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June 19, 2014

Clinging to a dangerous past: Dr Paul McHugh’s selective reading of transgender medical literature

By Mari Brighe


In a June 12th opinion article in the Wall Street Journal, well-known anti-transgender psychiatrist Dr. Paul McHugh attempts to make a case against supporting hormonal and surgical transition for transgender individuals. McHugh, professor of psychiatry at Johns Hopkins University, has been actively working against the medical treatment of trans people since the 1970’s. As the university’s chief psychiatrist, he was instrumental in closing the Johns Hopkins Gender Program in 1979, one of the first programs of its kind, citing the 1977 study by his Hopkins colleague Dr. Jon Meyer, which claimed that surgical intervention did not improve the psychological functioning of the individuals treated.  McHugh himself admits to directing Meyer to conduct to further his anti-trans agenda in a 2004 article titled “Surgical Sex”. In the same article, McHugh also continues to preach the largely discredited “autogynephilia” theory of Ray Blanchard and J. Michael Bailey. McHugh is also known for filing an amicus curiae brief in Hollingsworth v. Perry, asserting that homosexuality is a choice, as well as for his participation of the campaign against Kansas abortion provider Dr. George Tiller– who was murdered in 2009 by an anti-abortion activist.

Dr. McHugh first attempts to draw a number of false and offensive parallels between gender dysphoria and conditions like anorexia, bulimia, and body dysmorphia in an attempt to demonstrate his assertion that gender dysphoria is not based in “physical reality”:

“This intensely felt sense of being transgendered constitutes a mental disorder in two respects. The first is that the idea of sex misalignment is simply mistaken—it does not correspond with physical reality. … The transgendered suffer a disorder of “assumption” like those in other disorders familiar to psychiatrists. With the transgendered, the disordered assumption is that the individual differs from what seems given in nature—namely one’s maleness or femaleness. Other kinds of disordered assumptions are held by those who suffer from anorexia and bulimia nervosa, where the assumption that departs from physical reality is the belief by the dangerously thin that they are overweight.”

Unfortunately, it appears that McHugh has decided to ignore the growing body of neurological and genetic research providing evidence of a biological basis for gender dysphoria. A 2009 study found a correlation between an increased number of a certain kind of sequence repeat in the Androgen Receptor gene and gender dysphoria. Another study in 2009 identified significant differences in cerebral grey matter structure in trans women who had yet to start hormone therapy when compared to cis men. In 2011, researchers noted that the structure of a sexually-dimorphic region of the brain, known as the intermediate nucleus, of trans women fell somewhere between cis men and cis women, while a similar difference was not noted castrated cis men. A 2013 functional brain imaging study of adolescents with gender dysphoria demonstrated a tendency for trans teens to perform more similarly to their identified sex (as opposed to their assigned sex) in a verbal fluency assessment, with similar correlation in brain activity during the assessment. Lastly, in 2013, a large study of monozygotic (identical) and dizygotic (fraternal) twins where at least one twin was transgender showed a far higher concordance of a diagnosis of gender dysphoria among monozygotic than dizygotic twins (33% vs 2.6%), which is strong indicator the existence of a biological factor in a trait. While much of the research into the biological aspects of trans people is still very new, Dr. McHugh’s assertion that no evidence for a biological basis for trans identities demonstrates a deplorable ignorance of current medical research.

McHugh then goes on imply that transgender surgeries do not improve the lives of trans people, and are actually causing harm:

“It now appears that our long-ago decision was a wise one. A 2011 study at the Karolinska Institute in Sweden produced the most illuminating results yet regarding the transgendered, evidence that should give advocates pause. The long-term study—up to 30 years—followed 324 people who had sex-reassignment surgery. The study revealed that beginning about 10 years after having the surgery, the transgendered began to experience increasing mental difficulties. Most shockingly, their suicide mortality rose almost 20-fold above the comparable nontransgender population. This disturbing result has as yet no explanation but probably reflects the growing sense of isolation reported by the aging transgendered after surgery. The high suicide rate certainly challenges the surgery prescription.”

McHugh, again, appears to selectively reading the literature to support his own agenda. It is first important to note that Dr. McHugh is grossly misconstruing the findings of the Karolinska study. The study compared the mental health of post-surgical trans people with age-matched cisgender controls. The study itself posits absolutely zero links between gender-confirming surgery itself and the mental health of these people, and the authors themselves caution against interpreting the data in such a way:

“It is therefore important to note that the current study is only informative with respect to transsexuals persons health after sex reassignment; no inferences can be drawn as to the effectiveness of sex reassignment as a treatment for transsexualism. In other words, the results should not be interpreted such as sex reassignment per se increases morbidity and mortality. Things might have been even worse without sex reassignment. As an analogy, similar studies have found increased somatic morbidity, suicide rate, and overall mortality for patients treated for bipolar disorder and schizophrenia. This is important information, but it does not follow that mood stabilizing treatment or antipsychotic treatment is the culprit.”

