Front Burner - The Canadian helping U.S states defend anti-trans laws

Episode Date: November 28, 2023

Since 2020, state-level politicians in the U.S. have passed dozens of bills that LGBTQ advocates say are anti-trans. When it comes to defending these laws in court, states have been turning to an unlikely ally: Toronto psychologist James Cantor. He’s testified in more than 20 cases in the U.S. involving transgender issues. Today on Front Burner, CBC investigative journalist Jonathan Montpetit on Cantor’s influence, and how his scientific expertise is being weaponized by conservative Christian groups and Republican politicians to roll back trans rights in the U.S. For transcripts of Front Burner, please visit: https://www.cbc.ca/radio/frontburner/transcripts Transcripts of each episode will be made available by the next workday.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. I'm Jonathan Mobitsy. I'm a reporter with the CBC's investigative unit. Mr. Clerk, please take the vote. Ayes 77, 16, nays.

Send Bill 1 and receive a constitutional majority. I hereby declare a pass, an objection, a motion to re-sear his table. Bob, next bill, Mr. Clerk. House Bill 66. Since 2020, state-level politicians in the U.S. have passed dozens of bills that LGBTQ advocates say are anti-trans. These new laws restrict everything from what sports teams trans people can play on to what bathrooms they can use. Many of these new laws ban gender-affirming care for minors,

treatments that doctors say can be medically necessary. Trans teens and their families feel like they're being chased out of their homes. If another child my age needed life-saving health care and it was denied to them, people would lose their minds. The reality is that we're pretty much refugees in our own country. And then we have to say to ourselves, do we want to continue to raise our kids in an area that's so intolerant? And if they're willing to do that, then what else are they willing to do? When it comes to defending these laws in court,

states have been turning to an unlikely ally, a Canadian psychologist. This is Media Unit 1 in the video-recorded deposition of Dr. James Cantor. He's a trusted expert witness for the anti-trans movement, called upon to question gender-affirming care. Very many people exaggerate the amount of suicide and suicidality that's reported amongst trans populations. Leveraging a reputation built at a world-renowned Toronto clinic, alongside a group of like-minded

psychologists. Of any single cohort of researchers in trans medicine, their work gets cited and mobilized the most by anti-trans crusaders. Today on FrontBurner, we're talking about the influence of a Canadian psychologist and how his scientific expertise is being weaponized by conservative Christian groups and Republican politicians to roll back trans rights in the U.S. Welcome to Nashville, where the local time is 10.02. Please stay seated with your seatbelts down. Tennessee has been at the forefront of the recent surge in anti-LGBTQ legislation, passing more of these

laws than any other state in the U.S. This year alone, state politicians have passed five different bills that threaten trans rights. One of these laws bars teachers from using a trans student's pronouns. Another prevents trans students from playing on certain sports teams. And in the spring, Tennessee joined a growing number of other states in banning access to gender-affirming care for minors. Now, teens will no longer be able to get medical treatments that can help them deal with gender dysphoria. That's the distress a person can experience when their body doesn't align with their gender. I flew down to Tennessee to find out what was behind this campaign against trans rights. Hi there.

Hi. Hi, how are you? I'm Jonathan. Hi, Josh. Nice to meet you. Meet you. Kyleen. Nice to meet you, Kyleen. against trans rights. Sabi Kumar is one of the Republican politicians in the Tennessee legislature who has sponsored many of these anti-trans bills. Representative Kumar. All right. How are you? Very good. How about yourself? Good, good, thanks. Thanks so much for meeting with us. Sure, it's a pleasure. Please have a seat.

His office near the Capitol is filled with trinkets he's picked up at flea markets, including a white-painted tablet that says, I pray for America. Those are brought to me by constituents. The first question I ask him is why he and his fellow Republicans keep trying to roll back trans rights. It is a very important issue because we have to realize that we are a conservative state. Tennessee and Tennesseans are conservative, and that is reflected in our legislature. Those conservative values are based on God, family, country, and the values that America was founded on. According to those values, homosexuality in the biblical scripture is an abomination.

