Transgender – Doctors should Keep Out of it

Confused about your gender? Then you will need specialised gender care!

Consider this scenario. A young boy wants to dress in girls’ clothes, play with girls’ toys, and expresses a liking for the colour pink. He says he is, or wishes he could be, a girl. His concerned parents wonder whether he has ‘gender dysphoria’ and take him to a so-called gender specialist.

Already we have two huge unwarranted assumptions: that gender dysphoria is something a person ‘has’ in the sense of a medical diagnosis like diabetes or bronchitis; and that the proper person to see for this situation is a gender specialist, whatever that is.

I have argued before that gender dysphoria is a confusing pseudo-medical term; it should be abandoned. It’s no more a diagnosis that rhino dysphoria or masto dysphoria – unhappiness over the shape or size of one’s nose or breasts, respectively.

The term, nonetheless, is increasingly used to refer to unhappiness or dissatisfaction due to a perceived discrepancy between one’s ‘gender identity’ and one’s biological sex. To put it another way, it refers to a feeling, belief, sense, or delusion that one was ‘born in the wrong body’. An example of this is Jazz Jennings who declared he had ‘a girl brain in a boy body’.

People are free to believe anything they like, but what happens if they become seriously unhappy because there is no connection between their beliefs and external reality? Then it is the unhappiness that may need treatment. For example, in the case of a girl who believes she is ‘really’ a boy and is distressed because her belief conflicts with the objective situation, what the transgenderists would advocate is that, if the girl so wishes, doctors and surgeons should use their skills to attempt to change her body to resemble that of the opposite sex!

When I say doctors should keep out of it, there may nonetheless be a place for psychiatrists (medically qualified specialists in so-called mental diseases) because unhappiness in this situation may be a symptom of other mental problems. But in general, a psychotherapist, family therapist, or counsellor would be the appropriate person to see if there is serious unhappiness over one’s biological sex.

In spite of this there seems to be a burgeoning number of clinics jumping on the bandwagon of gender care, whatever that means. One such is called Gender Plus. It’s run by some of the staff who used to work at the controversial Gender Identity Development Service of the Tavistock Clinic which is now suspended, pending review. Not to worry! Gender Plus offers private referrals for hormones and surgery for children and teenagers with gender dysphoria.

Gender Plus on its website declares it ‘has been set up to meet the need for timely access to high quality gender care that is person centred, holistic, respectful, and comprehensive.’ It obviously hasn’t been set up for untimely, low quality, non-person centred, unholistic, disrespectful, and non-comprehensive care. Thus, we can shorten this statement to: ‘Gender Plus has been set up to meet the need for gender care.’

What, then, is gender care? The only explanation to be found on their website is that they ‘provide specialist gender assessment for children, adolescents and young adults.’ Another assumption: gender is something that may need, not just assessment, but specialist (!) assessment.

If gender is a person’s internal, individual, and unique sense, feeling, or belief about themselves, how can this be assessed by anyone else? It seems, nonetheless, that Gender Plus has taken on the self-appointed task of offering to assess someone who is confused about his or her gender, whatever this word means.

It would be unobjectionable if they were just to offer psychological help, but what they are doing is facilitating access to hormonal treatment and surgery. In support of this controversial idea they reassuringly mention that ‘Our practice is guided by WPATH (World Professional Association for Transgender Health) Standards of Care and the [repetitively named] NHS Service Specifications for Gender Services.’ So that’s all right then.

Well, it isn’t all right. You can read a critique of the former here and a detailed examination of the latter here.

Although transgenderists may claim gender is a spectrum, or even that there is an infinite number of gender presentations, in practice it boils down to the following: male, female, male and female, neither male nor female, something in between, or something that changes from to time (‘gender fluid’).

In terms of treatment that may be offered – hormones with or without surgery – the options are rather more limited. One can attempt to change a male body to resemble that of a female, and vice versa, but what can be done for the other forms of gender identity? One could try to create a hermaphrodite with both male and female sexual characteristics, or one could remove the breasts and genitals so the person would appear asexual, but what could be done for a gender fluid person?

In practice, surgeons can only attempt male to female or female to male ‘reassignment’. This shows how artificial and meaningless such procedures are, to say nothing of the surgical and psychological risks, as well as the dubious ethics.

Hormonal treatment to delay puberty (‘puberty blockers’) should be banned in physically normal children or adolescents. (The rare abnormality of precocious puberty is a different matter.) The reason for this is that unless a child has gone through puberty it is impossible for him or her to give fully informed consent because they cannot know what they would be consenting to. And if they have a strong aversion to going through normal puberty, then this is what may need counselling and support – not experimental and irreversible bodily alterations on demand to attempt to change a fantasy or delusion into reality.

There is a further problem with Gender Plus. One of the team members is Dr Claudia Zitz, a clinical psychologist. In her brief biography we learn she worked in the NHS for ten years, etc., but then the writing continues: ‘They [sic] have specialist skills in gender assessments.’ What’s happening? Has she suddenly morphed into two or more people? Oh, I see. Her pronouns are ‘they/them’!

It’s bad enough to facilitate altering unhappy peoples’ bodies; now they want to distort the English language as well.

Text © Gabriel Symonds

Photo credit: Kajetan Sumila on Unsplash