Again, returning to the available medical literature on the subject, research seems to actually indicate that medical transition (including hormone therapy) has positive effects on the psychological states of trans people. A study published earlier this year found significant reductions in all comorbid anxiety and depression, as well as lowered overall functional impairment in trans individuals just 12 months after initiating hormone therapy. A study released in late 2013 showed that individuals on hormone therapy have both lower-levels of self-reported stress and lower blood cortisol levels (a key physiological marker of stress). Given the known effects of stress on physical health, this could also translate to risk reduction for a number of chronic illnesses. Even breast augmentation, often maligned as a particularly “cosmetic” intervention, demonstrated significant increases in sexual and psychosocial well-being. Other studies in 2009 and 2011 have shown similarly positive responses in both trans men and trans women who underwent gender-confirming surgeries. While it might be understandable (though not excusable) for Dr. McHugh to be unaware of the genetic and neurobiological research on trans people, it is inexcusable for a lauded psychiatrist to be either so woefully ignorant or deliberately deceptive in his presentation of the state of psychological research regarding the transgender population.

Missing entirely from McHugh’s analysis is any understanding or even mention of the tremendous discrimination, harassment, violence, and economic stability faced by the transgender community. According to the National Transgender Discrimination Survey, 78% of trans students had experienced harassment at school, 90% of trans people have experienced harassment in the workplace, 26% had a lost a job due to being trans (which, in turn, leads to a 4-fold increase in risk of homelessness), 19% had experienced housing discrimination, 19% had been refused health-care, 22% had been harassed by law enforcement. Overall, 63% of trans people had experienced a serious form of discrimination, while 23% had experienced what the NTDS categorized as “catastrophic” levels of discrimination. It can come as little surprise that people struggling with a serious condition of body integrity who are then simultaneously subjected to massive structural discrimination with little in the way access to the usual safety nets would be so likely to attempt to take their own lives. These are not individuals for whom transition-related treatment has failed; these are individuals that our society and social justice systems have failed.

Perhaps most offensively, Dr McHugh then goes on to attempt to break down transgender individuals into three wide and poorly defined categories- with absolutely zero research or evidence other than his own personal say-so. In the first category, he both equates trans people with criminals and takes an unnecessarily person swipe at Chelsea Manning:

“One group includes male prisoners like Pvt. Bradley Manning, the convicted national-security leaker who now wishes to be called Chelsea. Facing long sentences and the rigors of a men’s prison, they have an obvious motive for wanting to change their sex and hence their prison. Given that they committed their crimes as males, they should be punished as such; after serving their time, they will be free to reconsider their gender.”

This short paragraph is so problematic that it’s difficult to figure out where to begin. Firstly, Chelsea Manning has completed a legal name change. She is not stating a preference- her legal first name is Chelsea. Phrasing her identity in this manner is blatantly dismissive. Furthermore, Manning’s struggles with gender identity began long before her trial or conviction, so to attempt to cast it as an attempt to avoid men’s prison is frankly absurd and amounts to little more than a personal attack tangential to McHugh’s entire piece. More pressingly, given that few prisons provide transition-related care to prisoners, and that trans prisoners are at far higher risk of rape and assault from prisoners and prison staff alike, it’s ludicrous to claim that any “advantage” is gained in coming out as trans while incarcerated. McHugh’s next category blames the internet for the existence of trans identities:

“Another subgroup consists of young men and women susceptible to suggestion from “everything is normal” sex education, amplified by Internet chat groups. These are the transgender subjects most like anorexia nervosa patients: They become persuaded that seeking a drastic physical change will banish their psycho-social problems. “Diversity” counselors in their schools, rather like cult leaders, may encourage these young people to distance themselves from their families and offer advice on rebutting arguments against having transgender surgery. “

Extensive scouring of the Internet via Google turned up zero sex education programs with an “everything is normal” mantra, though the phrase does turn up in a number of blogs advocating “abstinence-only” sex education, an approach shown to utterly fail to produce any positive outcomes. I could also find no evidence of the supposed “diversity counselors” he mentions, and his comparison of those who support young LGBT individuals to cult leaders is nothing more than tired repetition of the same conservative fear-mongering of the queer population that endures in right-leaning population. It’s political posturing that he’s attempting to disguise as legitimate medical opinion through the abuse of his MD credentials and title at Johns Hopkins. McHugh also continues his obsessive focus on “transgender surgery”, which born out in the rest of article. He appears to harbor the same misconception that most of the US population does, that transgender = surgery. The truth is, of course, that the majority of medical side of gender transition is hormonal treatment, and only a small minority of trans people will ever have surgery (whether by choice or lack of availability). His insistence on discussing surgery as the primary medical aspect of transgender care is just further evidence of how dangerous out-of-touch Dr McHugh is with the current state of medicine. In his last self-designed category, McHugh places young children:

“Then there is the subgroup of very young, often prepubescent children who notice distinct sex roles in the culture and, exploring how they fit in, begin imitating the opposite sex. Misguided doctors at medical centers including Boston’s Children’s Hospital have begun trying to treat this behavior by administering puberty-delaying hormones to render later sex-change surgeries less onerous—even though the drugs stunt the children’s growth and risk causing sterility. Given that close to 80% of such children would abandon their confusion and grow naturally into adult life if untreated, these medical interventions come close to child abuse.”