And our constituents in majority believe that. So because we are following those biblical and godly values, that is reflected in the legislation that we pass. Now, be clear. The state's ban on gender-affirming care for minors is particularly contentious. Conservatives like Kumar say they want to protect children from being mutilated, which is how they refer to gender affirmation surgery. But prior to the ban, these surgeries were rare in Tennessee for anyone under the age of 18. Gender-affirming medical care more usually involves puberty blockers and, for some older teens, hormones like estrogen and testosterone. A growing number of studies has found these approaches can reduce the risk of depression, self-harm, and suicide in trans teens.

Puberty is often a time when gender dysphoria really spikes for people. That's Greta Bauer. She's director of the Eli Coleman Institute for Sexual and Gender Health at the University of Minnesota's medical school. This type of care is definitely not considered experimental in medicine. The standards of care for this come from the Endocrine Society, the World Professional Association for Transgender Health, the Pediatric Endocrine Society. All the major bodies of medical professionals have endorsed these standards of care.

Civil rights groups say it's unconstitutional to prevent teens from accessing medical treatments just because they're trans. The American Civil Liberties Union is one of the groups that challenged Tennessee's ban on gender-affirming care in court. My name is Josh Block. I'm a senior attorney at the National ACLU's LGBTQ Project. You know what? I'm going to hide my photo of myself. Block is part of the team working to overturn the ban. In our video call, I can see a giant filing cabinet behind him. He has several other cases like this and says the workload has been crushing. The stated objective in these laws about banning gender-affirming

health care is this idea that if we ban the health care, then kids will somehow magically not be trans. But in order to defend a ban on gender-affirming care, Block says states have to adopt a different strategy in court. They can't get up in court and say the reason for our laws is because we are ideologically opposed to transgender people. And so you need people with MDs or other degrees willing to support their arguments. The same experts that testify for the states on behalf of these health care bans are also testifying for them on behalf of restroom bans and on bans on teachers being able to refer to a trans kid by their proper pronouns. It's the same swath of experts testifying in all these anti-transgender cases. testifying in all these anti-transgender cases. One of these experts is James Cantor,

PhD in psychology from McGill and a career spent researching and practicing in Toronto. In more than two dozen cases in the U.S., Cantor's provided expert testimony casting doubt on the scientific consensus around transgender health. His testimony helped defend a teacher in West Virginia who refused to use the pronouns of his trans students. Right now in Loudoun County after a Virginia judge ordered the school system to reinstate a suspended teacher.

That teacher was suspended for... It was used to defend laws in Indiana and Utah that restrict what sports teams trans students can play on at school. New at 10, transgender girls in Indiana are now banned from playing on girls' teams at schools there. The new law kicked in today for grades... Cantor testified in support of Oklahoma's bathroom ban. Oklahoma joins a dozen other conservative states passing laws targeting the transgender population over bathroom use, sports, and gender-affirming treatment...

And this year, as Montana, Missouri, Texas, Georgia, Kentucky, Oklahoma, Idaho, Indiana, and Tennessee all moved to restrict access to gender-affirming care, Cantor helped each of them defend their laws in court. Who are you, and what do you do? Sure. My name is James Cantor, and I'm a sex researcher, of all things. Formally, I'm a psychologist and neuroscientist, but really what I do is study whatever it is that makes people into whatever it is they are, whether that's sexual orientation, gender identity,

or the really unusual sexual interest patterns, things we call the paraphilias. We're in Cantor's office in downtown Toronto. The room has soft lighting, abstract art on the walls, and a couch that's mid-century modern. Cantor says he just redecorated, but doesn't actually spend much time here anymore. I've essentially shut down most of my clinical practice, really really in order to be able to participate in these cases. Originally from New York, Cantor came to Canada as a graduate student in psychology. You know, I grew up a gay kid myself, just naturally wondering, you know, why am I different from the people around me? Then I was studying at what was then the Clark Institute of Psychiatry in Toronto.

at what was then the Clark Institute of Psychiatry in Toronto. But they were doing research, of all things, on what makes pedophiles pedophiles. They wanted to analyze in the brain, you know, what makes them interested in that. And just being confronted by that question all of a sudden expanded the question in my head. It wasn't just what makes gay people gay or what makes me different. Now it was what makes anybody into whatever it is they're into. I was now into the broad question. Up to that point in his career, the bulk of Cantor's research focused on pedophilia and sex offenders. But around five years ago, he became increasingly vocal in his criticism of gender-affirming care. Then, in 2021, one of the most conservative Christian lobby groups in the U.S.,

the Alliance Defending Freedom, approached him. They asked him to testify in support of a medical professor at the University of Louisville. The professor said he was fired for, among other things, suggesting parents should discourage their children from identifying as trans. So that one case, you know, made the news in those rounds. And then as other U.S. states and other lawsuits got involved, they needed to find somebody, again, willing to talk about the science. So that case led to another case, which led to another case.

