Saturday 13 April 2024

Transgender has become phrenology


It is very early days after Dr Hilary Cass’s review on gender services provided by the NHS in England. I am not a doctor, but my initial thought is that it is completely devastating for the transgender argument.

No one denies that there is such a thing as gender dysphoria, nor that there are people who wish to live their lives as the opposite sex or indeed sometimes as non-binary. The issue is how medicine ought to treat children who present with gender dysphoria.

Up to now the tendency both medically and politically has been to accept that when a boy or indeed a man claims to be a girl or woman then he must be believed and that we must all accept that a boy who claims to be a girl really is a girl.

Dr Cass argues however that a boy presenting as having gender dysphoria can have a variety of outcomes. Sometimes this child may grow up to be a transwoman, at other times he may come to accept that he really is a boy in which case he will grow up to be a man.

If left alone a boy with gender dysphoria may grow up to be a homosexual man. In this case his nascent attraction to boys will resolve itself not by his trying to become a girl but by his acceptance of his homosexuality. It may also be that such a boy finds that he wishes to live as a heterosexual get married and have children.

Once you accept that a boy with gender dysphoria may have a variety of outcomes it immediately becomes obvious that the treatment hitherto offered by the NHS with minimal evidence of its effectiveness amounts to something close to medical malpractice.

Dr Cass points out that even allowing social transitioning in a school or home situation might make it more likely that a boy who claims to be a girl seeks to obtain puberty blockers, hormone treatment and eventually surgery.

So, we have two boys. One who says he is a girl is told by friends and family and his school that it isn’t true. He may grow up to be a happy homosexual or heterosexual man. The other socially transitions, is put on puberty blockers, hormones and eventually has surgery to remove his male anatomy. But none of that treatment may have been necessary. He might have accepted in time that he was a boy.

Worse there is minimal evidence that such treatment is the correct response to gender dysphoria and lots of evidence that it leads to unpleasant side effects including infertility and the mutilation of the body.

Once you accept that a boy with gender dysphoria might decide in time that he really is a boy, then it becomes entirely unclear what could justify you allowing such a boy to socially transition, take puberty blockers, have hormones or surgery.

Faced with such a boy claiming to be really a girl, what evidence could you point to that would demonstrate that he really was a girl. You can’t point to his body because it is male. You can’t point to his chromosomes because they are male. But nor can you point to his claim that he is really a girl, because it is just as likely that such a claim by a nine-year-old boy that he is a girl will lead to him accepting when twenty that he is man.

Once you accept this then the predictive validity of the claim made by a boy that “I am a girl” becomes at best doubtful at worse obviously false. If left alone the boy with gender dysphoria may become a transwoman, but it is just as likely that he won’t. Given the explosion of cases of transgender cases in the past decades, it may be that the treatment of gender dysphoria by means of social transitioning, puberty blockers, hormones and surgery has itself been the cause of the explosion and has led to multiple cases of male genital mutilation.

Worse still once you accept that the claim that “I am a girl” may not be true because the person may change their mind, then it becomes clear that the mantra “transwomen are women” cannot be true either. If a boy may feel that he is a girl, but not really be a girl, because later he becomes a man, then this obviously applies to a transwoman also.

Once you accept that a boy’s feeling that he is a girl may be mistaken, then the very idea that we determine whether we are boys or girls by means of feelings collapses. We return to determining such things by bodies and anatomy.

In that case it is hard to imagine a case where healthy tissue should be amputated because of a feeling that might change. It would be better by far to treat gender dysphoria with therapy rather than surgery.

There is a long way to go. Transgender ideology has captured much of the Western world to such an extent that Dr Cass’s review will change things only slowly. But this is quite devastating for those who argued that people with gender dysphoria should be treated with untried treatments and surgery, and it is also devastating for those who argued that people with male bodies should be allowed into women’s spaces or to compete as women.

Once you accept that the subjective feeling of a boy that he is really a girl is not decisive in determining whether he really is a girl and you have to accept this if you accept that he may change his mind, then the trans argument collapses. There is no more reason to suppose that someone’s feeling that he is a girl is decisive in determining that he really is a girl than the bumps on his head are decisive in determining his personality.

Transgender has become phrenology. Any doctor or politician that assumes that it is literally possible to change sex is a pseudoscientist and must be careful in case they are prosecuted in the future for malpractice.

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