Here again, Dr McHugh appears to be warping and distorting medical reality to fit his own narrative and political position. McHugh is correct in his assertion that 80% of gender-nonconforming children do not go on to adult gender dysphoria. However, gender identity is far more firm in adolescents. Puberty suppression is NOT provided to prepubescent children- the current WPATH Standards of Care indicate that individuals should reach at least the Tanner Stage II of sexual development (meaning puberty has begun) before suppression can begin. Dr McHugh is drawing a false comparison, attempting to assert that the adolescents provided with puberty suppression are the same children of whom 80% will not have persistent gender dysphoria. They are, in fact, two very different and non-comparable groups. Furthermore, McHugh’s categorization of these treatments as dangerous (and constituting child abuse) is simply false. He provides zero evidentiary support for this statement, while medical research has established that delaying puberty is a safe intervention. Taken as a whole, it seems clear that Dr McHugh’s absurdly designed “categories” of trans people are little more than political grandstanding and fear-mongering created to smear and defame the whole of the transgender populace.

It is important to remember that the opinions of Dr. McHugh fly in the face of currently accepted medical practice and the positions of many major medical associations. The American Medical Association, the American Psychological Association, the American College of Obstetrics and Gynecology, the American Psychiatric Society, the American Public Health Association, and the World Professional Association for Transgender Health have all adopted positions supporting the medical necessity of transition-related care, including hormonal and surgical interventions, as well as expressing support for insurance coverage of these interventions. Despite his authoritative sounding title at a respected medical institution, Dr. McHugh’s opinions do not represent the views of the mainstream medical establishment, rather they are the erroneous, bigoted beliefs of a scientist who appears far too invested in his own antiquated, disproven theories and his anti-LGBT political position than the current state of medical affairs.

Dr. McHugh’s piece concludes with a firm assertion that trans people are nothing but mentally disturbed individuals:

“At the heart of the problem is confusion over the nature of the transgendered. “Sex change” is biologically impossible. People who undergo sex-reassignment surgery do not change from men to women or vice versa. Rather, they become feminized men or masculinized women. Claiming that this is civil-rights matter and encouraging surgical intervention is in reality to collaborate with and promote a mental disorder.”

In these final words, the true purpose of this missive appears to become clear. This appears to be a case of gaslighting in the most insidious and heinous of forms, that of a physician attacking a highly vulnerable minority that has already suffered for decades at the hands of the medical profession. His view of gender dysphoria as a psychological disturbance has been consigned to the wastebasket of medical history, much like hysteria, lunacy, and the disease view of homosexuality. However, it appears that McHugh’s ultimate goal here is to derail the ongoing press for transgender rights and equality by asserting that we’re all mentally ill, and hoping that his medical credentials will lend weight to that assertion. His reprehensible, dishonest misapplication of the current medical research to further his own political agenda is despicable, and it’s shameful that the Wall Street Journal would in such a piece.

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  • strenuous

    Astounding selective reporting and misrepresentation of Dr. McHugh perhaps the most prominent psychiatrist of his generation. The fact is that the data either way are exceedingly poor and sparse. But, this has not stopped activists such as the author to impose this ideology upon society. In all my years of science and medicine I have never seen anything pushed with so much fervor upon the medical community with so little evidence.

    • Is that merely your anonymous internet opinion or is that a fact assertion you care enough about to substantiate with evidence? I’m betting it’s the former.

      • Fraser Gascoigne

        Hi Cristan, having read this article I’m interested to hear your opinion of my opinion and interpretation. This article portrays that Dr McHugh is transphobic but I don’t think this is true. So far he has done studies (Whether you believe them to be biased or not he did do some) and he has tried to find alternate ways to make trans people not feel the stress and anxiety they would otherwise feel. He would appear to be against the operations which in truth seem to be quite intrusive and horrific.

        Now let’s, for the next part, say that there are biological differences such as genetic differences and neurological changes. If there is another way (other than operations and hormones) to alter these so the person feels comfortable once again without painful and dangerous procedures is that not a preferable outcome. Say they could go to a therapist who would then talk to them or a doctor who could give them a drug, in the same way depression could be tackled, is that not better than a series of operations costing a fortune and often causing many complications.

        Then there is the point that operations don’t often solve the issue, 41% of post of trans people attempt suicide compared to 4.6% of the standard population. People argue that this is due to social stigma but that is just not true as the rate of suicide in the trans community isn’t decreasing as it becomes more accepted and other stigmatised groups don’t have suicide rates that high. When it was illegal to be gay that suicide rates werent higher than that of the modern trans post op community, even gay people who have undergone traumatic conversion “therapy” have a rate of suicide at around 32%.