So part of it was just because I had a background in neuroscience, I became, you know, I just had the background and I had the knowledge to be able to help people answer these questions and therefore had to manage it legitimately in science. controversial, there aren't many scientists willing to say it out loud. What the science reveals isn't always popular. What is or isn't in the brain isn't always what people want to hear. Conservative state governments do want to hear from Cantor, and they're willing to pay him $400 an hour to testify. For this year, it's been double, maybe two and a half times what I would normally make in a year. So the money has indeed been very good, but really what I'm hoping still is to be able to take this time off and write a book or do something productive with the leftover time. In the Dragon's Den, a simple pitch can lead to a life-changing connection.

Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. Hi, it's Ramit Sethi here. You may have seen my money show on Netflix. I've been talking about money for 20 years. I've talked to millions of people and I have some startling numbers to share with you. Did you know that of the people I speak to, 50% of them do not know their own household income? That's not a typo, 50%. That's because money is confusing. In my new book and podcast, Money for Couples, I help you and your partner create a financial vision together. To listen to this podcast, just search for Money for Cups. When Cantor testifies about gender-affirming care, he tells the courts that social media and

peer pressure are causing more and more teens to identify as trans and seek out puberty blockers or hormone treatments. Everything happens on social media, everything photoshopped and perfected, and everybody's feeling insecure in that generation about the kind of woman they will be, the kind of man they will be. And so declaring, they're not even, the majority of them aren't even declaring themselves to be men. They're declaring some in-between status like fluid or non-binary, mostly to escape being compared to being a perfect woman, being a perfect man. A lot of people, what the situation looks like, are using trans status to escape their insecurities about their pending adulthood.

So it's not so much that I advocate, I don't advocate for any particular policy, that I advocate, I don't advocate for any particular policy, but really what these people need is the therapy for dealing with the situation that they're in and you know, broadband is one of the policies that's being introduced in throughout the US to produce it, but I can't say that that in and of itself is the best thing to do. The best thing to do, as I say, is to get these people the mental health treatment that they need. In his court testimony, Cantor often points to two studies to back up this phenomenon, which is sometimes called rapid-onset gender dysphoria. He also uses these two studies to suggest many teens with gender dysphoria also

have other mental health problems, which may be really causing their distress. But both of those studies have been widely contested. The first required a correction, and the second was eventually retracted. Here again is Greta Bauer. The evidence on this is very clear. There's no increase in, no elevated risk, no excess risk of personality disorders in trans and non-binary populations. What there is with regard to mental health is an extreme excess of depression, anxiety, and suicidal behavior and ideation. And these are things that research has consistently tied to experiences of transphobia and consistently found to be reduced with gender affirmation, whether that's medical gender affirmation, legal gender affirmation, or social gender affirmation.

Cantor also draws on contested research to claim that most teens who identify as trans will stop doing so as they get older. From his point of view, gender-affirming care creates more problems than it solves. So we seem to, in a lot of these kids, be causing prolonged gender dysphoria rather than allowing it to just kind of fall by the wayside by itself. Rather than letting these kids desist, we're encouraging it so that these now young teenagers don't know anything different. They don't know that there's possibly another way to live their lives. But Bauer says regret rates are actually quite low among teens who undergo treatment at gender identity clinics.

