doctor Christian Hamburger reported that the reason women sought his services was often so they could legally marry their girlfriends. Male-attracted FTMs were “super rare” according to Ray Blanchard, who practiced gender therapy from 1980 to 1995 in Toronto. 

Among UK youths seen by its Gender Identity Development Service (GIDS) in 2012, over 90% of girls said they were attracted to girls. A 2011 Dutch study found over 95% of girls who wanted to be boys from childhood through adolescence were attracted to girls. Of the first 70 kids whose puberty was blocked in the “Dutch protocol” study, 62 were homosexual and only one, a boy, claimed to be heterosexual. Today even middle-aged lesbians are flocking to plastic surgeons for chest masculinization (at 25:30). (Listen to gay detransitioners share their stories on a 2023 Genspect conference panel.) 

Gays want to change sex because they’re isolated, misinformed, uncomfortable being different, traumatized by bullying, exposed to social contagion in “the community,” trying to expand their dating pool, targeted by groomers, or they hate themselves. 

Not all trans people are homosexual. Fetishists have been in the mix since Einar Wegener. People with delusions have also sought genital surgery. Lately a wide range of kids, including autists and sex abuse victims, have come down with “gender dysphoria” after being indoctrinated online or at school. But in this post, I’m focusing on gays of all ages – a group of people who are naturally susceptible to sales pitches for sex change.

So: do people identify as trans because they’re gay? And is that something we should worry about? Here are the answers their therapists have given over the decades.

View #1: It’s Not Happening

The mental health industry’s evergreen answer to both questions is “nah.”

Harry Benjamin’s Acolytes

Homosexuals and transsexuals were two distinct categories of people, according to Harry Benjamin. An endocrinologist by trade, he freestyled about psych topics and his theories influenced the first wave of American gender shrinks. 

In The Transsexual Phenomenon (1966), Benjamin explained that the male transsexual wasn’t gay because:

“He does not like [the gay life]. He actually dislikes homosexuals and feels he has nothing in common with them.”

Same for lesbians:

“Sexually, female transsexuals can be ardent lovers, wooing their women as men do, but not as lesbians, whom they often dislike intensely.”

Thus confident that transsexuals and homosexuals weren’t the same people, Benjamin asserted:

“The homosexual is a man and wants to be nothing else. He is merely aroused by another man. Even if he is of the effeminate variety, he is still in harmony with his male sex and his masculine gender.”

(Like a lot of people when they’re discussing gays, Benjamin tended to lapse into phallocentricity.)

Benjamin also wrote that transvestites (fetishists) did not want genital surgery. 

Gender doctors with actual psych credentials clung to Benjamin’s model, which I’ve called the false trichotomy. Well into the 1980s, the media and even judges dutifully parroted their claim that homosexuals were distinct from transsexuals. 

One more thing about Benjamin’s “classic transsexuals”: he said they identified with the opposite sex from childhood. That’s a common characteristic of gays.

Ira Pauly

Gender doctors soon had to acknowledge that gays were seeking their services, and that few if any of their patients fit Benjamin’s ideal of a transsexual. But some prominent gender shrinks resisted reality for years, drawing dubious a distinction between “primary” and “secondary” transsexuals. In 1983, the psychiatrist Ira Pauly presented a paper with co-authors:

“[Others maintain] that patients who request sex reassignment are usually secondary transsexuals, that is transvestites or feminine homosexuals. … We find, however, that most requests for sex reassignment do come from primary transsexuals whose cross gender identification goes back to childhood, and appears to be quite stable over a period of many years.”

Around that time Pauly was transing a 14-year old lesbian. 

The Puberty Blockers

Kids can be perceived as masculine or feminine from toddler-hood, but they don’t develop sexuality until puberty. This can lead a kid to identify with the opposite sex before they can possibly figure out they’re gay – it’s a decade-long head start for trans identity that should make mental health professionals worry about misdiagnosis. But many of the profession’s leaders have instead assured everyone that that can’t possibly happen because “gender identity” is real and develops independent of sexuality.