        It’s quite obvious that more research is needed in this area and if we can’t do that regardless of our views or affiliations then there is no hope for more effective treatments and if we only take studies from one side of the debate we will never get an objective outcome.

        I would also like to say it should be classed as a mental disorder in my opinion simply due to the correlation with suicide rates and the fact that there is a conflict between feeling and reality no matter the causation they have male bodies but female minds or vice versa. The cause is irrelevant, there is a clear disparity between what they feel and what they know to be reality which causes stress and real symptoms.

        I keenly await your response and hope you take this in good faith, I would also like to say I did not mean this to offend or insult simply to expand my own understanding of the issue by gathering arguments from others with what, I assume from your other comments, are differing opinions to my own.

        Fraser Gascoigne

        • I believe that you’re as interested in my opinion as you are the facts. You obviously get your information from alt-right sites that peddle outright lies regarding trans issues because you’ve come here in your hubris regurgitating the very ignorance they peddle. First, let me quote to you from our handy-dandy glossary what “transphobic” means:

          Generally refers to the strong tendency to reject non-cisgender people, issues, causes and/or concerns. Within trans discourse, the “phobia” in transphobia usually refers to the strong behavioral tendency to reject (eg, a “hydrophobic” substance). However, the term in very specific instances, may be utilized to indicate a presumed fear-based cause to observed anti-trans behaviors.

          In 1979, McHugh was able to end trans care at Johns Hopkins and later wrote that it was his goal to force the closure of the hospital’s gender program saying, “It was part of my intention, when I arrived in Baltimore in 1975, to help end it.” McHugh went on to describe his professional assessment of how and why transgender medical care was made available at Johns Hopkins:

          The zeal for this sex-change surgery–perhaps, with the exception of frontal lobotomy, the most radical therapy ever encouraged by twentieth century psychiatrists–did not derive from critical reasoning or thoughtful assessments. These were so faulty that no one holds them up anymore as standards for launching any therapeutic exercise, let alone one so irretrievable as a sex-change operation. The energy came from the fashions of the seventies that invaded the clinic–if you can do it and he wants it, why not do it? It was all tied up with the spirit of doing your thing, following your bliss, an aesthetic that sees diversity as everything and can accept any idea, including that of permanent sex change, as interesting and that views resistance to such ideas as uptight if not oppressive. Moral matters should have some salience here.

          Compare McHugh’s fact assertions about the genesis of the Johns Hopkins’ program with the way the program’s creator, Dr. John E. Hoopes, described the program in 1966:

          After exhaustively reviewing the available literature and discussing the problem with people knowledgeable in the area. I arrived at the unavoidable conclusion that these people need and deserve help… Over the years, psychiatrists have tried repeatedly to treat these people without surgery, and the conclusion is inescapable that psychotherapy has not so far solved the problem.

          McHugh’s position is not only flatly rejected by Johns Hopkins, but by every reputable medical, psychological, psychiatric, and social work body from the AMA through the Social Worker’s association. There’s a reason why McHugh doesn’t publish in peer-reviewed journals; you’ll only find his nonsense published by religious/political identitarian groups.

          You wrote: “Say they could go to a therapist who would then talk to them or a doctor who could give them a drug, in the same way depression could be tackled, is that not better than a series of operations costing a fortune and often causing many complications.” You might want to read this Wiki article:

          You then pompously write, “Then there is the point that operations don’t often solve the issue, 41% of post of trans people attempt suicide compared to 4.6% of the standard population.” JFC, you have that exactly backwards.

          When you read LifeSite, TERF blogs, Britebart, the federalist, etc, you’re making yourself both more ignorant and more confident in your ignorance. Educate yourself and stop imposing your ignorance upon non-cis people.

  • William Ric-Hansen

    Well whilst he might be selective in his reading of facts, the author is no different. There are other studies that have different conclusions all the time.

    Regarding the mental illness thing, showing that there is a genetic or biological basis for something does not show it is not a mental illness. Depression and Anxiety disorders are disorders but there is a biological and genetic basis (most of the time). Modern man seems convinced that if something can be proven to have a biological footprint that it’s natural or normal. That is not the case.

    Regarding whether someones gender changes, that depends how you define gender. If you use a biological basis for gender, it’s clear that actually peoples gender can’t really change in 99% of the cases (Caitlyn Jenner for example). If you start talking about gender identity and saying that determines gender then anyone can change gender. But that’s really just semantics, when we talk about gender using different definitions then you’ll never get anywhere.

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  • Chase

    What I find funvn’y and sad is that people are saying this doctor is transphobic. He was head of one of best most prestigious hospitals in the world. He is an expert and to argue otherwise is idiotic. Just because you dont agree with it doesnt mean he is wrong. It is not healthy to do this to your body. Especially when you hear parents giving hormones. They should be charged with child abuse.

