In 2022, the World Professional Association for Transgender Health (WPATH) published its eighth Standards of Care. With an unprecedented number of individuals seeking gender-affirming care over the past decade, the Standards of Care is a clinical guidance for professionals across the world. With 18 chapters and 97 co-authors from all over the world, two chapters were co-written by a psychologist here in Buffalo who has worked with transgender and intersex clients for the past five decades: Dr. Tom Mazur.
Dr. Mazur has been at the forefront of transgender medicine since it was an obscure field, one that many clinicians knew little about.
Dr. Mazur expressed many perspectives that relegated him to an era that is widely viewed as a bygone era in transgender healthcare. He brought along his copy of Harry Benjamin’s The Transsexual Phenomenon. Dr. Mazur proudly proclaimed himself to be a “gatekeeper,” a term that is largely used to refer to clinicians who restrict gender-affirming care to as few people as possible. He would also like to be called a “moderate.” He opposes any attempt by conservative politicians to turn his field into a political issue.
“Politics has no place in this. It should be something that’s debated and discussed by the medical field and the professional health care people,” he said.
On the other hand, Dr. Mazur expressed concern toward transgender activists, who he believes are also needlessly politicizing this field and bullying longtime acquaintances of his, such as Dr. Ken Zucker. He said he believes WPATH has become an activist organization. He remembers a time when parents were encouraged not to tell their children of their intersex condition.
Tom Mazur was born in 1946 in Miami, during the genesis of the postwar baby boom. After being accepted into St. Louis University, he pursued his graduate work at Baylor University but had to leave after getting drafted into Vietnam. After the war, he returned to Baylor and received his PsyD in psychology. He said he was drawn to psychology because of his desire to understand human behavior.
After getting his PsyD, he did his postdoctoral work at Johns Hopkins University, which at the time was the only clinic in the United States that performed gender-affirming surgery. It was there he first met Dr. John Money.
“John was an interesting character. He was tough to work with at times. He was very bright. Very articulate and very driven,” Mazur said.
Dr. John Money, the man credited for coining terms such as “sexual orientation,” “gender roles” and “gender norms,” words now part of our everyday vernacular. Dr. Money’s reputation though has been under attack for decades after two of his patients committed suicide in a well-publicized case. When a boy in Canada had his penis burnt off in a routine circumcision, the family took their son to Johns Hopkins where Dr. Money recommended that he be raised as a girl. Raised as Brenda Reimer, the child, later known as David, and his twin brother Brian were referred to in the psychological literature as the “John/Joan” case.
Brenda eventually de-transitioned and changed their name to David. Both siblings subsequently committed suicide as adults, and Dr. Money has been widely blamed. Dr. Mazur informed me in conversation that the twins came from a family with a predisposition to mental illness, and he points out that there have been other similar cases to the Reimer’s in which the child successfully accepted their gender identity. Mazur believes that his former mentor has been unfairly maligned.
Looking back, Dr. Mazur thinks fondly of his experience working for Dr. Money, calling it “rewarding.”
In a time when only an estimated 1,000 people in the U.S. received gender-affirming surgery, Dr. Mazur’s first published study came in 1975. His work with seven trans women in the Baltimore area focused on their long-term outcomes.
“They were nice people… You had to get permission to [interview] because you [had] to go to their house and talk to them,” Mazur said.
Dr. Mazur arrived in Buffalo in August 1979, after Anne Ehrhardt, a colleague of John Money, accepted a job at Columbia. At Oishei Children's Hospital, Mazur worked with intersex patients and children with growth deficiencies.
He points out that puberty blockers are a now controversial political issue when they were (and still are) largely prescribed to girls who had precocious puberty, an early-onset form of puberty.
When I asked him about what causes gender incongruence and if it is a more biological or environmental phenomenon, he said “Well, it's both but nobody has actually nailed [it] down in any definitive way… there's studies in medicine that suggest some biological phenomena going on. Other people will say it has to do with your environment… so it’s still a mystery.”
Turning toward modern-day gender-affirming care, Dr. Mazur took many views that placed him in the old guard of transgender healthcare.
“I’m on the more conservative side of this. I’ve been accused of being old school. And I don’t have any problem with that,” Mazur said. “I think many in the mental health system think “gender-affirming” means giving the person what they request without proper evaluation or discussion.”
Despite his more conservative views on gender-affirming care, like many old-school sexologists of the 20th century, such as Benjamin and Money, he exudes empathy for his patients. His long career has led him to cross paths with many remarkable patients. One patient is a trans woman who has lived as a woman for more than 50 years but has never received surgery or hormones.
“Their life hasn’t been easy in many ways… Some people just feel uncomfortable seeing people that have a different gender identity or sexual orientation or whatever. That’s what we’re all trying to do — trying to get people to be more receptive,” Mazur said.
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Photo: Courtesy of Ken Smith