Shrinks have claimed since at least 1972 that gender identity solidifies in early childhood. The first purveyor of that dogma was psychiatrist John Money, whose work in support of that thesis was discredited in the 1990s.

When US gender doctors started transing 12-year olds with puberty blockers in the mid-2000s, they repeated Money’s (never proven) hypotheses about early-life gender identity formation, without citing him. 

The World Professional Authority for Transgender Health (WPATH), which included mental health professionals, actually acknowledged that most “gender dysphoric” prepubescent children desisted and grew up to be gay in its 2012 publication, Standard of Care version 7 (SOC7). But it claimed that day 1 of puberty was a bright red line that changed everything:

“In contrast, the persistence of gender dysphoria into adulthood appears to be much higher for adolescents. No formal prospective studies exist. However, in a follow-up study of 70 adolescents who were diagnosed with gender dysphoria and given puberty-suppressing hormones, all continued with actual sex reassignment[.]”

Other researchers have read that study (from the famous Dutch protocol literature) to suggest that blockers disrupted the natural process of growing into one’s sex. But WPATH didn’t consider that, instead treating this one data point as bulletproof support for the ancient wisdom that 12-year olds who identified with the opposite sex would never desist. Mental health professionals relied on SOC7 to recommend kids for blockers.

One of the chief gender doctorates pressuring the UK health authorities to prescribe blockers was the psychologist Richard Green. He knew all about the desistance literature. He’d authored a book in 1987 called “The Sissy Boy Syndrome: The Development of Homosexuality.”

Tavistock Leadership

The Tavistock is a formerly-prestigious mental health clinic in the UK. Its Gender Identity Development Service (GIDS) treated minors until recently. Hannah Barnes reports in Time to Think (2023):

“Most people have told me that homophobia was a problem [for GIDS patients], and particularly among the adolescent girls who were presenting in huge numbers.”

Barnes cites the observations of psychologist Kirstie Entwistle, who was based in GIDS’ Leeds practice:

“The level of homophobia she witnessed generally across her caseload shocked Entwistle. She says it wasn’t discussed in the team, and there was no training on how to talk about sexuality with young people.”

GIDS clinicians did not routinely address sexuality with their patients, it seems from the Cass Report. This means that they weren’t screening kids for internalized homophobia and they weren’t counseling them about how vaginal atrophy or stunted penile growth would affect their future relationships.

Some GIDS clinicians knew they were transing away the gay (more on them in a minute), but the institution itself was in denial. 

Concerned gay clinicians said their director, Polly Carmichael, implied they couldn’t be as objective as their straight colleagues. Carmichael denied it, but then their unnamed colleague told Barnes that fears of transing away the gay were from “a number of clinicians who were gay … so they’re not coming from a neutral standpoint.” 

According to gay clinician Matt Bristow:

“[W]e put up with hearing homophobic remarks being made on a daily basis for a number of years. And when we tried to talk about that in the team, it was kind of ignored.”

Jack Turban

The DSM-5 changed the criteria for Gender Identity Disorder (GID) and renamed it Gender Dysphoria. Now people have to literally say they are the opposite sex in order to score a diagnosis. Otherwise, GD is basically the same as GID, which itself was always a sham diagnosis.

The change to requiring certain magic words (“I’m a boy”) was not based on clinical studies showing they had predictive value. 

Today’s gender doctors like the psychiatrist Jack Turban dismiss the desistance literature by arguing the kids in those studies were diagnosed with GID, not GD. It’s their new fig leaf; they no longer hide behind the dubious data point that WPATH SOC7 used.

Turban is gay. He’s in a better position than the average straight clinician to see the hazard that gender medicine poses to young gays. He’s also in a better position than the average straight clinician to build a brand as an LGBTQ guru. 

View #2: It’s Happening and It’s OK that It’s Happening

Doctors Who Transed Lesbians

Early gender doctors refused to treat straight women. The only women they would trans were lesbians, and they seemed comfortable doing so – they didn’t strain to distinguish female transsexuals from homosexuals the way they did with males. The UCLA psychiatrist Robert Stoller came to believe female transsexuality was “an ultimate form of homosexuality.”

