Here is the evidence. Responding to the Transgender Moment , sex is a bodily reality that can be recognized well before birth with ultrasound imaging. The sex of an organism is defined and identified by the way in which it he or she is organized for sexual reproduction. Organisms can exist at various levels, from microscopic single cells to sperm whales weighing many tons, yet they are all characterized by the integrated function of parts for the sake of the whole.
Sex as a status—male or female—is a recognition of the organization of a body that can engage in sex as an act. The conceptual distinction between male and female based on reproductive organization provides the only coherent way to classify the two sexes.
Apart from that, all we have are stereotypes. Sex is understood this way across sexually reproducing species. No one finds it particularly difficult—let alone controversial—to identify male and female members of the bovine species or the canine species. Farmers and breeders rely on this easy distinction for their livelihoods. And yet, in an expert declaration to a federal district court in North Carolina concerning H. Lawrence Mayer responded in his rebuttal declaration: I have searched dozens of references in biology, medicine and genetics—even Wiki!
In fact the only references to a more fluid definition of biological sex are in the social policy literature. Mayer is a scholar in residence in the Department of Psychiatry at the Johns Hopkins University School of Medicine and a professor of statistics and biostatistics at Arizona State University. Modern science shows that our sexual organization begins with our DNA and development in the womb, and that sex differences manifest themselves in many bodily systems and organs, all the way down to the molecular level.
In other words, our physical organization for one of two functions in reproduction shapes us organically, from the beginning of life, at every level of our being. They can affect appearances. They can stunt or damage some outward expressions of our reproductive organization. Or, as Princeton philosopher Robert P. As I demonstrate in When Harry Became Sally , the medical evidence suggests that it does not adequately address the psychosocial difficulties faced by people who identify as transgender.
Transgendered men do not become women, nor do transgendered women become men. Ten to fifteen years after surgical reassignment, the suicide rate of those who had undergone sex-reassignment surgery rose to twenty times that of comparable peers. McHugh points to the reality that because sex change is physically impossible, it frequently does not provide the long-term wholeness and happiness that people seek.
Arif, which conducts reviews of healthcare treatments for the NHS, concludes that none of the studies provides conclusive evidence that gender reassignment is beneficial for patients. It found that most research was poorly designed, which skewed the results in favour of physically changing sex. There was no evaluation of whether other treatments, such as long-term counselling, might help transsexuals, or whether their gender confusion might lessen over time.
Hyde said the high drop out rate could reflect high levels of dissatisfaction or even suicide among post-operative transsexuals. In , a new review of the scientific literature was done by Hayes, Inc. Hayes found that the evidence on long-term results of sex reassignment was too sparse to support meaningful conclusions and gave these studies its lowest rating for quality: Statistically significant improvements have not been consistently demonstrated by multiple studies for most outcomes.
The study designs do not permit conclusions of causality and studies generally had weaknesses associated with study execution as well. There are potentially long-term safety risks associated with hormone therapy but none have been proven or conclusively ruled out. The Obama administration came to similar conclusions. In , the Centers for Medicare and Medicaid revisited the question whether sex reassignment surgery would have to be covered by Medicare plans.
Despite receiving a request that its coverage be mandated, they refused, on the ground that we lack evidence that it benefits patients. Based on a thorough review of the clinical evidence available at this time, there is not enough evidence to determine whether gender reassignment surgery improves health outcomes for Medicare beneficiaries with gender dysphoria.
There were conflicting inconsistent study results—of the best designed studies, some reported benefits while others reported harms. The quality and strength of evidence were low due to the mostly observational study designs with no comparison groups, potential confounding and small sample sizes. Many studies that reported positive outcomes were exploratory type studies case-series and case-control with no confirmatory follow-up.
The majority of studies were non-longitudinal, exploratory type studies i. Several reported positive results but the potential issues noted above reduced strength and confidence.
After careful assessment, we identified six studies that could provide useful information. Of these, the four best designed and conducted studies that assessed quality of life before and after surgery using validated albeit non-specific psychometric studies did not demonstrate clinically significant changes or differences in psychometric test results after GRS [gender reassignment surgery].
