The Curious Case of Jack and Jill*: Unabridged

* names and some details of clinical cases changed to protect privacy

Act One

 A Crisis of Identity

The number leapt out at me.  One hundred and three!

An incandescent flash of comprehension flooded my brain.

It was fourteen years ago.  I was standing beside the trauma bay bed, holding one of Jack’s tiny clenched fists in my hand as I gazed at his contorted face, his tongue thrusting rhythmically and his eyes rolled insistently upward.

His spasming body was submerged in a beehive of activity.  Medical personnel supplied critically needed oxygen, readied resuscitation equipment, and delivered intravenous medications and fluids.

Paramedics had crashed through the doors ten minutes earlier, wheeling Jack on a stretcher.  It had been a sleepy Monday morning in the ED to that point, the mundane chit-chat of nursing staff disturbed only by the raspy breathing and occasional seal-bark cough of a young boy with croup.  After dosing the young lad with dexamethasone and settling a misty mask of epinephrine over his face to ease his breathing, I sat in the doctors’ cubicle with my resident, killing time by quizzing her on the case we had just seen.

The relative peace stood in stark contrast to the chaos of a day earlier.  Influenza had invaded our city in full infectious glory; it seemed on Sunday afternoon that every coughing child in Calgary had found a nook in our waiting room from whence to spray virus-packed streamers of snot.

It had been a little nutty.  A little “quiet time” this morning was welcome.  I slouched in my chair, somnolent almost, listening to Joanne clumsily regurgitate what she knew about croup.

The shrill ring of the red patch phone shattered my reverie.  An ambulance was minutes away, siren wailing, speeding toward the hospital with three-week-old Jack.

His panicked mother had called 911 after finding him twitching uncontrollably in his crib .  Paramedics were at her house within minutes.  They applied an oxygen mask to Jack’s face and slipped an intravenous line into one of his miniature veins.

A drop of blood on a test-strip revealed a critically low blood sugar.  One of the medics promptly pushed a dose of concentrated dextrose into his intravenous, expecting the seizures to stop.  But his spasms persisted, his breathing irregular, his limbs stiffening and relaxing, stiffening and relaxing.

As they loaded Jack into the ambulance the medics administered an IV dose of lorazepam, a powerful drug that reliably terminates convulsions.  But to no avail – his seizures continued.  As the ambulance raced toward the children’s hospital the medics called to give us the heads up.

“Give him another dose of lorazepam,” I advised, “and we’ll see you when you get here.”

As they blew into the trauma room Jack was still convulsing.  I took stock: Newborn baby.  Unrelenting seizures.  Low blood sugar.  No response to a corrective bolus of dextrose.  Nor to two doses of lorazepam.

“Eighty milliliters of saline and 200 milligrams of ceftriaxone – and check his glucose again!”, I ordered as my team swung into action.

Fluids and antibiotics infused.  Blood sugar re-measured: normal.

“Phenobarbital, 80 milligrams IV!”.

Phenobarbital delivered.  No response.

“A blood gas, please!  And give him 80 milligrams of fosphenytoin!”

Phenobarbital and fosphentyoin are potent anticonvulsant medications, and I was growing concerned by the parade of anti-seizure drugs Jack was receiving.  Each of these drugs, like the lorazepam delivered earlier, depresses the “drive” to breathe; cumulatively they can cause a patient to stop breathing entirely – and respiratory arrest can lead on to full cardiac arrest.

The situation was dire.  The “blood gas” test I had ordered would assess the carbon dioxide level in Jack’s system and help me decide whether I needed to intubate him, “capturing” his airway by placing a plastic tube in his windpipe.

We began infusing the fosphenytoin while I waited for the respiratory technician to complete the test, assisting Jack’s breathing as best as we could with an oxygen mask sealed over his grimacing face.  His seizures continued, unfazed by the chemical onslaught.

The technician bustled into the room, blood gas results clutched in her hand.

“His CO2 is 68!” she announced, nodding to her partner at the head of the bed to ready the intubation equipment; the sky-high value was proof that we weren’t supporting his breathing adequately.  She held the slip of paper in front of me.

In addition to calculating carbon dioxide levels, the blood gas machine measures serum electrolyte concentrations.  Listed on that paper, below the CO2 value, was a sodium level of 103.  And profoundly depressed sodium levels, rarely seen, can cause intractable seizures – seizures resistant to all usual interventions.

