Skip to content

J. Paul Fedoroff vs. transgender people

J. Paul Fedoroff was a Canadian psychiatrist and anti-transgender activist. Fedoroff published on “paraphilia” and transgender topics. Fedoroff supported the disputed diagnoses “autogynephilia” and “autoandrophilia.” Fedoroff worked at Canada’s notorious CAMH clinic at a time when the vast majority of trans people seeking healthcare were turned away, and Fedoroff argued that federal funds should not be used for bottom surgery.

Background

John Paul Fedoroff was born on August 23, 1958 in Saskatoon, Saskatchewan to medical researcher Sergey Fedoroff (1925–2012) and Muriel “Elaine” Fedoroff (1927–2014).

Fedoroff grew up in Saskatchewan and attended University of Saskatchewan, earning a bachelor’s degree in 1960, followed by a medical degree. Fedoroff then did postdoctoral work with John Money at Johns Hopkins from 1988 to 1990, followed by a fellowship at the Clarke Institute of Psychiatry.

Fedoroff was a staff psychiatrist at Johns Hopkins School of Medicine, Toronto Hospital, Whitby Medical Health Centre, and the Clarke Institute (now CAMH). Fedoroff served as president of anti-trans sexology trade group International Academy of Sex Research (IASR).

Fedoroff served as the Director of the Sexual Behaviors Clinic at the Royal Ottawa Mental Health Centre. Fedoroff was Associate Professor of Psychiatry at the University of Ottawa and Vice-Chair of the Royal Ottawa Health Care Group Research Ethics Board (REB). Fedoroff’s research interests included the assessment and treatment of “paraphilias” in order to prevent crime, specializing in individuals with developmental delay or brain injury.

Fedoroff was married to psychiatric nurse Beverley Ida (Hill) “Bev” Fedoroff (1964–2015) from 1999 to 2015. Fedoroff then married Evelynn (Lind) Fedoroff.

Fedoroff died January 16, 2023.

Claims about pedophilia

Fedoroff was critical of how the DSM-V classified pedophilia, because it was the only paraphilia that was not split into a differential diagnosis. Federoff believed that sexuality has five distinct components with varying levels of mutability:

  • genetics
  • gender
  • sexual drive
  • sexual orientation
  • sexual interest

In 2014, Fedoroff and coauthors published a paper claiming they had developed a program to cure pedophilia. Despite criticism from peers, Fedoroff continued to make these claims.

As evidence that problematic paraphilic interests do change, Fedoroff noted in a book co-edited by Stephen B. Levine that “sex crime rates are dropping, the incidence of sex crimes decreases as people age, and the likelihood that a known high-risk sex offender will ever re-offend decreases the longer the offender does not commit a crime-as well as the self-report of men and women with paraphilic disorders.”

Fedoroff’s program emphasized seven axioms:

  1. Above all, champion consent. Nonconsensual treatment reinforces patient’s attitudes about nonconsensual sex.
  2. Be optimistic.
  3. The agent of change is the patient. Claiming they are liars creates an atmosphere of distrust.
  4. You work for the patient.
  5. Paraphilic disorders thrive in isolation. Group therapy helps.
  6. Reporting patient offenses is therapeutic as well as legally required in many jurisdictions. 
  7. Focus on five interventions: disclosure of children at risk, complete assessment, and three drug classes: SSRIs, antiandrogens, and GnRH analogs.

Because Fedoroff’s cure claims were based on changes measured by penile plethysmograph, critics have stated that Fedoroff’s findings could be “caused by measurement error, regression to the mean, or clever faking by the test subjects.”

Debate with Ray Blanchard (2000)

While working at CAMH, Fedoroff published a debate with Ray Blanchard on public funding of transgender healthcare, focusing on genital surgery. This debate is often presented as evidence of Blanchard’s “progressive” views, even though the two are transphobic in many overlapping ways. Below is an excerpt from Fedoroff’s argument against public funding for trans genital surgery.

Currently, TS [transsexual] is the only psychiatric disorder for which genital surgery is the mainstay of treatment. It is the only psychiatric disorder in which no attempt is made to alter the presenting core symptom. To date, there is no definitive evidence that surgery is more helpful than anything else.