For adolescents who are referred for gender-affirming medical care, identity seems to be pretty consistent with the exception that, you know, in our study over a couple of years of follow-up, about one in five changed how they registered their identity in the survey. But this is primarily between binary trans and non-binary identities. As people are trying to figure out, you know, how to best characterize their gender, they weren't necessarily moving that to cisgender identities. In interviews and in testimony, Cantor likes to

say he doesn't have opinions, that his opposition to gender-affirming care is based solely on science. I have no ideology in either way. All I have is the current state of knowledge, and the current state of knowledge with more research, you know, may change. So we don't have good evidence saying that either social transition or biological or surgical transition, we don't have good evidence saying that that improves anything. The problem is that these days with research being done by people who do have a foregone conclusion, they're not producing very objective research. Cantor told a judge in Georgia recently that major medical associations like the American Academy of Pediatrics and the Endocrine Society, all of whom support gender-affirming care, are, quote, just trying to please the activists. In his own testimony, Cantor has been selective about the evidence he includes, as we hear in a video deposition he gave last year in West Virginia.

Cantor here is being questioned by a lawyer representing an LGBTQ rights group. And so are you aware that this study found that access to gender-affirming hormones during adolescence was associated with lower odds of recent depression and having attempted suicide in the past year? In a retrospective survey, I'm aware of that, yes. And at the time you authored your report, were you aware of this study? Yes, I was. Did you cite this study in your report? No, I did not. It's not methodologically sound enough.

Cantor's issue is with studies that don't involve a randomized control trial, which are generally considered the gold standard when it comes to proving causality in science. But in this case, it would mean giving one group of trans teens access to gender-affirming hormones while giving another group of trans teens a placebo. Experts and advocates say that would be unethical, given these treatments are already considered the standard of care. Later in that West Virginia deposition, Cantor was asked about his clinical experience treating gender dysphoria.

You personally have not diagnosed any child or adolescent with gender dysphoria, right? Correct. And you personally have never treated any child or adolescent for gender dysphoria, right? Correct. Okay. Much of the gender research that Cantor does trust is by his former mentors and colleagues at Toronto's Centre for Addiction and Mental Health,

once known as the Clark Institute of Psychiatry, and now widely referred to by its acronym, CAMH. Cantor worked at CAMH from 1998 to 2018, a time when it came under increased criticism from the trans community in Toronto. For many years, the Clark Institute was the only clinic in Ontario that approved requests for gender confirmation surgery. It had a reputation for making this process extremely difficult. Within the trans community, the Clark Institute was often referred to as Jurassic Clark.

I worked at a gender clinic from 1980 to 1995. That's Cantor's mentor at CAMH, Ray Blanchard, explaining the process on The Jolly Heretic, a podcast that also features interviews with white supremacists and eugenicists. We've required patients to live for two years as the opposite sex before considering them eligible for approval for surgery. And during those two years, they either had to work full-time or go to school full-time as the opposite sex. And for a lot of them, surgery was almost anticlimactic. Now that whole gatekeeper model is almost universally regarded as if it had been some kind of gross oppression,

some human rights violation of the first water, and now the model is informed consent. If you think you're trans, well, it's your body, your life, go for it. But many patients at the Clark say the process was invasive Well, it's your body, your life, go for it. But many patients at the Clark say the process was invasive and the doctors there unhelpful and uncaring. Transactivist Martine Stonehouse told the Archives, a Canadian LGBTQ archive project, about her experiences at the Clark in the 1980s.

They'd have you sit there and watch a movie while they had a vacuum device hooked up to your genitalia, wanting to see what you got aroused with. So their ideas of psychiatry and so on were outdated at that point. And at first they were trying to say that based on their assessments and so on that I was a gay man that was frustrated. Well, the point was is I wasn't gay. I felt that I was the wrong gender. The Youth Gender Clinic at CAMH had a similar gatekeeping philosophy.

It was run by a psychologist named Kenneth Zucker. Zucker worked with parents to encourage children with gender dysphoria to accept the sex they were assigned at birth. He no longer works at CAMH, but he still believes in this approach. I reach him via video call at his home in Toronto. Zucker, now in his 70s, continues to treat patients in private practice. Suppose you can help a kid feel more comfortable in a gender more congruent with their birth sex. One could argue that all things considered, life might be a little easier. So it would not require, for example,

later hormonal suppression or contrasex hormone therapy or what some people call nowadays gender-affirming surgery. Zucker's approach is controversial. In 2003, a fellow psychiatrist compared it with conversion therapy. Zucker denies that's accurate. In 2007, LGBTQ activists disrupted a speech Zucker was giving at a CAMH event. When it was announced in 2008 that Zucker and Blanchard were going to help write entries about gender in the new Diagnostic and Statistical Manual of Mental Disorders, nearly 10,000 people signed a petition in protest. And in 2015? It's Metro Morning on CBC Radio. For Wednesday, I'm