Susan Bradley

The psychiatrist Susan Bradley founded a gender identity clinic for minors in Toronto in 1975. I’ve written about the regressive 1995 book she co-authored with Kenneth Zucker. 

In 2022 Bradley recalled one of her first patients, a young woman who wanted to be a man. Bradley “helped” her through her medical transition. Afterward the patient “was able to marry” her best (female) friend. 

“I don’t think he had ever considered doing – being gay, or being lesbian and engaging in that type of relationship.”

Years later, in the patient’s grief after her wife died, she decided she needed phalloplasty. Bradley laughed as she recounted “signing papers” for her to receive the risky, disabling surgery, in which flesh is harvested from one part of the patient’s body, carved out, and stitched to her groin. 

“It turned out for me to be a very interesting situation.”

Bradley’s interviewers (Sasha Ayad and Stella O’Malley) brought her to the subject of transing away the gay. Bradley acknowledged that “there are opportunities for [trans-identified kids] to emerge as gay or lesbian.” But she claimed that she could not have helped such patients back when she was treating them because there was no “support group” to refer them to. Addressing the subject on her own with the patient apparently was not an option.

Bradley defended her transing of that first lesbian FTM patient in the 1970s:

“I would probably have had difficulty trying to convince him that being lesbian was a reasonable outcome at that point because socially it was not very acceptable … they feel they don’t have any other solution … it becomes, what do you do with it [laughing] … but I think some [lesbians] can find something in the transition where somebody accepts them for who they are, and I think that’s going to work.”

What training did Bradley seek to understand lesbians, and when? Did she provide grief counseling to her widowed patient before referring her for genital surgery?

In recent years Bradley has become concerned that autistic kids are being transed. 

Ray Blanchard

The psychologist Ray Blanchard is gender-famous for his work analyzing fetishist MTFs in the 1980s and 90s, whom he dubbed “autogynephiles.” Like his peers, he noted that just about all MTFs were either homosexual or fetishists. In 2023 he explained to Julie Bindel that he was never very interested in the gay patients because for them, transing was just “one additional step.” He’s also described this cohort as “feminine gay men who jumped the tracks.”

In 2017, Blanchard co-authored a piece for 4th Wave Now with psychologist Michael Bailey. They were aiming to explain the different types of gender dysphoria to a lay audience of parents of teens who identified as trans, which included many cases of “rapid-onset gender dysphoria” (ROGD). Since these kids had been gender-typical until recently, they were probably straight. Blanchard and Bailey wrote:

“To us, the most tragic group [of trans-identified kids], along with their families, includes those who have acquired rapid-onset gender dysphoria. … They are at risk for unnecessary, disfiguring, and unhealthy medical interventions.”

I suppose they’re implying the surgeries are necessary for homosexual gender-dysphoric kids who defied gender stereotypes from a young age. But there’s no credible research to back them up.

Blanchard is rumored to be gay. Not the type who’s jumped the tracks.

The Manuals

The US psych establishment used to worry about gay people but no longer does, judging by its manuals.

In 1994, the American Psychiatric Association published the fourth edition of its Diagnostic & Statistical Manual (DSM-IV). It included a diagnosis called “sexual disorder NOS [non-specified],” which encompassed “persistent and marked distress about one’s sexual orientation.”

This meant, basically, that clinicians should be on the lookout for internalized homophobia. When determining whether to diagnose a patient with GID (or anything else), clinicians had to weigh whether she actually suffered from sexual disorder NOS.

In 2013, the DSM-5 was published. It contained no diagnoses related to sexual orientation.

In 2015, the American Psychological Association published “Guidelines for Psychological Practice With Transgender and Gender Nonconforming [TGNC] People.” It did not warn of the risk of misdiagnosing gays as trans. Yet it contained this observation:

“Through increased comfort with their body and gender identity, TGNC people may explore aspects of their sexual orientation that were previously hidden or that felt discordant with their sex assigned at birth.”

In other words, some gays can’t pursue relationships with people they’re attracted to unless they think of themselves as the opposite sex. Should these patients be treated for internalized homophobia? No, because no such thing exists (according to the DSM-5).

