Let’s look at what the British Medical Association (BMA) has to say about trans and non-binary patients in a document they put out in March 2022 called ‘Inclusive Care of Trans and Non-Binary Patients’.
Stating the obvious
They start by stating the obvious: ‘It is important that all groups within the patient population have access to appropriate, timely, high quality healthcare.’ I have always believed that as doctors we should ‘take patients as we find them’, treat them with respect and not let our prejudices or personal opinions colour our judgement over their care. There are limits to this, however, where minors are concerned. What are we supposed to do in the case of a Jehovah’s Witness who refuses consent for a life-saving blood transfusion for a child, or in the case of a parent who wants a doctor to amputate the healthy foreskin of the penis of a male infant or child?
Assigned at birth
The BMA then gets into terminology. We are informed that ‘transgender’ and ‘trans’ are ‘umbrella terms to describe people whose gender identity is not the same as, or does not sit comfortably with, the sex they were assigned at birth.’ (My emphasis.)
How can a medical organisation write like this? As I have repeatedly pointed out, sex is not assigned at birth. Sex is established at conception and recognised at birth as male or female. To say sex is assigned implies it can be reassigned, but that is nonsense.
They next inform us that gender identity is ‘every individual’s personal, internal sense of their own gender.’ But if we take out the superfluous words ‘personal’, ‘internal’, and ‘own’ we are left with a circular statement: ‘Gender identity [is] every individual’s sense of their gender.’ We can put this more succinctly as: ‘Gender identity is one’s sense of gender’, or even more shortly as ‘Gender identity is gender.’ What, then, is gender? The BMA document doesn’t tell us, so let’s turn to some dictionary definitions:
Either the male or female division of a species, especially as differentiated by social and cultural roles and behavior. (dictionary.com)
A group of people in a society who share particular qualities or ways of behaving which that society associates with being male, female, or another identity. (Cambridge Dictionary)
The characteristics of women, men, girls and boys that are socially constructed…As a social construct, gender varies from society to society and can change over time. (WHO)
So it appears gender is a social construct.
The BMA helpfully defines gender incongruence as ‘discrepancy between a person’s gender identity, their sex assigned [sic] at birth and their primary/secondary sex characteristics.’ Furthermore, we are told that ‘gender incongruence is now a specific diagnostic term in ICD-11.’ (This refers to the WHO’s International Classification of Diseases, 11th edition.)
Keeping with the WHO for the moment, in their document on ‘Gender incongruence and transgender health’, more confusion follows: ‘Trans-related and gender diverse identities are not conditions of mental ill-health…[they are] conditions related to sexual health.’ But if gender incongruence is a specific diagnostic term and if trans-related and gender diverse identities are ‘conditions’ of sexual health, then by definition they are abnormalities of one sort or another.
The BMA is similarly muddled over gender dysphoria:
Gender dysphoria: psychological and physiological discomfort or distress that is caused by a discrepancy between a person’s gender identity, their sex assigned [sic] at birth, and their primary/secondary sex characteristics. Gender dysphoria is not in and of itself classified as a mental illness. Untreated, gender dysphoria can severely affect the individual’s quality of life and potentially lead to mental ill health such as depression or anxiety. (My emphasis.)
What do they mean ‘in and of itself’? Is it a mental illness or isn’t it? And what physiological (physical) discomfort are they referring to? If gender dysphoria may need treatment to avoid severely affecting the individual’s quality of life, then it certainly sounds like an illness to me. But if gender dysphoria is not a mental illness, then what is it? Is it a physical illness or brain abnormality, and if so, what is the evidence for such an idea? Or is gender dysphoria normal (or a variation of normal) for some people in the same way that homosexuality appears to be? And what ‘treatment’ are they referring to? Experimental use of hormones and surgery!
The BMA’s definition of gender expression suffers from the same problem:
Gender expression/presentation: the way in which a person expresses their gender identity, typically through appearance, clothing, and behaviour.
How else can you express your gender than through appearance, clothing, and behaviour? Clothing obviously affects your appearance so they could leave that word out. Also, ‘presentation’, or how someone ‘presents’, are medical jargon words. (For example, ‘The patient presented to the hospital with abdominal pain.’). So we can simplify the definition to: ‘Gender expression is the way in which a person expresses their gender identity through appearance and behaviour.’ This can be condensed to: ‘Gender expression is the expression of gender identity.’
We’re going round in a circle again. But in any case this is manifestly untrue. A man could have a strong sense of identity as a woman but could keep this to himself and dress and behave as a conventional man. Identity does not have to be expressed in appearance and behaviour, or at all.
The problem with the medical view of transgenderism is the assumption that gender dysphoria is an entity that exists in nature. Such a notion is reflected in The British Medical Journal (BMJ), 11 March 2023, where there is an article, ‘Caring for young people with gender dysphoria’, as if this is comparable with, say, young people with diabetes or arthritis. But gender dysphoria, if we simplify the BMA’s definition quoted above, is ‘discomfort or distress caused by a discrepancy between a person’s gender identity and their sex’.
The article also says: ‘If we have the best interests of young people at heart, the surely our duty is to offer evidence informed care?’ Note the question mark. How about doctors having a duty to offer care based on common sense?
Accepting reality – or drugs and surgery?
The treatment for gender dysphoria, if requested by the person suffering such discomfort or distress, as with any other mental symptom, should be to help the patient explore, work through, resolve, or at least come to terms with the underlying conflicts and traumas that appear to be relevant in their causation. And if no underlying problems emerge to account for the discomfort or distress, then the best course may be to help the person accept his or her feelings, or as the BMA puts it, the sense, of his or her own gender. But no. The default position is that if you declare yourself to be trans, then the best course of action is to offer ‘affirmative’ care, which means lifelong hormonal treatment and life changing surgery!
Similarly, the idea of ‘specialists in gender dysphoria’ mentioned in the BMJ article above, is questionable. What is the function of such specialists? It appears to be to help people who are confused over their gender to receive gender-affirming care, that is, experimental drugs and surgery; it should never be used in children or adolescents. And surely, before contemplating such treatment every effort should be made to help people accept their reality.
Nice warm feeling or a lifetime of regret?
The expression ‘gender affirming’ has a nice positive, warm feeling about it. But it’s false. It means affirming the validity of people’s fantasies, feelings, or sense that they’re in the ‘wrong’ body and therefore should be offered treatment to change their appearance to imitate that of the opposite sex – a step that one could regret for the rest of one’s life. See this link, courtesy of Binary Australia:
Text © Gabriel Symonds
Picture credit: Wikimedia Commons. The picture is of Lili Elbe (1882–1931) by Gerda Wegener. Lili, a Danish trans woman, married Gerda Wegener; they were both painters. Lili underwent four gender affirming surgical operations but died from complications of the last one.