The Birds and the D’s
If ignorance was bliss, my fellow humans, we’d be permanent residents of Nirvana.
Because we will always be ignorant.
The Age of Enlightenment upended that dreary calculus, seemingly, by highlighting mankind’s powers of reason, transforming the intellectual and philosophical landscape of 18th century Europe and ushering in unprecedented discovery and inquiry. “Sapere aude!” proclaimed Immanuel Kant, summing up the exuberance of that era: “Dare to be wise!” Or, more loosely, "Dare to think for yourself!"
And on that foundation of reason we’ve built a towering edifice of science and knowledge - towering, that is, compared with what was known before. As I’ve written elsewhere, every era finds us basking in an age of unprecedented enlightenment – until the rear-view mirror of history exposes it as an age of slightly less ignorance. We scale mountains of knowledge and swim oceans of discovery - only to find mountains more magnificent to tackle and oceans more vast to explore.
As a good friend likes to remind me, “the truth is.”. But getting to that truth is maddeningly elusive. The Apostle Paul observed long ago that we “see through a glass darkly”: pure comprehension of truth remains perpetually out of reach. It’s best that we proceed humbly, holding the lamp of our current understanding as high as we can.
And, by that flickering light at least, there is scant support for the concept of “gender fluidity”. Rather, gender is best understood as “binary, with exceptions”. Boys are boys and girls are girls, each half of the binary represented by a bell curve; and within each bell curve we see a spectrum of expression from feminine to masculine, from Barbie-loving to rough-and-tumble males, from girly-girl to tomboyish females. This is perfectly normal (and desirable – imagine the blandness of a world without it), and the range of expressions within the binary carries, for the most part, through to adulthood. Exceptions to the binary norm, as in some individuals with disorders of sexual development, serve only to prove that rule.
But the absence of evidence has proven no impediment for the trans-activists, whose fanatical adherence to the myth of gender fluidity has veered head-long into mysticism. The light of reason has vanished entirely, so far down the ideological rabbit hole have they fallen. And woe unto those who dare to disagree with the new sexual orthodoxy: any dissent is labeled as bigoted, irrational, and hateful.
And as a pediatrician and a father, I’m aghast at how this threatens our youth.
The fluidity myth emerged from the real and rare phenomenon of gender dysphoria. The cause of gender dysphoria remains, in many cases, unclear. In some, as explained in "Act Two", it derives from an identifiable DSD. And in others it has been linked to a host of psychological, social, and psychiatric ills: autism spectrum disorder, homophobia, bullying, anxiety, neglect, broken homes, abusive homes, drug addiction, depression, et cetera. And to state what should be obvious, youth struggling with gender dysphoria don’t choose to be afflicted: one might sooner choose waterboarding as a path to serenity.
Thankfully, as good evidence has shown, gender dysphoria resolves in 80 to 95% of afflicted youth. “Watchful waiting” and counseling settles them comfortably into the gender identity consistent with their biological sex.
But dare to champion this proven, cautious approach today and you shall be buried under an angry avalanche of accusations of bias, hatred, and human rights violations. Just ask renowned psychologist Dr. Ken Zucker, who employed this method for more than thirty years at a gender-identity-disorders clinic in Toronto, successfully guiding hundreds of young people to restored mental health. Then the trans-activists came gunning for him and he was summarily fired, his clinic shut down.
By the activist gospel, there is only one path to gender salvation: children and teens must simply be “affirmed” in their dysphoria and helped, should they choose it, down the pathway to sex reassignment.
Incredibly, the American Academy of Pediatrics, continuing its steady evolution away from its historical role as steward of pediatric health, has clambered aboard the trans-activist train. The AAP’s position statement on the care of “gender-diverse” children, issued this fall, holds "affirmation" to be the only acceptable option; a position based, as Dr. James Cantor detailed in a withering exposé in Sexology, on nary a shred of evidence.
This is the same AAP that touted a study concluding that crossing a busy street requires calculations too complex for kids less than 14 years old. That’s right: too young to cross the street, too young to buy cigarettes or booze or to take in an R-rated movie, but old enough to make the enormous, life-changing decision to attempt the impossible: to cross the highway to the other sex.