The drafters of the TGNC Guidelines included Walter Bockting, who perjured himself in 2008, and Laura Edwards-Leeper, who built her career helping Norman Spack trans 12-year olds.

Both the DSM-5 and the 2015 Guidelines note the connection between homosexuality and “gender” distress. (Guidelines: “Although some research suggests a potential link in the development of gender identity and sexual orientation, the mechanisms of such a relationship are unknown.”) These manuals neutrally state the facts and move on.

Tavistock Clinicians

Barnes describes the view of some GIDS clinicians at the Tavistock:

“[They] acknowledged that while they suspected that some young people might be gay, the world they lived in made being trans (and straight) a preferable option. It wasn’t ‘converting gay kids,’ but accepting reality. GIDS psychologist Dr. Alex Morris gives an example of a young [boy] who lived in a rural part of the country …”

Morris says to Barnes:

“Are they really gay? Or are they really trans? Or is that a really unhelpful way of thinking about it? And for me, it’s an unhelpful way of thinking about it.”

Elsewhere Barnes quotes the clinician Natasha Prescott:

“So sometimes I might raise something [with colleagues], and it would make people feel, I don’t know, quite anxious or attacked. But then there was a real wish to protect people from horrible, unpleasant feelings, so someone would swoop in and just make it nice.”

I wonder if Morris was one of the clinicians who tried to avoid “unpleasant feelings.” 

View #3: It’s Happening and It’s Not My Fault

Norman Fisk

Defenders of the false trichotomy tended to complain that patients knew what they wanted to hear (they’d read Benjamin) and so fabricated their bios. If homosexuals slipped under the knife that way, you couldn’t blame their innocent psychologists. This defensiveness persisted at least through 1979.

Stanford psychologist Norman Fisk in 1974 expressed the problem more softly:

“I feel that many of these patients were in full flight from … effeminate homosexuality … and were rushing to embrace the diagnosis of transsexualism for many valid reasons.”

Fisk argued that gender doctors should stop striving for “the differential diagnosis aimed at clearly identifying a subgroup of patients termed transsexuals[.]” 

He proposed replacing the true-transsexual paradigm with “gender dysphoria,” a looser concept that included those flying homosexuals. He cited a study showing that “classical transsexualism” didn’t predict how successful a patient would be post-op (perhaps because the whole concept was a gender doctor fantasy).

Fisk explained why transition might appeal to gay patients:

“In our society, it is certainly much more acceptable and non-socially stigmatizing to have a legitimate medical illness than it is to suffer from a supposed moral perversion, sexual deviation or fetish.”

Fisk wrote in the tone of a neutral observer, but he wasn’t one. He pushed and profited from the view that transsexuality — excuse me, gender dysphoria — was a medical condition.

Paul Walker

Psychologist Paul Walker echoed Fisk in a 1985 documentary. He acknowledged that compared to the “moral problem” of homosexuality, “you would rather label yourself with a medical problem,” meaning transsexuality.

Walker himself was openly gay. By 1979 he expressed concerns about transing gays who should be receiving “psychotherapy” instead. In the 1980s he operated a practice on Castro Street in San Francisco, which included treatment of gay men for “problems of loneliness.” But he also kept transing people.

Walker hardly ever studied the human mind through a lens other than gender. John Money mentored him as a student; Reed Erickson funded his work from his grad school days through moves to Texas and then San Francisco. In 1979, Walker co-founded the Harry Benjamin International Gender Dysphoria Association (HBIGDA) and became its first president. 

Walker’s overarching loyalty was to gender medicine. He hoped to improve and legitimize it through HBIGDA; he also hoped to expand the franchise to patients who planned to be “gay” post-transition, like his friend Lou Sullivan.

When Fisk and Walker claimed gays wanted to escape “moral” judgment, they were pointing the finger at religion. But religion isn’t the only culprit behind homophobia and gay isolation. And priests didn’t invent gender medicine.