“Give him fifteen milliliters of 4% normal saline!” I directed. “Hold off on intubation!”

A nurse quickly drew the hypertonic saline solution into a syringe and administered it to Jack.

Bingo.  His seizures stopped.  His body relaxed; his breathing resumed a regular cadence.

Crisis averted.

But why was his sodium so low?

I had my suspicions.  I examined Jack carefully.  The prolonged seizure and avalanche of drugs had left him extremely drowsy, but he was perfectly formed, physically unremarkable in every way.  Except for one thing: while his genitalia appeared normal, his scrotum was empty – no testicles to be found.

Additional testing confirmed my hunch:  Jack was a girl.  An abdominal ultrasound detected a uterus and two ovaries, and chromosome analysis revealed a 46, XX karyotype.

The newborn girl, as it turned out, had a disorder of sexual development, a rare condition called congenital adrenal hyperplasia.  A key enzyme was missing: its absence not only played havoc with sodium levels but generated a production-line blockade in the manufacture of steroids.  And that led in turn to the accumulation of massive amounts of testosterone.

The excess male hormone had saturated the amniotic fluid enveloping my patient in utero.  Her external genitalia, heavily influenced by the testosterone bath, masculinized completely, the clitoris elongating and thickening to resemble a penis, the labia fusing to form a pigmented, wrinkled “scrotum”.

Jack’s parents were stunned.  But they recovered quickly and handled the situation with grace and humour.  Birth announcements that eighteen days earlier had celebrated the new arrival with “It’s a boy!  Please welcome Jack!” were hastily revised and redistributed: “Ha, ha, medical error: she’s actually a girl.  Please welcome Jill!”.

And in due course, when Jill was older, surgical wizardry revised her genitals, dividing the scrotum to restore a normal vagina and shrinking the clitoris to proper size and position.

Problem solved.  Jill blossomed into a beautiful little girl, and she lived happily ever after.

Or did she?

Act Two

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 roughly analogous to the transgender battle ongoing in our culture, that 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 as Albert Einstein said, to remain silent is to be guilty of complicity, .

The subject matter is complex, at once more difficult and more nuanced than most are willing to admit.  Blundering blindly through this minefield isn’t wise: we’ll blow ourselves up and cede victory to ideologues on the extremes.

We need an accurate map, and this long essay is my attempt to provide one.  I’m under no illusion, medical grounding notwithstanding, that my perspectives are without error.  “Deep thinking” is not 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”, and I’m fortunate to occupy the first half of that equation.)  And while I’m not bereft of common sense, I was overlong in school:  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 spawned roughly thirty offspring apiece 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 portion of this essay, 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 individuals 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 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.


Act Wisely

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 (DSD), 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, 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” of this series, 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 settle 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 (trans-women) and masculinized women (trans-men) – and trans-women are not women, trans-men are not men, and to say that they are is simply a fabrication.  For trans-woman 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 – this 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 the trans-activist takeover continues 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: most gender dysphoric youth settle, after appropriate support, into the gender identity congruent with their sex – and the majority 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 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 fled to her room and 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.


*views expressed by the author in this essay are his own

5 Replies to “The Curious Case of Jack and Jill*: Unabridged”

  1. Thank you so much for your factual, thoughtful, knowledgeable, ultimately loving article.
    I have a gay grandson whom I love dearly and a niece in the transitioning process with her daughter.
    This has been so helpful.
    I look forward to hearing more from you at CSC

  2. As christians, we have our identity in Christ. Whether one is attracted to the opposite sex or is attracted to multiple people of the opposite sex we must remember and submit to God’s plan as outlined in the Bible. To give into our fleshly desires will not lead to a life of grace but one of pain. We must also love people and affirm their humanity but not affirm their sinful lifestyle. Life on earth is short but eternity is forever. Let’s not lose sight of that.

    1. “And always remain at the side of your children, no matter what, whether you agree with them or not. Never, ever abandon them.”

      George, I’ll spend my eternity knowing I showed love. I won’t lose sight of that.

  3. Dr. Les. Thank you for sharing your educated and highly respected opinions and insights. I hope to continue reading more thought provoking posts.

    Kind Regards,

    W. Sibold RN, MN

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