By the AAP’s reckoning, if a dysphoric prepubescent child is insistent, consistent, and persistent in his or her opposite-gender identity – if a girl, for instance, is insistent that she is a boy, consistently asserts that she is a boy, and persists in the belief that she is a boy for more than six months - then that child is to be affirmed in that identity and, as soon as puberty threatens (at age 11, on average, for girls, age 12 for boys), invited to begin puberty-blocking drugs - step one on the sex reassignment pathway.
And it’s not a pathway for the faint of heart. Puberty-blocking drugs arrest children in a pre-pubescent state (“buying time”, ostensibly, for children to be certain of their decision). This is followed in a few years by cross-gender hormones to stimulate characteristics of the opposite sex - estrogen to grow breasts and female “curves”, testosterone to acquire masculine proportions, a deep voice and facial hair. Finally, sex-reassignment surgery finishes the job: in boys, the penis and testicles are amputated, a “vagina” produced by creating a cavity lined with pieces of penile and scrotal skin; in girls, the uterus and ovaries are removed, and a chunk of muscle and skin from a forearm is carved out and rolled up to fashion a “penis”, complete with an inflatable tube that can be pumped up on demand to achieve sexual “function”. Once all these alterations are complete, life is lived as the “opposite” sex, permanently infertile and, to maintain it all, complete with a mandate to take lifelong sex steroids – powerful hormones that can spin off blood clots, coronary artery disease, high blood pressure, and cancer.
It’s sobering stuff – and we are expected to believe that 11-year-old children possess the maturity and insight necessary to choose such drastic modification.
But, we are told, puberty-blocking drugs are “completely reversible”: if a child who begins this medication has a change of heart two or three years later, he or she can simply stop the drug, and the pubertal cycle will “re-awaken” and carry through normally to completion. No harm done.
Except that children who start puberty-blocking drugs don’t change their minds; roughly 98 percent persist in their desire to transition and progress to cross-gender hormones. Compare that number to the less than 20 percent rate achieved with watchful waiting and counseling, and it’s clear that chemical blockade of puberty isn’t “reversible”. And it’s not hard to see why: imagine the dystopian psychosocial environment created for these children, frozen in prepubescence as their peers move through the complex changes of puberty. They are left behind, stranded on an arrested-development island populated by adult voices affirming them in their cross-gender dysphoria. Shifting into “reverse” after the decision is taken to block puberty is, for all practical purposes, impossible: the die is cast.
To expect pre-pubescent youth to make the radical decision to move down this pathway is to make a mockery of informed consent, the bedrock principle that guides ethical medical interventions. One does not know what one cannot yet know: puberty brings profound perceptual changes that children cannot fathom before they go through it. Pre-pubescent children are no more acquainted with what their world will look like after puberty than Donald Trump is conversant with the mores of Miss Manners.
I attend occasionally to patients with anorexia nervosa, also known as body dysmorphic disorder. Despite being stick-thin, these individuals believe with every fiber of their being that they are overweight. In the face of multiple metrics of evidence that they are underweight, they studiously starve themselves in a quest to become ever thinner. It’s a perilous pursuit: body energy reserves deplete, metabolism slows, heart rates plummet, and cardiac arrhythmias suddenly kill if congestive heart failure doesn’t do the job first. Anorexia nervosa remains the most lethal of psychiatric disorders: up to 20 percent of people who have had anorexia for 20 years die of the condition.
Anorexics require intensive psychiatric care to correct their distorted self-image, as well as careful nutritional rehabilitation. What we do not do, as physicians caring for these patients, is enable them in their delusion so long as they are insistent that they are fat, consistently believe that they are fat, and persist in the belief that they are fat. We don’t affirm them in their fatness and help them down the road to starvation by withholding food and starving them of counsel. That would be called malpractice, if not murder. Yet this is how the trans-activists, and the AAP, would have us approach gender dysphoria.
The anorexia analogy isn't exact: some gender dysphoric children, after all other avenues are exhausted, undergo transition in order to relieve their distress - there simply isn't any other solution, and these individuals must be cared for, respected, and supported like anyone else. But, to reiterate, transitioning, with its profound, life-long implications, is simply unnecessary in the vast majority of cases.
