On a Friday afternoon in Nashville last October, several hundred people gathered in a plaza near the state capitol for an event billed as the “Rally to End Child Mutilation.”
The rally was organized by a right-wing pundit who had been claiming the transgender care clinic at a Nashville hospital was drugging and mutilating children.
The crowd, according to published reports, was a mix of religious conservatives, masked members of the Proud Boys and the leaders of the Republican state caucus.
By the end of the rally, the politicians had vowed to ban what’s known as gender-affirming care for minors, which usually involves hormone treatments rather than surgery.
Within months, a ban was signed into law.
Civil rights groups promptly challenged it in court, arguing a ban on puberty blockers and hormone therapy would cause “irreparable harm.”
They pointed out that the reigning medical consensus considers these treatments safe and effective for teens with severe gender dysphoria. (They did not challenge the ban on gender-affirming surgeries for minors.)
In its response, the state didn’t call on pundits or preachers, or repeat sensational claims about child mutilation
Instead, it turned to a roster of experts known for questioning mainstream medical opinion under oath — including Toronto psychologist James Cantor.
Cantor is one of the most in-demand witnesses for states defending their transgender policies in court.
Since 2021, he’s testified in 25 different cases, including for West Virginia, Indiana and Utah as they defended laws that bar trans students from school sports. He testified for Oklahoma last year as it defended restrictions on which bathroom trans students can use.
More recently, Cantor has been called on by several states that are defending their bans on gender-affirming care in court, Tennessee among them.
“I will give the science to whoever it is that asks,” Cantor said in a recent interview at his Toronto office.
He estimates he has more than doubled his income this year by providing testimony in gender-care cases, often citing the controversial research of former colleagues at Toronto’s Centre for Addiction and Mental Health.
“I essentially shut down most of my clinical practice, really, in order to be able to participate in these cases,” Cantor said.
Gender-affirming care: acceptance and backlash
The recent laws in the U.S. banning gender-affirming care target protocols pioneered by Dutch clinicians in the 1990s for treating adolescent gender dysphoria.
The protocols have been modified over time, but generally involve using reversible puberty blockers to allow younger teens to make decisions about their gender identity.
Older teens who wish to pursue transition can be given estrogen or testosterone in order to develop sex characteristics in line with their gender identity, according to the standards of care from medical organizations such as the World Professional Association for Transgender Health.
Most major medical associations have since come to consider gender-affirming care as medically necessary, and with the expansion of gender clinics in the U.S. the treatments are now more widely available than ever before.
That has alarmed many conservatives, who see gender-affirming care as part of a progressive ideology that is undermining traditional values.
Amid a nation-wide increase in anti-LGBTQ legislation, at least 20 states have passed laws to restrict or outright ban access to the treatments.
‘Biblical and godly values’
Christian conservatives have been at the forefront of this legislative push, and many lawmakers freely acknowledge their own religious motivations.
“Homosexuality in the biblical scripture is an abomination. And our constituents, in majority, believe that,” said Sabi Kumar, a Republican representative in Tennessee who has sponsored several bills considered anti-trans, including the state’s recent ban on gender-affirming care.
“So because we are following those biblical and godly values, that is reflected in the legislation that we passed.”
After the Tennessee legislature passed its ban on gender-affirming care, several clinics abruptly stopped offering medical treatments for their trans patients, fearing repercussions once the law came into effect.
“If another child my age needed life-saving health care and it was denied to them, people would lose their minds,” said Zane Batts, a trans 15-year-old from Knoxville.
Families with trans children have been left with the choice of either having to travel regularly out of state to seek care or move somewhere else entirely.
“The reality is that we’re pretty much refugees in our own country,” Ash, a single mother of a 12-year-old trans boy, said as she packed up her home in Smyrna, Tenn., this summer. CBC News is withholding her family name to protect her child from potential harassment.
“It’s a humanitarian catastrophe facing these families,” said Joshua Block, an attorney with the ACLU who works on many of the organization’s trans rights cases.
“It’s a health-care desert for transgender people in half of the country.”
