The Birds and the Bees
Imagine, for a white-knuckled moment: you are hunkered down on a battlefield, commanding officer to a platoon of shell-shocked soldiers. Ahead of you lies an open stretch of scrubby terrain peppered with concealed land mines, beyond that the safety of a sheltering bunker; behind you, hard on your heels, a swarm of enemy soldiers. You have no choice but to go forward, to lead your squadron across that booby-trapped pasture, desperately hoping that your troops aren’t exploded to splatters and tatters of blood and gore.
But at the last second, as you’re about to order that gut-wrenching dash for refuge, you find in your rucksack a detailed map of those landmines. Drenched with sweaty relief, you and your platoon pick your way quickly and safely across to that bunker.
That’s a rough analogy for the transgender battle ongoing in our culture, a toxic stew of vitriol, misunderstanding, and outright nonsense. It’s a treacherous debate - easy to put a foot wrong and get blasted to bits.
But join the debate we must, if we care one whit about where this is headed. The casualties are mounting, and to remain silent is to be guilty of complicity, Albert Einstein said.
The subject matter is complex, at once more difficult and more nuanced than most parties to the conflict understand or are willing to admit. Blundering blindly through this minefield isn’t wise: we’ll blow ourselves up and cede victory to screwball ideologues on the extremes.
We need an accurate map, and this long essay is my attempt to illuminate the landscape. I’m under no illusion, medical grounding notwithstanding, that my perspectives are without error. “Deep thinking” is hardly my forte. Socrates advised, “By all means marry: if you get a good wife you will be happy; if you get a bad wife you will be a philosopher”. I’m fortunate to occupy the first half of that equation. And while I’m not bereft of common sense, William Osler pointed out that “common sense in matters medical is rare, and is usually in inverse ratio to the degree of education.” So take what I offer with a pinch of salt.
That aside, a bit of biology: A defining characteristic of all mammalian species, a fact known to every high school student, is that mammals are organized as male and female for the purposes of reproduction. Little gamete meets big gamete, sperm meets egg, and voilá: new little mammal.
Early in my career, when I was a veterinarian serving hard-working farmers on the windswept prairies of eastern Saskatchewan, I witnessed first-hand the success of this scheme. Without fail, a few ecstatic bulls left free to plunder a large group of accommodating cows produced a bumper crop of calves on the ground. Prisoners to their biological drive, successful bulls each spawned roughly 30 offspring each breeding season.
And, as a general rule, humans don’t seem any different. Granted, most of us properly confine ourselves to mating less energetically than free-range bulls, but men connect with women, children are produced, and thus we propagate our species. The birds and the bees, and all that.
But is that the whole story? Is the Platonic ideal of absolute dimorphism actually what we see in the natural world?
A couple of weeks before I wrote this piece, I published “Act One” as a stand-alone piece to my blog and shared it on social media. Atop the article, I deliberately - perhaps provocatively – placed the symbol claimed by the transgender movement, a motif that fuses the Mars and Venus symbols for the sexes. I did so knowing full well the perils of conflating, if only pictorially, a disorder of sexual development (DSD) with the “transgender experience”.
I wasn’t overly surprised when I got scorched by criticism. Trans-activists were upset by the insinuation that they have a “disorder”; conservatives berated me for implying that transgenderism is rooted in biology. After a dog-pile of vicious remarks on Twitter, capped by one worthy who decided I was a corrupt charlatan in the pocket of big pharma supplementing my income by mutilating children in a shadowy back-alley clinic, I deleted the thread to which I’d added my essay and blocked the most unhinged of the twits screaming at me from their keyboards. (If I was to weave together all the febrile threads on Twitter ranting about transgender issues, I’d have a cord the diameter of Earth itself.)
It was unpleasant, but so be it: if you can’t stand the heat, get out of the kitchen. But I’ll stay in this kitchen, for now, no matter how hot it gets. Because there’s a method to my madness, as you shall see.
It should go without saying (from a medical viewpoint, at least) that calling something a “disorder” isn’t a moral judgement. Pathology isn’t bigotry: it’s simply a departure from the healthy order of things. If I diagnose someone with diabetes, or appendicitis, or schizophrenia, I don’t think any less of them.