The AAP, inaugurated in 1929 and with 67,000 pediatric specialists in its ranks, sets as its mission the pursuit of “optimal physical, mental, and social health and well-being for all infants, children, adolescents and young adults”. How a policy potentially conducive to the physical and psychological damage of children fits into that mandate is baffling, and deeply distressing. It’s like watching Mother Theresa mutate into Heinrich Himmler.
One would think, given the profound, irrevocable implications of the puberty-blocking “affirmation” approach, that the AAP could have readily marshaled mountains of solid evidence to support it. But one would be wrong. Because there isn't any. There's not a single large, randomized, controlled trial in the pediatric literature comparing long-term outcomes between this approach and the method of watchful-waiting with counseling, and not a single quality study carefully assessing the supposed benefits and potential harms of long-term cross-gender hormone administration.
This is the antithesis of evidence-based medicine, and it leaves me incensed, appalled that we dare to openly violate the ethical standards that govern all other areas of medicine, that we are stomping all over the sacrosanct principle of non-maleficence (“do no harm”) that has always governed our profession.
But wait: perhaps there is evidence in the adult literature, at least, from which we can extrapolate some benefit. Perhaps if we look at the cohort of adults who have undergone sex reassignment we will discover the idyllic panorama of resolved dysphoria and unbridled contentment promised to all by the trans-activists. Perhaps the pain of surgical amputations and additions, the infertility, the requirement to take hormones for life is all worth it in the end.
Again, there’s not much good data. One meta-analysis of 28 studies suggests that transitioning allows many adults to resolve their dysphoria; but the subjects in those studies are unmatched to controls, and the authors of the analysis readily admit to the poor quality of the evidence they reviewed. Overall, what decent research there is paints an unsettling picture. Most comprehensive is a Swedish study that followed 324 sex-reassigned individuals over a thirty-year period and compared them to random population controls: as a group they continued to exhibit, post-transition, considerably higher risks than the general population for mortality, suicidal behaviour, and psychiatric morbidity - with a completed suicide rate almost twenty times higher than comparable peers.
It must be stated plainly that a man cannot become a woman and a woman cannot become a man, and no amount of contorted ideological gymnastics can change that simple calculus – and to say so isn’t hate speech. It's most accurate to say that sex “reassignment” surgery produces feminized men (transwomen) and masculinized women (transmen) - and transwomen are not women, transmen are not men, and to say that they are is simply a fabrication. For transwoman Rachel McKinnon, recent “champion” of a woman’s cycling event in California, to claim “I am a woman, I have a body, therefore I have a woman’s body” is ludicrous. For all the knowledge she has of the complex innateness of actually being a woman, she might just as well imagine being a porpoise: “I am a porpoise, I have a body, therefore I have a porpoise’s body.” I could identify as a cucumber, I suppose, after closely observing the behaviour of a cucumber (the upper limit of complexity for my labouring brain), but I would be as deeply rooted to the vegetable patch (and my sanity) as I am to the planet Mars.
Dr. Oliver Sacks, dearly departed giant of neurology, tells the story of a man who mistook his wife for a hat. The afflicted gentleman was beset by visual agnosia, unable to accurately process what he saw. The fact that he thought his wife to be a hat didn’t make her a hat, however, any more than I am a cucumber - nor was she able to turn into a hat. She remained very much his wife, comfortably at his side, supporting him as they looked to the good Dr. Sacks for assistance. And men who mistake themselves for women are not women and cannot become women, and vice versa: women who mistake themselves for men are not men, nor can they become men.
Despite enduring all the pain of transition to attempt life as the opposite sex, a number of trans individuals come to deeply regret their decision. Some attempt to “detransition”, to try to head back from whence they came. (Dysphoria, disease, disorder, desistance, and now detransition - the chorus of D’s has swelled to full dissonant orchestra – the third act of my long dissertation has officially earned its caption). But it’s difficult, to put it mildly, to physically and psychologically undo what has been done.
With all of the above in mind it seems clear that the radical decision to pursue sex “reassignment” should be seen as the very last resort, after all other options are exhausted. But saying as much to the activists is like waving a red flag in front of a bull.