    • I’ll just leave Mchugh’s own words here to counter your credulous appeal to authority: “It was part of my intention, when I arrived in Baltimore in 1975, to help end it.”

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  • Jaisal

    Claiming that the mainstream medical community supports medical transition is no guarantee in itself that transition is the best treatment. Psychiatry and surgery have a very chequered history. It is not so long ago that frontal lobotomy was the gold standard treatment for many mental health problems, that forced sterilisation of those with learning difficulties or unmarried mothers was advocated and that conversion therapy for gay people was standard practice. All of these were mainstream medical opinions.

    It seems therefore very important to at least consider with an open mind the evidence of those who buck the current trend. The author frequently asserts that McHugh’s motivation for disagreement witht the currently fashionable mode of treatment can be attributed to bigotry. But could it not just as well be attributed to his concern that current treatments are in some instances unethical.

    Given for example that 80% of gender non conforming children desist and grow up to be happy with their sex, the current trend for affirming a child’s stated identity without question and increasingly advocating early social transition seems to be dubious. Especially when a Dutch study revealed that early social transition is the greatest predicative factor in medical transition. If a child can live happily without surgery and a lifetime of hornonal treatment this is surely the best outcome.

    He is also right in his claim that medical transition does not change biological sex is a fact hardly evidence of an accusation of being a bigot. At best it is possible to say that for some people resembling the opposite sex through surgery may make them happier but anyone claiming that it has really changed their sex is suffering under a delusion.

    The influence of social contagion especially in adolescents is well documented in anorexia and other conditions. There are many tumblr and reddit sites teenagers visit questioning their gender identity where they are given such advice as ‘ if you’re questioning your gender identity then that’s good evidence in itself that you’re trans’ or told that on the basis that they play opposite sex avatars on computer games or that they always liked playing soccer that this is concrete evidence of trans identity. The fact that there has been a 400% increase in youth referals to gender clinics is suspect. Can there really be that many young people who were in the closet? When whole groups of school friends are transitioning together one much surely ask if there isn’t at least an element of contagion and fashion involved.

    Bradley Manning may genuinely have had gender issues that predated his prison sentence but McHugh’s point regarding the advantages of claiming a trans identity are correct. In the UK a recent government report by gender specialists found that there was a rising tide of male prisoners claiming a trans identity most of some were sex offenders and whom the specialists felt the claims were spurious. The motivation was transferal to a womens prison, in the hope of an easier ride along with the idea that parole boards might be more sympathetic.

    The brain studies to determine a neurobiological basis for transness are not definitive. A biological basis for homosexuality is yet to be found and there are a thousand more studies in this. That is not to say that homosexuality is a choice rather that epigenetics and environment seem to play the largest part. Trying to claim brain differences as proof of anything is problematic given that the brain is plastic. It is hard to ascertain whether a difference in the brain is causing a behaviour or whether it is the result of a behaviour.

    Many of the trans studies do not control for sexual orientation station so that the differences are actually those registered between gay and straight men rather than trans women and straight men.

    Twin studies show for same sex identical twins there is a higher chance than between non identical twins to be trans (similar results are found for gay people). However they are also more likely to have had the same environment growing up. The evidence that there may be a slim genetic or hornonal effect is not evidence that trans people really are the opposite sex. It could as easily be evidence that the brain is more likely to be in error like in a car with with a faulty thermostat.

    For many trans people the aetiology of their condition is unclear but there are several examples where gender identity with was not the reason rather a history of sexual abuse, not wanting to go through puberty, a parents expectation or preference for the opposite sex, internalised homophobia etc. It would seem that caution is needed before prescribing that the drastic measures of hormones and surgery are the first line treatment. Given that the treatment often involves sterilisation and is in counties such as Iran clearly used as a form of gay conversion therapy, being a little more circumspect would be wise.

    The article itself is hugely biased andd slammed intent on promoting it’s agenda by doing its best to undermine McHugh largely by mudslinging rather than proper analysis. The caveats Mchugh lists show he has a far more nuances view on the subject than the author of the article is prepared to concede.

    • If the reality was that PMcH wasn’t caught lying numerous times and the central issue really was a mere appeal to authority, you might have a point. The problem with your comment is that his view was the gold standard about half a century ago and, moreover, his peers from around the world have called him out for lying in the media about research, oftentimes relying upon disco-era “research” like the Sissy Boy Syndrome study, as you’ve done here:

      Given for example that 80% of gender non conforming children desist and grow up to be happy with their sex, the current trend for affirming a child’s stated identity without question and increasingly advocating early social transition seems to be dubious. Especially when a Dutch study revealed that early social transition is the greatest predicative factor in medical transition. If a child can live happily without surgery and a lifetime of hornonal treatment this is surely the best outcome.