Matt Galloway. Good morning. Yesterday, the Center for Addiction and Mental Health announced that it is, in its words, winding down its Child, Youth, and Family Gender Identity Clinic, saying the clinic didn't reflect the latest and best practices in the field. Dr. Quam McKenzie is with me now to talk about the changes and the future of the gender identity field at CAMH. Good morning. Good morning, Matt. Was CAMH using conversion therapy on young people who are questioning their gender?

The review doesn't say that there was reparative therapy going on, but it doesn't say that there wasn't reparative therapy going on. Now, we don't think that's good enough, so we want to move the way the service works to a place so that this isn't even a question. This shouldn't be a question. Zucker was fired. He sued for wrongful dismissal and settled out of court.

Cantor left CAMH a few years later to start his own practice, but he looks back fondly on the time he spent working alongside Blanchard and Zucker. I felt like a junior officer just assigned to the bridge of the enterprise. There was Mr. Spock and Captain Kirk themselves, you know, where I just got to absorb and watch the conversations, but also to adopt what they did as role models. CAMH never reopened its youth gender identity clinic, but now embraces the gender-affirming care model for its adult

patients. But that doesn't mean Zucker and, of course, Cantor have lost their audiences completely, especially south of the border. I must agree with a noted researcher from Toronto, Dr. Ken Zucker. He's written that social... Zucker and Cantor are often name-dropped by conservative lobbyists when they push for laws that restrict trans rights. Dr. Kenneth Zucker, who is really the world's expert in this, has written extensively on are often name-dropped by conservative lobbyists when they push for laws that restrict trans rights. Dr. Kenneth Zucker, who is really the world's expert in this, has written extensively on

the harms of doing a social transition. Stan such prominent figures as Steven Levine, Kenneth Zucker, Paul McHugh, and James Cantor, among others. These doctors are giants in the field. To put this in perspective, I reach out to Jules Gill-Peterson, an historian at Johns Hopkins University in Baltimore. She specializes in the medical history of transgender youth. There has been a kind of second life to the ideas and principles of the clinicians who worked at the CAMH clinic.

That cohort of folks who worked out of CAMH, I'd have to say probably of any single cohort of researchers in trans medicine, their work gets cited and mobilized the most by anti-trans crusaders. They seem to be sort of the most commonly cited researchers when people are trying to discredit gender-affirming care or simply cast doubts on trans people's trustworthiness. All right, y'all want to go see the shop? Take a little poke around? In Tennessee, the ban on gender-affirming care, which Cantor helped defend in court, is seen by trans people as part of a broader campaign against their very existence.

And so it's not really about protecting children. It's about keeping us scared. Hoping that if life is so uncomfortable for trans people, that we will detransition in order to assimilate into their version of society, or that we will just kill ourselves. And that's, to speak frankly, that's just how it is. That's Jocelyn Fish. We're speaking in the cafe she runs in Knoxville. There's a rug at the front door that says,

The Gayest Place in Town. Inside, pride flags hang from the ceiling. The walls are jammed with campy art, books, and coffee mugs. Jocelyn's cafe doubles as a sort of community center for trans people in the area. In Tennessee, it's a rare space where no one cares what pronouns or what bathrooms you use. It's, again, just an amazing space with a bunch of amazing people. And, again, I don't know where we would be without the space and the people in it. At the cafe, I meet up with a 14-year-old who who lose access to their gender-affirming medication because of the ban.

It was really devastating, honestly, because as a trans minor, it's really disheartening to see. Because people really just want to live their lives and as someone who knows and like a large number of trans people and as a trans person myself it's like we're no different than anyone else we're just people living our lives and also the fact that they're putting bans on necessary healthcare is just completely insane to me because it's like if another child my age needed life-saving healthcare and it was denied to them people would lose their minds. What do you see your future like in Tennessee? I'm not entirely sure to be honest. If I'm being completely honest, I don't probably plan to like live in Tennessee my entire life, but like how I see my future like near future here.

