[sally]

Today, however, the APA's position is that therapies that try to turn homosexuals into heterosexuals are unethical. Homosexuality is now considered to be a normal variant of human behavior, so though a therapist might treat a person because they struggle with the stigma associated with homosexuality, therapists who practice in accordance with the guidelines established by the association don't treat the behavior itself.

Because Ehrensaft sees transgenderism as akin to homosexuality, she says, she thinks Zucker's therapy — which seeks to condition children out of a transgender identity — is unethical.

But that isn't how Zucker sees it. Zucker says the homosexuality metaphor is wrong. He proposes another metaphor: racial identity disorder.

"Suppose you were a clinician and a 4-year-old black kid came into your office and said he wanted to be white. Would you go with that? ... I don't think we would," Zucker says.

If a black kid walked into a therapist's office saying he was really white, the goal of pretty much any therapist out there would be to make him try to feel more comfortable being black. They would assume his mistaken beliefs were the product of a dysfunctional environment — a dysfunctional family or a dysfunctional cultural environment that led him or her to engage in this wrongheaded and dangerous fantasy. This is how Zucker sees gender-disordered kids. He sees these behaviors primarily as a product of dysfunction.

The mistake the other side makes, Zucker argues, is that it views gender identity disorder primarily as a product of biology. This, Zucker says, is, "astonishingly naive and simplistic."

Zucker has come to believe that taking the view that kids are born transgender ultimately produces more transgender people.

"By declaring the child as transgendered at, say, age 3 or age 4 or age 6, and then saying in a sense, 'Go with the flow,' ... that will impact, I believe, on how the kid's gender identity differentiates," he says.

In other words, allowing a child like Jonah to transition in kindergarten will essentially track him into becoming a transgender adult. And for Zucker, no child under the age of 10 or 11 can be definitively labeled transgender. He says that kids' gender identities are flexible. And that even a child like Jonah, who appears to be absolutely consistent from the ages of 1 and 2, can change.

But Ehrensaft says this position is too absolute. While she agrees that it's important to be very, very careful about applying a transgender label to a young child, it is at least possible. And Ehrensaft is clearly as disapproving of Zucker's form of therapy as he is of hers. She says it's wrong to take away a child's toys, to police the people he spends time with, the pictures he draws — even the colors he draws with.

"To me, this is coercive therapy," Ehrensaft says. "And I don't think we should be in the business of coercing people. ... I would say all the kids I've worked with who have gone through that kind of treatment, they have not come out better; they've come out worse."

For Ehrensaft, the lessons of the early therapeutic approaches to homosexuality — therapies that sought to "cure" the patient of homosexual desires — are clear.

"If we allow people to unfold and give them the freedom to be who they really are, we engender health. And if we try and constrict it, or bend the twig, we engender poor mental health," she says.

The Problem with the Color Pink

It does seem to be the case that, at least in the short term, Carol's son Bradley is struggling in some ways with Zucker's therapy. Carol says it was particularly hard at the beginning.

"He was much more emotional. ... He could be very clingy. He didn't want to go to school anymore," she says. "Just the smallest thing could, you know, send him into a major crying fit. And ... he seemed to feel really heavy and really emotional."

Bradley has been in therapy now for eight months, and Carol says still, on the rare occasions when she cannot avoid having him exposed to girl toys, like when they visit family, it doesn't go well.

"It's really hard for him. He'll disappear and close a door, and we'll find him playing with dolls and Polly Pockets and ... the stuff that he's drawn to," she says.

In particular, there is one typically girl thing — now banned — that her son absolutely cannot resist.

"He really struggles with the color pink. He really struggles with the color pink. He can't even really look at pink," Carol says. "He's like an addict. He's like, 'Mommy, don't take me there! Close my eyes! Cover my eyes! I can't see that stuff; it's all pink!' "

Still, Carol says, Bradley has made some progress. Today, he is able to play with boys. He has a few male friends, and has said that he now enjoys boy things. And there are other signs of change.

"I mean, he tells us now that he doesn't dream anymore that he's a girl. So, we're happy with that. He's still a bit defensive if we ask him, 'Do you want to be a girl?' He's like 'No, NO! I'm happy being a boy. ...' He gives us that sort of stock answer. ... I still think we're at the stage where he feels he's leading a double life," she says. "... I'm still quite certain that he is with the girls all the time at school, and so he knows to behave one way at school, and then when he comes home, there's a different set of expectations."

Despite these difficulties, Zucker clearly feels it's important to at least attempt change. He points out that the burden of living as the opposite gender is great, and should not be casually embraced.

"We're not talking about minor medical treatments. ... You're talking about lifelong hormonal treatment; you're talking about serious and substantive surgery," he says.

Jonah, Now Jona

For their part, Joel and his wife Pam say they are clearly happy with the choice they've made. Joel says he now thinks of Jonah as his daughter, and he says that she — Jona — is thriving.

"She's so comfortable with her own being when she's simply left to be who she is without any of these restrictions being put on her. It's just remarkable to see."

In terms of which of these therapies is more prevalent in the United States, Ehrensaft says there is absolutely no doubt.

"Zucker's," she says.

Ehrensaft hopes this will change. She says that professional opinion on this subject is in incredible flux — that the treatment of transgender children is becoming a kind of civil rights issue, in the same way that the psychiatric treatment of homosexuals became a civil rights issue in the 1970s.

In the meantime, though, Zucker's approach continues to thrive. He says nearly 80 children are on the waiting list at his clinic in Toronto.