Given the profound distress inherent in gender dysphoria, any measures we can take to reduce its incidence should be welcomed. But trans-activists are striving, despicably but successfully, to achieve the opposite, igniting an epidemic of gender dysphoria with fiery gender-fluidity sermonizing. And there can be no better way for trans-activists to deepen the pool of gender dysphoric children than by establishing gender fluidity as dogma in our schools. If the purple gender unicorn hasn’t yet made its way into your local school curriculum, the propaganda that underpins that banner of falsehoods almost certainly has, and increasingly backed by our laws.
The unicorn graphic displays “gender identity”, “gender expression”, “sex assigned at birth”, “emotionally attracted to”, and “sexually attracted to” as distinct categories, each in turn depicted as an infinite spectrum of choices. It’s a mind-bending array of inventions exploded from a few kernels of truth, and impossible for the average adult to grasp - let alone for the bewildered primary-school children to whom it is being pitched. Last year, during the brief period in my home province of Alberta in which the purple beast made an appearance in the province’s public schools (the cartoon was withdrawn after a public backlash), the daughter of an acquaintance returned home from kindergarten to announce that she had decided to be a unicorn. One doesn’t need to be a psychologist to appreciate the rampant confusion being seeded in young minds by the wilful obliteration of science-based norms.
If we allow the trans-activist takeover to continue apace, we will one day look back on the forced sterilization and surgical alteration of many of our children as one of the worst crimes ever perpetrated against mankind. And as with many of humanity’s darkest seasons, we shall stand guilty of allowing the history books to reveal that carnage before the truth on this matter can get a proper hearing.
The trans-activists will certainly not be according that truth a hearing: their Trojan horse of “tolerance”, having galloped deep into our midst, is busily dispensing “social justice” warriors intent on stamping out all dissent. No debate. No conversation. No nuance. No limits.
And in the face of this clear and present danger to our children and our culture, sadly, numerous conservatives are reacting contemptibly, slinging arrows from a vile quiver stocked with derision, spite, and malice into a discussion that rather requires empathy, compassion, and wisdom.
For too long many conservatives have remained uninformed, often willfully so, of biological variations and disorders that legitimately give rise to gender dysphoria. And more than any other segment of society, they continue to stigmatize those who wrestle with psychological and psychiatric disturbance, unwilling to subscribe to the time-tested maxim: “There but for the grace of God go I.”
The odiferous “check your privilege” mantra that has permeated our culture and smeared white male heterosexuality should rightly be replaced by “check your ignorance”, as admonishment to be properly informed before pontificating about issues of complexity and nuance.
Most annoying is the sanctimony and smugness of many “Christians” who are fortunate enough to be born cleanly heterosexual, who have never had to walk a solitary inch in the shoes of those who are struggling. They are quick to ridicule the notion that one can feel like the opposite gender while not actually being the opposite gender. But they remain oblivious to the corollary truth: that a non-conflicted heterosexual person cannot have the foggiest clue as to what it’s like to live with gender dysphoria - or to be attracted to the same sex, for that matter.
That's a segue to a very large elephant in the gender dysphoria room, one that religious conservatives in particular would prefer to ignore: the vast majority of gender dysphoric youth who settle, after appropriate support, into the gender identity congruent with their sex are homosexual. And the alarming truth, as sex researcher Dr. Debra Soh has pointed out, is that some parents would rather have a same-sex oriented child transition to the opposite sex and live as a heterosexual than countenance their son or daughter as gay. It’s a repugnant form of conversion therapy, and what is most disturbing, as Dr. Soh puts it, “is that these parents will be lauded as open-minded and ‘on the right side of history’, when in actuality, they are homophobic.”
The fact that genuine gender dysphoria is rare matters not at all – whether it’s one in ten or one in a million makes not a smidgen of difference as to how afflicted people should be treated. Jesus said, “Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did it for me.” I’m no theologian, but I would say to all the Christians waving their Bibles about in fits of moral outrage: that book is riddled from start to finish with the overarching admonition to “love the Lord your God, and your neighbour as yourself.”
