The Truth Gender Clinicians Tried to Ignore - Dr Susan Bradley (#43)
16 October 2025
With Dr Susan Bradley
North America
Dr Susan Bradley co-founded Toronto's first paediatric gender clinic in 1975, treated more than 400 gender-dysphoric children, and chaired the DSM-IV subcommittee on gender identity disorders. She now describes the medicalisation pathway as harmful. Her clinical evidence on desistance, puberty blockers and autism over-representation maps closely onto the conclusions of the Cass Review and NHS England's decision to end routine puberty blocker prescriptions for under-18s outside a research setting.
Dr Susan Bradley spent close to five decades at the centre of paediatric gender medicine. She co-founded Canada's most prominent child gender clinic at the Centre for Addiction and Mental Health in Toronto in 1975, and chaired the DSM-IV subcommittee on gender identity disorders. She assessed and treated more than 400 children presenting with gender dysphoria. The perspective she now offers is not that of an outside critic but of a clinician who was present at the founding of modern paediatric gender medicine and has watched its direction change in ways she considers catastrophic. Her most consistent clinical finding — one that became politically unfashionable after 2010 — is that the majority of gender-dysphoric children do not persist in their dysphoria into adulthood. In her clinic, nearly all who desisted went on to identify as gay or lesbian. That finding, replicated across multiple longitudinal studies, was central to the evidence base that informed the Cass Review, which concluded that watchful waiting and thorough psychological assessment remained the appropriate clinical response, and that affirmation-only approaches rested on evidence of poor quality. Bradley is direct about puberty blockers: she does not believe they are reversible, and data from the original Dutch protocol shows that approximately 90 per cent of children who begin suppression go on to cross-sex hormones. The reassuring "pause button" framing used with parents and commissioners was not borne out by clinical reality. NHS England reached the same conclusion in 2024, ending routine puberty blocker prescriptions for gender dysphoria outside a research setting on grounds of insufficient evidence for long-term safety and psychological benefit. She also addresses the significantly elevated rates of autism among those presenting to gender clinics — estimated at three to six times the general population rate. Autistic young people may be particularly prone to forming fixed beliefs around a perceived solution to their distress. The Cass Review identified the same over-representation and recommended that gender services develop substantially greater expertise in neurodivergent assessment, rather than treating autism as incidental to a gender presentation. The episode recounts the closure of Ken Zucker's clinic at CAMH in 2015, following an activist campaign that accused the service of practising conversion therapy. CAMH later retracted its findings, issued a formal apology, and paid Zucker a reported settlement of $586,000. Bradley frames this as the moment clinically cautious practice was effectively prohibited in Canada. The pattern — clinicians raising concerns and facing professional and reputational pressure as a consequence — was documented in the UK context too, through testimony gathered during the Cass Review process. The warnings Bradley raised across decades of clinical practice have now been validated by independent review on both sides of the Atlantic. The Cass Review, NHS England's revised service specification, and the government's restrictions on puberty blocker prescriptions collectively reflect the conclusion she had reached from the clinic floor long before policy caught up: that enthusiasm outpaced evidence, that the pathway from distress to medication was too short, and that children deserved more thorough and exploratory care.