      Since you seem to, at least on the surface, know something about tras research, the source you’re pulling from is either incredibly bias or you want to harm children. Either you don’t know (because your source is bias) that the DSM standard for kids receiving a “gender identity disorder” diagnosis was changed after CAMH sexologists wormed their way onto the DSM GID workgroup so that kids DID NOT NEED TO HAVE GENDER DYSPHORIA to get a “gender identity disorder” DX or you know and want to pretend that gender dysphoric and non-gender dysphoric kids are the same thing. Since 1994, the DSM was changed by CAMH sexologiests to conform with Dr. Green’s sissy boy syndrome standards. Before, in the DSM III, kids had to have an insistent and persistent experience of their BODY that was trans. That was changed in the DSM IV so that a child could be given a GID diagnosis for merely being gender non-conforming. Pretending that the “research” you’re citing doesn’t use this (now) discarded (and very sexists) standard is harmful to gender nonconforming kids and transsexual kids alike. Choosing to spread this misinformation is choosing to harm children. You should stop doing it.

      He is also right in his claim that medical transition does not change biological sex is a fact hardly evidence of an accusation of being a bigot. At best it is possible to say that for some people resembling the opposite sex through surgery may make them happier but anyone claiming that it has really changed their sex is suffering under a delusion.

      Ah, here we go. Sex essentialism. Let me guess, you’re part of a group that thinks sex boils down to a handly slogan or two, amirite? Phenotype isn’t a sexed attribute or, if it is, the only “real” phenotype if it’s what one is born with and that doesn’t change, right? People don’t have masculinized bodies, they are “male bodies”; people don’t have feminized bodies, they are “female bodies”, right?

      As far as brain studies go, I agree. They aren’t definitive. I think more research should be done, but pretending that what you’ve written here is anything like a reasonable response to someone who’s been called out by his peers numerous times for lying is silly. Pretending that gender nonconforming kids and transsexual kids are the same thing is also silly… and very dangerous. Again, if you care about kids, you should stop promoting the sissy boy syndrome standards. Those standards have killed kids.

  • Andi

    “His reprehensible, dishonest misapplication of the current medical research to further his own political agenda is despicable, and it’s shameful that the Wall Street Journal would such a piece.”

    Missing a word or two at the end of the article; WSJ would _______ such a piece?

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  • Kat

    Very aptly put. People like this Dr. are sick and should lose title of scientist when they begin and continue to foster beliefs wish and whims as superior to facts, as science is the purview of fact. He has now demonstrated that he is a theologian, not a scientist. Grade A work on this article, by the way… you totally rebutted all these ridiculous assertions by this “doctor”.

  • Little

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  • Amy

    I do agree with the article, but I can’t help thinking that trans-sexuality is still…wrong. We have studies proving trans-sexuality is okay and other studies proving its not, but the whole idea of trans-sexuality is people questioning their gender and believing they are the wrong gender, right?
    The whole idea of trans-sexuality sounds crazy to be honest. I’m a woman, but if I believe that I’m a man people should suddenly call me a man and I am a man because of what I think? If I’m born a woman then I can’t change it. No matter what a person does to change their gender they will always be the gender that they were born as, and maybe transgender citizens could understand that and acknowledge it.
    I’m not justifying trans-gender people as mentally ill or ignoring the fact that they do face discrimination and stigma. However, I believe that gender isn’t a choice and people are either born a girl or boy. People can associate themselves as any gender they want, but they’ll still be either a girl or a boy. Jenner may be a “girl” now but in my eyes he is Bruce, a man.

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  • j John

    I feel bad for the mentally ill people that pretend they ate a gender other than what they were born.
    The transgender movement is clearly mental illness, just like homosexuals.
    The truth is the truth, and it doesn’t “evolve” with time.
    The truth is that transgender people need medication, not encouragement

    • You’re not alone in standing on the banks of the river as you are being passed by the riverboat of truth—truth that finds itself on the RSH (right side of history). There exists no transgender “mental disorder”. Please feel free to reply with your source. Gender dysphoria describes the mismatch between the physical…note physical…body and gender identity which we all have in varying degrees of weight. The medication you refer to is categorized as “psychotropic” meds…and there are plenty but I assure you that hormones address the endocrine system, not the mind. Of course you know this already so my comment is addressed to those who don’t.

      Perhaps you are referring to the DSM/APA manual that often makes errors and in time with science and research acknowledges their errors and does the right thing: removes a false pathology and therefore revises and updates its future publications. Medical and psychological disciplines have never been, are not, and never will achieve a state of perfection. The only persons that “play pretend” are actors/performers who wear disguises for the purpose of showmanship and titillation—the domain of many male (often gay) actors and many straight men who practice cross-dressing as a fetish for sexual diversity and enhancement.

      Thank you for participating and I hope I have been respectful in pointing out the foolishness, inaccuracies, and quack science behind your statement…not you…but your statement. The truth is the truth…and that we exist is not a fable, myth, or fiction—we truly exist. Now excuse me while I go eat me a gender…. 😉

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  • Jake

    I just don’t get people sometimes. Trans people have a problem: their body doesn’t match up with their brain, and that can be very uncomfortable. If there was some way to change people’s brain to be okay with their body it might be reasonable to argue for that, but given that the only part we currently have the power to do anything about is the body, that looks to be the best avenue for treatment. Besides “yuck, it’s gross” I can’t really see what there is to even argue about here.