I guess plan to just I feel like mainly just be as vocal about queer and trans issues as possible in the area because like I'm stuck here for a very long while and I would like to make it better for other queer people that live here and myself so that that's my goal for at least the near future. I turn to their parents who are at the table with us, listening closely. When you guys hear about that uncertainty, about wanting to stay in Tennessee, what goes through your minds? I think the first thing that I think is that someone shouldn't have to leave their home because other people are making it unlivable. That's not something a 14-year-old should have to think about.

I want to give you a chance to speak to some people who've been affected by these laws directly. Sure. You mentioned that we went down to Tennessee. We spoke to families with trans children. We spoke to trans teens themselves. What would you say to these people who are really feeling the effects of a law that you have kind of gone to court and helped defend? really feeling the effects of a law that you have kind of gone to court and helped defend? First, I hesitate to say exactly that I defend a law so much as I defend the science. What a government does with the science is what a government does with the science. And I always

want any government, whether the U.S., Europe, Canada, to make any decision based on the best science available. You're still choosing a side, though, in a court case. No, the side is choosing me. If my read of the science were different, then it would be the other side that hired me. I mean, if they came to you and said, Dr. Cantor, we would like you to testify. No, I'd rather not. or we would like you to testify. No, I'd rather not.

Yeah, and that was a tough question that I had to ask myself when they did start asking. Ultimately, the decision I came to myself was that I'm a scientist. My job, I will give the science to whoever it is that asks. But some of the people asking for a science are intent not just on rolling back trans rights, but LGBTQ rights in general. The Alliance Defending Freedom, the group that first approached Cantor back in 2021, opposes gay marriage and in the past has supported sodomy laws and helped spread the myth that gay men are more inclined to pedophilia. Is there a line that you would draw in terms of groups that you'd be willing to work with?

That's a good question. I don't have a line, a particular line in mind, but I have trouble imagining, you know, once I'm willing to work with, again, groups with whom I disagree on every other issue, but on this one, you know, the conclusions lead to the same place. I feel like I've already crossed that. It's hard for me to imagine a group with whom I would have greater disagreement, but still have this one issue in common. Earlier this month, Cantor testified in support of a British Columbia nurse who made a series of anti-trans comments online, including a pledge to misgender trans people and accusing

them of having low intelligence. This was the first time that Cantor has testified in Canada about transgender issues. He reportedly told the hearing that the nurse's comments would actually help trans people. Dealing with uncomfortable ideas, he said, would encourage them to, quote, develop the skills anyone needs to live in a diverse society, end quote. Cantor told me he sees himself as one of the few remaining defenders of free speech. The general media, universities, Ivy League universities, simply going along with what's popular and what they think will make them look good in social media

rather than permitting, never mind encouraging, actual debate. So it's that so many people just let these central institutions of democracy and free thought, just let them fall without a fight. That's where I've really become disappointed. But to his critics, Cantor is a dangerous archetype. The self-professed, you know, liberal curmudgeon who loves to go against the blind faith of liberals, right? It's sort of just a very popular kind of posture to authorize very conservative beliefs. That's Jules Gil Peterson, the historian at Johns Hopkins we heard from earlier. But it kind of just sort of dovetails with Cantor's whole shtick, right?

Which is that, like, for example, for a supposed expert, does it matter that he never actually has worked with trans youth in a clinical setting ever? I mean, you know, I think any reasonable person might say, well, hold on, this guy's an expert and he's never worked with these people in this field of healthcare? Well, why are we listening to him, right? Out of context, in a political proceeding, you know, he can bring a veneer that in many ways is enhanced by the international reputation of Canada as a liberal, reasonable, scientifically enlightened kind of country. And so it's kind of incredible in some ways. The showmanship of it, I think, is in many ways very sophisticated. But the purposes to which it's being put are just so alarming.

That's all for today. This edition of FrontBurner was made in collaboration with Sylvain Gilchrist and the CBC's investigative unit. It was produced by Alison Cook at CBC's audio doc unit and Elaine Chow at FrontBurner. Thanks to Kit Kohlberger for their editorial advice. I'm Jonathan to cbc.ca slash podcasts.