Psychiatric advocacy of TS surgery has the following effects:

  • it legitimizes surgery as a solution for a (presumably) psychiatric condition
  • it simultaneously pathologizes TS as a psychiatric condition and as a surgically treatable disorder
  • it does not affect the core symptom (belief that one belongs to the opposite sex)
  • it confirms the TS person’s belief that they are abnormal, pathological, and untreatable
  • most importantly, it diverts resources from finding a true cure for this disorder toward a band-aid, unproven, and potentially misguided solution.

Finally, no one who has sat across from a man who is tearfully begging to be castrated can fail to appreciate the extreme anguish that TS patients endure.

However, we also sit across from patients with Munchausen’s syndrome who plaintively beg for the same procedure. Both would be “happier” if referred for surgery, but I maintain that our response should be the same: to humanely and respectfully save our patients from the consequences of their disorder, even if it means admitting we don’t have a cure…yet.

References

Blanchard R, Fedoroff JP (2000). The case for and against publicly funded transsexual surgery. Psychiatry Rounds 4:2 (April 2000). [PDF]

Müller K, Curry S, Ranger R, Briken P, Bradford J, Fedoroff, JP (2014). Changes in Sexual Arousal as Measured by Penile Plethysmography in Men with Pedophilic Sexual Interest. The Journal of Sexual Medicine Vol. 11, Issue 5, pp. 1221–1229. https://doi.org/10.1111/jsm.12488

Mehler Paperny, Anna (November 7, 2014). “I thought I’d be that way forever”: How do you treat a violent sex disorder?. Global News http://globalnews.ca/news/1656981/i-thought-id-be-that-way-forever-how-do-you-treat-a-violent-sex-disorder/

Losardo RJ, Gutiérrez RC, Prates JC, Moscovici M, Torres AR, Martínez MA (2015), Sergey Fedoroff: A Pioneer of the Neuronal Regeneration. Tribute from the Pan American Association of Anatomy. Int. J. Morphol. [online]. 2015, vol.33, n.2, pp.794-800. ISSN 0717-9502. http://dx.doi.org/10.4067/S0717-95022015000200059

Fedoroff, J. Paul (July 29, 2016). Pedophilia: Interventions That Work. Psychiatric Times. 33 (7). https://www.psychiatrictimes.com/view/pedophilia-interventions-work

Fedoroff JP (2016). Managing versus successfully treating paraphilic disorders: the paradigm is changing. In: Levine SB, Risen CB, Althof SE, eds. Handbook of Clinical Sexuality for Mental Health Professionals. Taylor and Francis; 2016:345-361. ISBN 9781317507468

Obituary (October 21, 2015). Beverley Ida Fedoroff, December 19, 1964 – October 16, 2015. Ottawa Citizen https://ottawacitizen.remembering.ca/obituary/beverley-fedoroff-1066189401

Obituary (October 21, 2015). Beverley Ida Fedoroff (Hill). The Globe and Mail https://www.legacy.com/ca/obituaries/theglobeandmail/name/beverley-fedoroff-obituary?id=41439965

Blackwell, Tom (August 16, 2017). “Man says he was cured of pedophilia at Ottawa clinic: ‘It’s like a weight that’s been lifted’ But skeptics worry about the impact of sending pedophiles into the world convinced their curse has been vanquished”. National Post.

Fedoroff JP (August 20, 2018). Can People with Pedophilia Change?: Yes they can! Current Sexual Health Reports. 10 (4): 207–212. doi:10.1007/s11930-018-0166-1

Fedoroff JP (2019). The Paraphilias: Changing Suits in the Evolution of Sexual Interest Paradigms. Oxford University Press ISBN 9780190466329

Royal Ottawa Health Care Group (February 03, 2023). A Legacy of Community Safety: Dr. J. Paul Fedoroff (August 23, 1958 – January 16, 2023). https://www.theroyal.ca/news/legacy-community-safety-dr-j-paul-fedoroff-august-23-1958-january-16-2023

Obituary (February 4, 2023). J. Paul Fedoroff M.D., 1958 – 2023. The Globe and Mail https://www.legacy.com/ca/obituaries/theglobeandmail/name/j-fedoroff-obituary?id=40423207

Resources

Wikipedia (en.wikipedia.org)

University of Ottawa (uottawa.ca)

PubMed (pubmed.ncbi.nlm.nih.gov)

  • J. Paul Fedoroff
  • https://pubmed.ncbi.nlm.nih.gov/?cmd=Search&itool=pubmed_AbstractPlus&term=%22Fedoroff%20JP%22[Author]