Kenneth Zucker

Kenneth Zucker is a child and adolescent gender psychologist in Toronto. He acknowledges that gender medicine takes a toll on the body and that young children who announce a cross-sex gender identity may change their mind. For those smidgens of honesty he’s been canceled by activists and adopted by gender critics.

Zucker “supports” kids who want to transition once he believes their gender identity has solidified. In his 1995 book with Susan Bradley, his 2000s media hits, and his 2020s appearances on the gender-critical circuit, he’s opaque about the details. Lately he says he wants to help kids become content as non-stereotypical members of their sex. But if that doesn’t work by age [unclear] then trans ‘em.

Zucker is agnostic about socially transitioning kids at a very young age, even though he acknowledges that makes them more likely to transition later.

Tavistock

Barnes on GIDS:

“Clinicians would never dream of telling a young person that they weren’t trans, or that they were gay instead.”

Sure, being so blunt might alienate the kid. Therapists probably should be strategic in how they approach a gay patient who’s in denial, or a child who’s clueless and scared.

But were GIDS clinicians craftily plotting to lead gay kids to the truth? In many cases, they were referring them to an endocrinologist.

View #4: It’s Happening and It’s Bad

Some mental health professionals have gotten it right. Kinda.

Charles Socarides

In 1969, Charles Socarides observed that transsexuals were “either transvestites, homosexuals, or … struggling against intense homosexual urges.” In the era of the false trichotomy, this put Socarides ahead of his time. He thought that for a man, identifying as a woman “alleviates … guilt for his homosexual object choice.” 

Socarides opposed gender medicine. He also opposed homosexual sex. He devoted his career to developing methods of conversion therapy for gays, never backing down even as researchers found evidence homosexuality was inborn and his own son came out to him.

The Guys Who Shut Down the Johns Hopkins Clinic

Johns Hopkins opened its gender clinic in 1966. Some of the psychiatrists there were opposed from the start. Some were into it, like Jon Meyer. But by the mid-70s Meyer was skeptical that his patients were benefiting from gender medicine. He conducted a study. While “transsexuals” reported satisfaction after surgery, their lives were just as disastrous as before. Meyer’s work convinced his boss, Paul McHugh, to shut down the clinic in 1979.

These psychiatrists knew they were transing gays. In 2004 McHugh wrote:

“One group [of transsexual patients] consisted of conflicted and guilt-ridden homosexual men who saw a sex-change as a way to resolve their conflicts over homosexuality by allowing them to behave sexually as females with men.”

But the study was marred by a bias against “gender-inappropriate” relationships. For example, an MTF who married a regular man was scored as a success; an MTF who paired off with another MTF lost points.

Leslie Lothstein

Leslie Lothstein was a psychiatrist at Case Western in Ohio when he published a book on FTMs in 1983. He argued that clinicians should try to treat these patients with therapy before transing them. 

In the book, Lothstein references the patients’ lesbianism. For example, he notes their motives include “saving a relationship in which she fears that a lover might abandon her if she does not become more masculinized” and “increase her sexual libido in order to compete with other men for female lovers.” 

Lothstein left Case Western in 1986. By 2002 (perhaps long before that) he was no longer practicing gender medicine. 

Stephen Levine

The psychiatrist Stephen Levine has been at Case Western since the 1970s (he must have crossed paths with Lothstein). He acknowledges that gender medicine has side effects. He’s concerned about “premature” labeling of kids as trans because they might grow up to be gay.

But Levine doesn’t oppose transition for adults. He doesn’t even oppose it for minors. Under cross-examination he explained why he might occasionally trans a kid:

“We don’t know what to do and we eventually go along with the patient’s sincere desire to try hormones.”

Levine is fundamentally a gender doctor. He believes that gender identity is real and meaningful. I’m putting him on the honor roll because of his (paid) testimony about kids who might grow up to be gay. But when it comes to gay adults – well, who has he been transing all these decades?

Tavistock

The clinicians who spilled to Barnes about homophobia got it. Or at least, they were onto something. Many blew the whistle or simply bolted because they thought the way GIDS practiced was unethical. Many opposed a pill-mill model of care; they wanted to administer talk therapy before resorting to endo-scramble. But that doesn’t mean they opposed medicalization.

