Is changing gender as simple as changing clothes?

Political correctness is not only contrary to the spirit of the First Amendment of the American Constitution but also makes for soporific discourse. Newsweek’s recent cover story on transgenders certainly proves that the priests of tolerance and diversity have successfully exorcised the ghost of satirist H.L. Menken from the mainstream media. Newsweek’s coverage  was so saccharine that I needed wet wipes after each page.

An issue involving sex and castration should generate a lot of hotly disputed questions. Unhappily, Newsweek relegated any dispute to the usual evangelical bogeyman, with mild scepticism replacing controversy. After all, it averred, we can’t really know the difference between men and women, or male and female. Even the experts at the International Olympic Committee plead ignorance, it was claimed, when it comes to "scientifically" differentiating between a man and a woman. (If East Germany still existed I guess that its athletes could get their medals back!)

At conception, men and women are bestowed an unchanging role in the procreation of offspring. As male and female, we can either participate or not participate in that relationship; but we can’t switch roles. We can't be reassigned.

Newsweek also avoided the other key debate about this difficult issue: whether or not transgenders have a mental illness or merely an inconsequential desire. The word "transgender" is a neologism coined by activists to denote people who at least sometimes identify themselves with the opposite sex. Typically, these folks are transsexuals and/or transvestites. Both transsexuals and transvestites have been in the psychiatric "Diagnostic and Statistical Manual of Mental Disorders" (DSM). Transvestitism is intense sexual arousal to women’s clothing. Transsexuals identify themselves as the opposite sex. In 1980, transsexualism was added to the third edition of DSM. In 1994, the term "gender identity disorder" replaced transsexualism.

Doctors get involved because transsexuals often demand hormones and surgery to fulfill their desires. But are physicians enabling a mental illness or merely complying with a cosmetic request?

Many transgender activists object to the "crazy" label. The brother/sister of actors, Rosanna, David and Patricia Arquette was featured in Newsweek. Alexis Arquette is on a crusade against current standards of care. He/she complains that sceptics are "questioning the sanity of people like myself". Most sexual reassignment centers require two years of counselling before the procedure. Alexis objects to the counselling and seems to propose that physicians ought to treat castration and penile amputations as casually as nose jobs.

A few years ago I attended a program at the American Psychiatric Association’s Annual Conference. An editor of the DSM was under attack for describing gender identity disorder as a mental illness. But in the course of the debate, in a remarkable display of having your cake and eating it too, the transsexual woman who argued against its inclusion was forced to admit that a DSM diagnosis was necessary after all. Why? Because otherwise people suffering from the disorder could not get their health insurance company to cover the cost of the procedures.

Which leads to the $64,000 question. If transsexualism is a disease, then is sexual reassignment the cure?

Let's look more carefully at this notion. Sexual reassignment, with hormone treatment and surgery, is a woolly term which is used far too casually. Take the word "reassignment". What are defenders of transsexualism implying when they use it? In my view, they are relying upon both hoary old Freudian ideas and a silly recent movement called constructivism. The upshot of these two schools of thought is that nature is unimportant compared to nurture. Society and technology always trump biology. So using the word "reassignment" implies that sex is an arbitrary category imposed by the dominant culture through the family. From this perspective, sex is merely a societal convention. In the same way that we expect men to be soldiers and women to be nurses, we expect boys to be boys and girls to be girls. But things can change: women can become soldiers and men can become nurses. So, hey, why can't boys become girls and girls become boys?

Our unquestioning acceptance of the phrase reflects the modern separation between sex and reproduction. Sex has lost its primary meaning as a relationship of two beings vis-à-vis the procreation of life. At conception, men and women are bestowed an unchanging role in the procreation of offspring. As male and female, we can either participate or not participate in that relationship; but we can’t switch roles. We can't be reassigned.

What happens in sexual reassignment? Doctors employ a range of pharmaceutical, surgical and cosmetic procedures to produce either more feminine or more masculine features. Some trans-women may only take up electrolysis and breast augmentation. Others spend tens of thousands for amputation, castration and vaginal construction. Obviously, these procedures destroy the procreative relationship.