We go so far in my profession as to label disturbances of health as “disease”. Only amidst the craziness of our current discourse have these time-honored, useful terms become politically-charged and pejorative. Call them “variations” or part of “human diversity” if you wish: it doesn’t change the fact that these conditions must usually be addressed, or bad things will happen. I’ve been battling a rare cancer for a dozen years: whether I term it “disorder” or “disease” or” baked apple pie” doesn’t change the fact that had I not attended properly to its treatment the bastard disease would have snuffed me out long ago.
As explained in Act One, Jill floated as an embryo in a testosterone-infused bath that torqued her external genitalia to a masculine appearance. But the wash of male hormone also saturated her developing brain – and not without consequence. While most baby girls born with congenital adrenal hyperplasia (CAH) grow up to be comfortably female, this isn’t always the case. Approximately five percent of these children, most often those with the most severe virilization (the ones with the highest in utero testosterone exposure), are conflicted about their gender identity as they grow up. Through no fault of their own, simply due to their embryonic “XX” brains being soaked in testosterone, they experience “gender dysphoria”.
The Oxford dictionary defines gender dysphoria as “the condition of feeling one's emotional and psychological identity as male or female to be opposite to one's biological sex.” It is a genuine phenomenon, and in affected CAH females it’s not difficult to grasp the biological root of its genesis.
CAH is rare, affecting one in 15,000 live births. But there are more than twenty-five disorders of sexual development, or DSD (previously referred to as “intersex”). It’s a dog’s breakfast of missing sex chromosomes, extra sex chromosomes, enzyme deficiencies, faulty hormone receptors and so on and so on.
Collectively, 1.7% of live births are born with a DSD, according to a comprehensive review in the American Journal of Human Biology. Put another way, given the planet’s current gallery of 7.5 billion humans, roughly 128 million people are living with one of these disorders.
Most infants born with a DSD are born with external genitalia that permit ready categorization as male or female; a small minority have ambiguous genitalia at birth (some develop genital ambiguity later in life). A smaller minority develop gender dysphoria, unable to slot themselves easily into the gender “binary” that governs most of the world’s population.
It’s important to note that these disorders affect ALL animals, not just humans. When they occur in the wild, the law of the jungle dictates that the fittest survive. In the agricultural arena, affected animals tend to get culled - no great tragedy, I suppose, since their fate is not materially different from their peers. They just end up in the slaughterhouse a little bit earlier.
But we are unique in the animal kingdom. We are human, and we choose not governed by the law of the jungle. Unless we subscribe to the monstrous Holocaust eugenics mentality of Josef Mengele, we don’t advocate culling those who are different from us. We are moral creatures, endowed with empathy, inclusiveness, and tolerance for the differences among us.
Ironically, it is a rainbow flag of inclusion and tolerance that trans-activists are waving as they aggressively battle to revamp sexual culture, trailing an ever-lengthening streamer of an acronym: LGBT has undergone muscular expansion, almost overnight and as if on anabolic steroids, to the present 2SLGBTQIAP+ (or a version thereof). For the uninitiated: 2-spirited (but only if you are First Nations), lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, pansexual, and the plus for everybody else. I doubt the expansion will end before the entire alphanumeric code has been recruited to the cause.
For most lesbians, gays, and bisexuals, their gender is comfortably aligned with their sex. But not so for the transgender category, as is self-evident, or for any of the categories which have sprouted directly from the transgender movement; all of it fired, ostensibly, by gender dysphoria - the same dissonant feeling experienced by some of those with a DSD. In contrast to those cases, however, it has been difficult to pinpoint biological roots for the dysphoria afflicting transgender people.
The transgender community, which carefully cordons itself off as outside of and distinct from the DSD community, is genetically binary (XX or XY). But it subscribes, by and large, to the notion that it is possible to transition from one sex to another, as well as to the fiction of “gender fluidity”, the idea that gender exists on a spectrum. And seemingly overnight these watery ideas of transition and fluidity have coalesced into an ideological tsunami threatening to obliterate all reasonable discussion.
To be continued.
*names and some details changed to protect privacy.
*views expressed in this blog reflect the personal opinions of the author and should not be construed to represent the opinions, views, values, or practices of Alberta Health Services or its member hospitals