Barnes:

“These clinicians do not take a hard-line view on medical interventions. All supported young people in going forward for puberty blockers.”

View #5: It’s Happening and It’s Funny

Barnes:

“[T]here was even a dark joke in the GIDS team that there would be no gay people left at the rate GIDS was going.”

What’s Wrong with These Shrinks

The mental health industry has not covered itself in glory when it comes to treating trans-identified gays. How has it done with gay patients in general?

As a young lesbian in late-2000s NYC, I perceived my therapists as well-meaning but maladroit. Once I told a therapist I felt like everyone was staring at me whenever I went out with my girlfriend. She suggested I was just dating the woman for attention. (It was very common back then for people to accuse young feminine lesbians of wanting attention. And I did want attention — from women.) I didn’t think non-lesbian shrinks would ever understand that part of my life, but I told myself (incredibly) that being gay wasn’t the cause of my problems, anyway.¹

I suspect psychology has never really mastered the gay experience. Only a fraction of researchers are themselves gay, of course, and many of those who are gay are ensorcelled by gender identity theory. The lack of leadership when it comes to homosexuality leaves clinicians in the field to wing it.

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Picture a woman presenting for her first therapy appointment. She’s slouching in a flannel shirt from the men’s department that’s baggy at the shoulders. Her hair is cut short. The therapist perceives her as awkward, with a squeaky voice that doesn’t match her lumberjack outfit. When the patient says she’s thinking of transitioning, the therapist affirms her.

Over the next year, the patient medicalizes. Testosterone makes her confident. She smiles more. Her shirts fall elegantly off her more muscular shoulders, especially after mastectomy. The road is lined with milestones – she and the therapist are accomplishing transformation together. They can measure it in whiskers and octaves. 

The patient makes friends in a trans dude support group. He has blossomed under my care, thinks the therapist.

It can be exhilarating to accompany gay people on the early stages of their gender journey. It can also be fun belonging to the gender doctor community. Mental health practitioners in this field command the respect of surgeons, not to mention Daniel Radcliffe.

Homosexuals are the most appealing gender patients. Their mental problems aren’t intractable and (in the opinion of the therapists) they look cuter on cross-sex hormones. If not for the gays, gender therapists would have to spend most of their time with autogynephiles.

The therapists most invested in transing gays are the ones ranked as “experts” on gays. Or “LGBTQ folks,” to use the correct terminology.

The Therapist Who Helps Gays

Ayad and O’Malley recently interviewed Scarlet, a young gay man who’d been transed in his early teens. He recalled asking his endocrinologist who would be attracted to him as a trans woman – gay men or straight men. The endo responded: “Both.”

Gays have never received satisfying information about their sexual orientation. In the past, scientific research was patchy; around 2012 it became weirdly suppressed. The gender industry exploits the resulting ignorance, filling the gaps and slathering over the facts with propaganda. Now young gay boys are learning that everyone is attracted to neutered men with breasts and surgical wounds next to their anus. 

It’s hard for therapists to handle patients like Scarlet who’ve been lied to by other authority figures. Barnes writes about a conversation she had with Andrea Walker, a social worker at GIDS, on the difficulty of explaining medical side effects of puberty blockers to deluded kids:

“Although it was important to be honest, in order to try to gain informed consent, ‘actually you’re dismantling these fantasies of young people, aren’t you?’ [Walker] says. ‘That’s what I felt I was doing. I was making young people who are already really sad and vulnerable, really, really sad.’”

Therapists face a choice when a trans-identified lesbian shows up at their door. They can play cheerleader to a process that is mainly physical and powered by medical doctors, thereby gaining expertise in the cutting-edge specialty of LGBTQ care. 

Or the therapist can dismantle the patient’s fantasies. No affirmation. No referral to a support group. No professional esteem, and perhaps a complaint to the licensing board.

The patient might not come back. If she does, the therapist can begin to learn how to treat gay patients. 

Follow me on X – Unyielding Bicyclist

1. The cause of most women’s problems is that they’re straight.