In a discussion of the largest and most robust study—the study from Sweden that Dr. McHugh mentioned in the quote above—the Obama Centers for Medicare and Medicaid pointed out the nineteen-times-greater likelihood for death by suicide, and a host of other poor outcomes: The study identified increased mortality and psychiatric hospitalization compared to the matched controls.
The mortality was primarily due to completed suicides We note, mortality from this patient population did not become apparent until after 10 years. The risk for psychiatric hospitalization was 2. The risk for attempted suicide was greater in male-to-female patients regardless of the gender of the control. Further, we cannot exclude therapeutic interventions as a cause of the observed excess morbidity and mortality.
These results are tragic. And they directly contradict the most popular media narratives, as well as many of the snapshot studies that do not track people over time.
As I explain in my book , these outcomes should be enough to stop the headlong rush into sex-reassignment procedures. They should prompt us to develop better therapies for helping people who struggle with their gender identity. And none of this even begins to address the radical, entirely experimental therapies that are being directed at the bodies of children to transition them.
The Purpose of Medicine, Emotions, and the Mind Behind the debates over therapies for people with gender dysphoria are two related questions: How do we define mental health and human flourishing?
And what is the purpose of medicine, particularly psychiatry? Those general questions encompass more specific ones: If a man has an internal sense that he is a woman, is that just a variety of normal human functioning, or is it a psychopathology? Should we be concerned about the disconnection between feeling and reality, or only about the emotional distress or functional difficulties it may cause? What is the best way to help people with gender dysphoria manage their symptoms: Settling the debates over the proper response to gender dysphoria requires more than scientific and medical evidence.
Medical science alone cannot tell us what the purpose of medicine is. Science cannot answer questions about meaning or purpose in a moral sense. It cannot tell us how human beings ought to act. While medical science does not answer philosophical questions, every medical practitioner has a philosophical worldview, explicit or not. Some doctors may regard feelings and beliefs that are disconnected from reality as a part of normal human functioning and not a source of concern unless they cause distress.
Other doctors will regard those feelings and beliefs as dysfunctional in themselves, even if the patient does not find them distressing, because they indicate a defect in mental processes. But the assumptions made by this or that psychiatrist for purposes of diagnosis and treatment cannot settle the philosophical questions: Is it good or bad or neutral to harbor feelings and beliefs that are at odds with reality?
Should we accept them as the last word, or try to understand their causes and correct them, or at least mitigate their effects? We must also look deeper for philosophical wisdom, starting with some basic truths about human well-being and healthy functioning. We should begin by recognizing that sex reassignment is physically impossible. Our minds and senses function properly when they reveal reality to us and lead us to knowledge of truth.
And we flourish as human beings when we embrace the truth and live in accordance with it. A person might find some emotional relief in embracing a falsehood, but doing so would not make him or her objectively better off. Living by a falsehood keeps us from flourishing fully, whether or not it also causes distress.
This philosophical view of human well-being is the foundation of a sound medical practice. Michelle Cretella, the president of the American College of Pediatricians—a group of doctors who formed their own professional guild in response to the politicization of the American Academy of Pediatrics—emphasizes that mental health care should be guided by norms grounded in reality, including the reality of the bodily self. For human beings to flourish, they need to feel comfortable in their own bodies, readily identify with their sex, and believe that they are who they actually are.
For children especially, normal development and functioning require accepting their physical being and understanding their embodied selves as male or female. The implicit and sometimes explicit model of the doctor-patient relationship is one of contract: This modern vision of medicine and medical professionals gets it wrong, says Dr.
Professionals ought to profess their devotion to the purposes and ideals they serve. Mental health care must be guided by a sound concept of human flourishing.
The minimal standard of care should begin with a standard of normality. Cretella explains how this standard applies to mental health: One of the chief functions of the brain is to perceive physical reality. Thoughts that are in accordance with physical reality are normal. Thoughts that deviate from physical reality are abnormal—as well as potentially harmful to the individual or to others.
This is true whether or not the individual who possesses the abnormal thoughts feels distress. Our brains and senses are designed to bring us into contact with reality, connecting us with the outside world and with the reality of ourselves. Thoughts that disguise or distort reality are misguided—and can cause harm. In When Harry Became Sally , I argue that we need to do a better job of helping people who face these struggles.