The most famous transsexual, Renee Richards, has publicly expressed regret about her decision. Born as Richard Raskind in 1934, she went to Yale and became an eye surgeon and an international tennis star. She even married and fathered a child. But in 1977 she had sex reassignment surgery. She even competed in the US Open in various women's and mixed doubles. But in February 2007, she told the New York Times, "Better to be an intact man functioning with 100 per cent capacity for everything than to be a transsexual woman who is an imperfect woman."

Newsweek presents transsexuals’ pursuit of sex change as inevitable. However, sex researcher J. Michael Bailey in his book, The Man Who Would Be Queen, notes the decision for sex reassignment has a "rational component" and that the "large majority of boys who start out looking transsexual ultimately do not pursue sex reassignment."

The most outspoken critic of sexual reassignment has been Paul McHugh, MD, a member of the President's Council on Bioethics. After becoming chairman of the Department of Psychiatry at the elite Johns Hopkins University in Baltimore, McHugh began studying gender disorders and the sexual reassignment program at his university. After discovering that many transsexuals had strongly masculine interests, McHugh became sceptical of the standard story about "women trapped in men’s bodies." He became convinced that reassignment  should be discouraged. Eventually Johns Hopkins stopped doing the procedures.

McHugh’s scepticism was eventually supported by research indicating that bisexual and heterosexual transvestites and transsexuals are sexually aroused by the idea of being a woman. They fantasise about being the female during sex. A sexologist from the Canadian Clarke Institute, Ray Blanchard named this desire autogynephilia. Transsexual physician Anne Lawrence has described autogynephiles as "men trapped in men’s bodies."

In a 2004 article in the journal First Things, McHugh pulls no punches. In a long account of how he managed to persuade his colleagues that sex reassignment was bunk, he asserts that: "We psychiatrists, I thought, would do better to concentrate on trying to fix their minds and not their genitalia."

I have witnessed a great deal of damage from sex-reassignment. The children transformed from their male constitution into female roles suffered prolonged distress and misery as they sensed their natural attitudes. Their parents usually lived with guilt over their decisions — second-guessing themselves and somewhat ashamed of the fabrication, both surgical and social, they had imposed on their sons. As for the adults who came to us claiming to have discovered their "true" sexual identity and to have heard about sex-change operations, we psychiatrists have been distracted from studying the causes and natures of their mental misdirections by preparing them for surgery and for a life in the other sex. We have wasted scientific and technical resources and damaged our professional credibility by collaborating with madness rather than trying to study, cure, and ultimately prevent it.

Many cities have had much less qualms about cooperating with this madness. Last November, New York City’s Public Health Board recommended that people be allowed to change the sex on birth certificates if they provided evidence from a physician that the change would be permanent. Transgender advocates praise the health board for eliminating anatomy -- and any other physiological, genetic or medical requirements -- as proof of sex. A spokesman for the New York Transgender Rights Coalition, offering some armchair Freudian insights, praised the change as "a move away from American culture’s misguided fixation on genitals as the basis for one’s gender identity".

In moving away from anatomical considerations, health commissioner Dr Frieden announced a new standard for redefining one's own sex. Frieden emphasized that it’s the "permanence that matters". Permanence? For Frieden this meant two years of living as the opposite sex. But how would a doctor prove that this two-year requirement? With hidden cameras? A physician would become merely a rubber stamp for anyone who appears in his office and claims to have lived as a woman for two years. Still, transgender advocates pushed for the elimination of any medical requirements. 

The swift public response surprised the health board. Hospitals complained that women would be forced to share rooms with men. Prison officials complained that they would be forced to transfer men to female facilities. Dr McHugh warned the board that such changes would make sexual identification impossible. "I’ve already heard of a ‘transgendered’ man who claimed at work to be ‘a woman in a man’s body but a lesbian’ and who had to be expelled from the ladies’ restroom because he was propositioning women there," he said. "He saw this as a great injustice in that his behavior was justified in his mind by the idea that the categories he claimed for himself were all ‘official’ and had legal rights attached to them."

The Board of Health withdrew the proposal. "This is something we hadn’t fully thought through, frankly." Health Commissioner Friedan admitted. "What a birth certificate shows does have implications beyond just what a birth certificate shows."

The madness is beyond transsexualism.

Theron Bowers MD is a Texas psychiatrist.


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