  • Pamela S

    I will offer myself as a counterexample to McHugh’s agenda, I mean, conclusion.

    The name that you see, Pamela, is not one that I chose for myself. It is the name that my parents actually gave me before I was born, because every doctor and other medical professional involved in my mother’s prenatal care was 100% dead certain that my mom was going to have a daughter.

    When I made my surprise appearance in the delivery room, my mom had to think of a different name in fairly short order. It doesn’t help that it’s a name that I dislike to this day.

    I first took my gender identity seriously when I was four, insisting that they refer to me as a girl. My parents began to get disturbed that I just wouldn’t drop it, insisting on it for months and months on end. My dad eventually began referring to me occasionally by a feminized adaptation of by birth name.

    Where does an insistent four year old get that, if not from within?

    I finally stopped when I entered kindergarten, acquiescing for the next several decades to a state of resignation and a kind of self-loathing, accepting yet despising the assigned package in which I live.

    Then, as now, when I see the manner in which so many cis het males conduct themselves, masculinize their appearance, and put forth this concept of “what it means to be a man,” I want to scream and stomp my feet repeatedly, “that’s not me!” And that is indeed, because it isn’t.

    Making the best of a bad situation, I began striving, quite successfully, for a super model’s body. That served to make me detest my exterior package less, and made it easier to live with myself. However, I realized only later why it resulted in a comparatively better fit with my inner self.

    I began realizing that perfecting my assigned physical body caused the world to interact with me in ways that are, in many ways, analogous how how the world interacts with women. I get my ass grabbed at karaoke bars. I know what it feels like to have people talk to my chest rather than my face, because it happens whenever I wear a tight-fitting shirt. I get treated with the extra courtesy that a classical “gentleman” would treat a lady.

    In it’s own surrogate way, it causes the world to interact me in a way that fits, somewhat better, my true inner self.

    But today, reading and hearing the news of the accelerating progress in transgender rights, I have begun to get excited about the possibility that I may, relatively soon, be able to be my true self, while I’m still on this earth.

    I just learned about this site, and I hope to stay around for a while.

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  • Nuala Shields

    Thank you Mari for this awesome article!

    The facts are out there, but those who choose to hate us, refuse to avail themselves of any education which would completely destroy their obtuse arguments.

    They are stuck on what they thought they learned in their 7th grade health class back in 1966 and they aren’t about to consider peer-reviewed medical evidence which has been published in the last decade or two, much less in the past few years.

  • Isn’t it remarkable how neatly Dr. McHugh’s transgender categories align with all of the American right wing’s favourite cultural bogeymen?

  • Elizabeth

    McHugh was a total douchebag back when John Money was there and was a close cohort of Money’s which makes him an even bigger douchebag. Money was a pedophile and on that subject I speak from a personal experience when he tried to feel me up when i was not quite 14.

    McHugh is a quack like Money was a quack and I am disturbed that he was given space in a paper to write his drivel. Was there an alternate post that contradicted what he wrote? Somehow I doubt that.

    Money was a great believer in parents teaching there children to be feminine and he actually accused me of that when we first met. I was not prepared to handle that type pf criticism and I think he knew that because I was emotional. McHugh was a big supporter of Money and the Reimer case where he had a boy surgically altered into a girl and told the parents to raise her as a girl. It was an abject failure and Reimer eventually went back to male but Money claimed for years, falsely, that this proved his case and McHugh publicly supported Money so that is where a lot of this bullshit comes from.

    Very sad that anyone gave this quack a forum.

    • “Was there an alternate post that contradicted what he wrote?”
      Heh….The Wall Street Journal, as owned by Rupert Murdock? Yah….no.
      Further, most of the comments in reply to the piece ran along the lines of “this is the most rational, well thought out article on this subject I have ever read. Finally some one willing to champion the truth.”
      To conservatives its only “science” if it fully supports whatever fantasies they’ve already concocted in their strange little minds as told to them by their preferred holy man or Bill O’Reilly. Otherwise its obviously wrong.

  • Dee Omally

    Excellent work Mari…where you beautiful people get the energy to produce such great and sourced work baffles me to this day. Trans history and persons will live enhance and quality lives from your very efforts.

    A few years ago when I joined the ranks of the mentally deranged, at least according to this quack, I recall facing that junction in the road: should I, like most before me go ultimately go stealth or be open. For some reason I almost immediately deduced that it was now time to relegate the “stealth” phase to history and be open. I remember thinking about how the LGB—once they made the decision to be loud, proud, and open—were making a bold and necessarily crucial statement: we are your neighbor, your grocer, your waiter and we see no need to be ashamed of our legal right to live our truth. Why should we be so embarrassed or ashamed of who we truly are by remaining in hiding akin to being registered sexual offenders?