Those wrestling with their gender identity, whether or not it is publicly apparent, are our friends, our neighbours, our families, our co-workers: they are the waitress in the restaurant down the street, the CEO of your firm, the accountant in the cubicle next to you, your teammate in beer-league hockey, your neighbour down the street, your sons and your daughters. And we are called to love them all as we love ourselves - no exceptions.
So we’d best get it together, take a hard look in the mirror, lose the ill-informed bigotry and lead with the love that Jesus actually preached. Otherwise we might as well capitulate and let the gale-force wind of activist ideology sweep us cleanly off the battlefield.
And it’s an ominous wind that is blowing, a hurricane blasting through our schools, our universities, our public spaces, scrambling the compasses of our medical and political leaders, cracking the foundations of society and ripping up morality by its roots. Common sense has been blown into the stratosphere and shredded to bits, and the trans-activist typhoon is spinning off shards of ideological shrapnel faster than we can keep up: the pronoun police are demanding that we use spoken Egyptian hieroglyphics; “gender-free” infants are being reared as “theybies”; "chest-feeding" has joined breast-feeding to support men who want to lactate; trans-women are invading women’s sports with their male physiques and hoovering up the medals; incarcerated trans-women are sexually assaulting female prisoners; trans-women are traumatizing residents of women’s shelters; feminists concerned by the erasure of “women” as a meaningful category are viciously attacked as TERFs (trans-exclusionary radical feminists); lesbians are persecuted as transphobes if they recoil at the idea of sexual relationship with transwomen, whether equipped with a penis or not; and in perhaps the sickest spin-off to date, a Canadian pedophile, convicted of sexually assaulting his three-year-old daughter, transitioned to womanhood to avoid the frontier justice assuredly awaiting him in the men’s penitentiary.
Like Theseus in A Midsummer Night’s Dream we are witnessing more lunacies “than vast hell can hold”. A Midsummer Night’s Dream is a comedy, but there is nothing funny about the trans-radical agenda. Left unchecked, this will end in tragedy, and not just for our children: in Shakespearean tragedy everyone loses.
Resistance is perilous, but it is not futile - nor is it optional. Feminists, people of faith, transgendered individuals troubled by what is being done in their name, homosexuals appalled by the seizure of their platform, concerned parents and physicians and educators and leaders: we have common cause, and we must stand united, armed with knowledge and clothed in empathy and compassion, and boldly speak truth, love, and reconciliation into this storm.
When Immanuel Kant adopted sapere aude as motto for the Enlightenment era, he was borrowing Horace’s words of advice to a fearful student: likening one who hesitates to take action to a fool waiting for a stream to stop flowing before he will cross, Horace counseled: “Sapere aude: incipe!” – “Dare to be wise: begin!”
That's sage advice for us as we engage in this important dispute. Wade into this turbulent river. Lend your voice to the fight. Elie Wiesel had it right: “Always take sides. Neutrality helps the oppressor, never the victim. Silence encourages the tormentor, never the tormented.”
And always remain at the side of your children, no matter what, whether you agree with them or not. Never, ever abandon them. I’ll punctuate that point and bookend this trifecta of essays with another true story from the front lines of emergency medicine.
Several months ago, an 11-year-old girl was rushed to our hospital in full cardiac arrest. She had hung herself in her closet following an angry exchange with her parents.
Our trauma team tried desperately to revive her, but to no avail: she died on the trauma bay bed.
In the horrific aftermath, the brutal context that led to her death was laid bare: she had been living, for many months, with gender dysphoria – she felt she was a boy, “trapped” in a girl’s body. Her tortured efforts to explain her feelings to her parents were met with alarm, dismissal, anger, denial, discipline. They would have none of it, so completely was her distress at odds with their personal moral construct.
And now their beautiful daughter is dead.
Our children need to know that they can ALWAYS come to us without fear of rejection, no matter what their difficulties; that they can share anything and everything without fear of condemnation; that we are their ultimate safe place; that we will walk with them through whatever hell the world throws at them; that they cannot shake loose our love for them.
As British songwriter Callum Scott sings so poignantly of his own parents in his latest release, a beautiful ballad extruded from the pain of his own difficult experience: “They loved me no matter what.”
No matter what.
Because we shouldn't have 11-year-old girls hanging senselessly in their closets.