In order to defend their transgender policies in court, Block said states usually abandon the religious rhetoric used by the politicians who passed them.
“They can’t get up in court and say the reason for our laws is because we are ideologically opposed to transgender people,” said Block, who is representing the ACLU in its case against Tennessee.
“You need people with MDs or other degrees willing to support their arguments.”
The unlikely ally
Cantor, who holds a PhD in psychology from McGill University, is in some ways an unlikely ally for the Christian right.
He is gay and describes himself as a liberal atheist and, above all, a scientist.
He compares his alliance with social conservatives to the U.S. and the Soviet Union working together to defeat Nazi Germany in the Second World War: two ideological opposites finding common cause on a narrow issue.
“I don’t pretend for a second that religious conservatives are using anything like my kind of thinking to come to their decision [about gender-affirming care],” Cantor said.
“The science just happens this time, on this issue, to be agreeing with the basic idea that transition is generally not the best idea for these kids.”
For much of his career, Cantor’s research focused on pedophilia and he served as an expert witness in several cases involving sex crimes.
It wasn’t until 2021 that Cantor began testifying about transgender issues, after being asked by the Alliance Defending Freedom, a conservative Christian legal advocacy group known for opposing LGBTQ rights.
He points to reviews conducted in the U.K., Finland and Sweden that have highlighted gaps in the research on puberty blockers and hormone treatments.
He also suggests that many teens who identify as trans are really just insecure about pending adulthood.
“It seems to be mediated by feelings of not fitting in with the people around them,” Cantor told a court in Georgia in August, where he testified in support of the state’s ban on gender-affirming care.
He encouraged the judge in that case to discount the views of U.S. medical associations — the American Academy of Pediatrics and the Endocrine Society among them — because “they’re just trying to please the activists.”
These associations, along with dozens of others including the American College of Physicians, have steadfastly opposed bans on gender-affirming care and have the opposite view about the science than Cantor has.
“Empirical evidence indicates that gender-affirming care … can alleviate clinically significant distress and lead to significant improvements in the mental health and overall well-being of adolescents with gender dysphoria,” a group of more than 20 medical associations said in a brief to the Georgia court.
Cantor never treated gender dysphoria
Under cross-examination by civil rights lawyers, Cantor has acknowledged he has never diagnosed or treated an adolescent with gender dysphoria, nor treated a minor who was undergoing gender-affirming care.
In Georgia, he also acknowledged that he only recently began authoring articles about gender issues and doesn’t collect original data.
He told the court, too, that he is a “scientist and professor;” according to his CV, he hasn’t been affiliated with a research institution since 2019.
The judge in the Georgia case initially blocked the state’s gender care ban from taking effect.
In her ruling, she echoed comments made by an Alabama judge, who said Cantor’s opinions about how best to treat gender dysphoria in teens carried little weight.
A judge in Tennessee also initially blocked that state’s ban on gender care. But recent appeals court decisions in Georgia, Alabama and Tennessee have reversed these lower court rulings, and allowed the bans to take effect.
All three of these decisions cited the “uncertainty” around the benefits of gender-affirming care.
CAMH research cited often by conservative lobbyists
Cantor’s understanding of the science around gender care was forged during the years he worked at Toronto’s Centre for Addiction and Mental Health (CAMH).
As an intern in the late 1990s at CAMH — then still known as the Clarke Institute — Cantor worked under Ray Blanchard.
In the 1980s and 1990s, Blanchard published a series of papers suggesting that trans women are, at their core, either homosexuals or men acting out a fantasy to see themselves as a woman.
“It challenges the conceptualization of male-to-female (MTF) trans as normal, ordinary women who happen to have been born in the wrong body,” Blanchard told the Daily Caller, a conservative news site, earlier this year.
At CAMH, Cantor also worked alongside Kenneth Zucker, who ran the centre’s youth gender identity clinic. They have co-authored a number of articles and editorials together.
Though Cantor worked in a separate unit, in court testimony he has cited his proximity to Zucker as a source of his expertise on gender dysphoria.