    There is no crime and no shame about being gay, as there is not in being trans. Soon, those who threw a kitchen sink of criminal inferences on gay Americans, as they are now with trans persons, recoiled under the power of truth—that gay persons were….surprise, surprise…persons but with a different sexual appetite. That’s it. With gay marriage becoming as normal as any marriage in rapid succession by state, those who opposed gay rights were left holding the kitchen sink so tightly that their trousers remain below their knees to this day.

    As they turn their bigoted sights toward trans persons, for some odd reason primarily transitioned females, they are desperately trying to pull their pants above their knees and become relevant once more. Desperate, they are seeking a direct route out of their own created demise—a demise we know as an * or a footnote by their name under the column we know as WSH (wrong side of history). They go by many names: Kevin Williamson, Lillian Bozzone, Keith Ablow, Denny Burk and of course Paul Mchugh. Interestingly, not one transitioned female shares their morbid views, perhaps because we “don’t exist.”

    The road to equality will, despite advances, always require maintenance and we need to turn only to Russian and Africa to see that rights can be gained, then taken away. We can never rest for this reason alone, however today in Trans history, namely 2014, Paul Mchugh and other quacks are part of an opposition that would not exist were it not for trans equality successes. There simply is no need for ratcheting up the opposition were it not for increased relevance of their “opposition”, we the trans community.

    May I remind my sisters of all stripes that Paul Mchugh need not rest comfortably behind the Psychiatrist name tag—we need look no further than the latest major court squabble to realize that the same name tag can be worn by players who reach entirely conflicting conclusions. A psychiatrist who is a doctor is a member of an occupation that is saturated by theories, always short on facts. In fact, the very field of psychiatry, despite professional repute and perception is one with a failed history of credibility, what with millions having suffered greatly for the pathology of being gay or transgender.

    Suddenly a new day dawns and with it the fresh air of a new truth: a same-sex appetite or a gender transition, with a snap of the DSM finger, perhaps like the waving of a magician’s hand suddenly removes stigma from person, with others like Paul Mchugh still clinging on to the side of a sinking ship. Sacrifice, devotion, intellect, and above all federal law has resulted in the Trans momentum of 2014. We have stepped out from the shadows, deluded that we were claimed to be, only to discover that quack psychiatrists and the SBC have traded places and now cower in fear in the shadows—-and scream to them with ears to hear, that we don’t exist. Ironically, it is they who practice this delusion, while we, by affirming out truth, are now proving to the world that Trans and sanity are not and never have been oxymorons. Just ask a trans child if they exist…without autogynephilia.

    • Dee Omally

      —>>>apologies for forgetting to review grammar 🙁

    • Dee Omally


      Above, Paragraph 4…….should read Kevin D. Williamson (National Review Online)

  • Kara

    A fascinating article! As an ex-physicist, I can’t help but use science and published papers to help understand myself. I have quite a collection bit this article, well researched as it is, has helped me expand that. Haters, like fundamentalists, dismiss all science that doesn’t support their dogma as “liberal science”. Increasingly though, in addition to proving what trans people have been saying all along, it looks like science, medicine and reality seem to have a liberal bias 😉

    • Jack

      Why do hysterical leftists forever substitute ‘hate’ for the more accurate ‘criticism’? Pathologising normal human emotions is one of their more sinister tricks of course and it’s curious how supposedly educated people ignore it. As to the childish assertion that political enemies monopolise dogma while truth inclines to agitators from that part of the political spectrum which has done more than any other to corrupt discourse and subordinate factual analysis to stringent ideological filtering I’m tempted to tell you to grow up. That you have no interested in truth, only your own version of it, is why the article and several replies to critics resort to neurotic mud-slinging, with daft allegations of right-wing reading habits and wanting to harm ‘kids’. There’s more of leftist zealot than impartial scientist in you.

      • What you’ve done here is, instead of substantiating any counter assertion, you’ve opted for an ad hominem attack… which is easy to do:

        [Why do hysterical rightists forever substitute ‘hate’ for the more accurate ‘criticism’? Pathologising normal human emotions is one of their more sinister tricks of course and it’s curious how supposedly educated people ignore it. As to the childish assertion that political enemies monopolise dogma while truth inclines to agitators from that part of the political spectrum which has done more than any other to corrupt discourse and subordinate factual analysis to stringent ideological filtering I’m tempted to tell you to grow up. That you have no interested in truth, only your own version of it, is why your comment and several like it resorts to neurotic mud-slinging, with daft allegations of left-wing reading habits and wanting to harm ‘kids’. There’s more of rightist zealot than impartial scientist in you.]

        If you actually care about the assertions you’ve made, why didn’t you care enough to substantiate them? If you have more to offer than a mere personal attack, why did you not engage with evidence? If any of the fact assertions in this article are demonstrably false, why not refute it with something other than a logical fallacy?

  • phyllis nowacki

    I do agree that Blanchard is full of hot air but there are so much medical evidence disputes his claims