“It [was] like being a young soldier and all of a sudden finding out that you’re fighting together with Gandalf or Merlin,” Cantor said of his early years at CAMH.
Under Zucker, the gender identity clinic at CAMH became one of the best known institutions of its kind in North America, and in 1999 was among the first to prescribe puberty blockers.
Zucker, though, also maintains that most children who experience gender dysphoria before puberty will overcome those feelings, either with or without therapy.
His therapeutic approach with children, he said in an interview, is aimed at reducing their gender dysphoria, even if that means respecting a parent’s wish to help their child feel more comfortable with their sex at birth.
“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,” Zucker told CBC News.
In a 2008 NPR story centred on a mother concerned about her effeminate son, Zucker is described counseling her not to let him play with girlish toys or draw pictures of princesses.
Zucker denies his approach resembles conversion therapy, a charge that’s been leveled by both peers and former patients.
In 2015, after years of activism by trans advocates, CAMH commissioned an external review of Zucker’s clinic.
Though the review did not reach a conclusion about whether conversion therapy was being practised at the clinic, CAMH said it was not meeting the needs of trans children and shut it down.
Zucker’s position was terminated; he sued for defamation and wrongful dismissal and later settled out of court. Blanchard had long since retired by then, and Cantor left CAMH in 2018 to start his own practice.
But in the U.S., as conservatives began to legislate on gender issues, the work of these former CAMH researchers found a new audience.
It is cited repeatedly in documents that conservative lobby groups have supplied to Republican lawmakers and their names have been invoked in legislative hearings in Pennsylvania, Ohio, Texas, Nebraska and Washington, D.C.
“They give a lot of credibility because they’re researchers and they’re highly respected clinicians as well,” said Quentin Van Meter, a former president of the American College of Pediatricians.
Not to be confused with the much larger American Academy of Pediatrics, the ACP is a conservative lobby group that supplies talking points to Republican lawmakers on medical issues related to abortion and transgender care.
Zucker, though, sees the gender care bans with the same eye as he sees laws in Canada that ban conversion therapy.
“I think politicians, whether they’re on the left, the middle or the right, should stay out of the consulting room,” he said.
In a statement, CAMH said that amid a rise in “global anti-trans legislation,” the centre is committed to “improving access to gender-affirming care and health outcomes for trans people.” It has not reopened its youth clinic for gender care.
A day in Knoxville
Despite his own involvement with conservative lobby groups and politicians, Cantor doesn’t see himself as culpable for the surge in anti-LGBTQ sentiment in the U.S.
“I don’t think I’m an accomplice at all. I’m much more of an outsider,” he said.
In August, after Tennessee’s ban went into effect, CBC News spent a day in Knoxville, speaking with members of the trans community.
Oscar Anderson, a young trans man who mentors local trans youth, said that with the ban in place, it is likely some teens will seek hormones on the black market.
“I don’t think a lot of people understand but when you’re in that mindset of not having access to care, you will do anything,” he said.
Destiny White, a counsellor, said the mental health of her trans clients dropped precipitously when the legislature passed the ban.
“Within the same week, I had two of my trans youth express suicidality for the first time, and one engaged in self-harm and disclosed it on the same day,” she said.
CBC News spoke with several other mental health practitioners in the Knoxville area who said they saw similar behaviour in their clients.
Zane Batts called the situation facing trans youth in Tennessee “scary” and “gross.”
“I feel like some people just don’t have the empathy to understand that we’re not trying to be malicious in wanting to live our best lives,” Batts said.
Batts’s parents have resolved to become more politically active this fall, hoping to convey to local politicians the consequences of their anti-trans agenda.
“If families like ours don’t go get the care that we need out of state, our children are going to die. It is that simple,” said Chrissie Batts, Zane’s mother.
By the end of summer, Ash, the single mother from Smyrna, managed to move her small family to Buffalo, N.Y.
She’s found accommodating doctors there for her son and schools that will respect his pronouns.
“It’s a very liberating feeling to be able to not have the fear and anxiety and stress that I had down in Tennessee,” Ash said.
“I feel, already, so much lighter.”