Mar 10, 2024

From the Border of Identity, Politics, and Medicine

The Lytle Community Health Center | USDA
The Lytle Community Health Center | USDA

By Anonymous MD

I am a physician, a husband, and a father. I am a religious man; my faith is at the very center of my life. I am politically conservative and subscribe to Objectivist philosophy, which focuses on pursuing solutions that are logical and evidence-based. I believe in small government, especially in medicine. As a physician, I find the main reason for the increased cost of care and the lack of access to it to be third-party interference, either from insurance companies or the government. The three most important things in my life are my God, my family, and my country. I would die for any of these, and I don't say that lightly. 

I was also identified as female at birth and was raised as a girl. I completed a gender transition as a young adult, going through male puberty and having gender confirmation surgery to allow me to live as the man I always was.

Gender dysphoria is a complex disorder. I have a unique perspective on the issue, and it is my hope that by sharing it I might encourage others to think critically about this incredibly controversial and politicized topic. In my opinion, the Left and Right tend to ignore the actual science in favor of their political views. 

I'll start by criticizing my own people. The Right's main problem is fear. Without basis in reality and without actual science to back it up (in fact, the science is against their view), conservative critics say that whatever physical features you are born with and your chromosomes will determine your gender. They ignorantly conflate sex with gender. They are often limited in their thinking that God would not make a "mistake" (neglecting to critically think about this... He didn't make a "mistake" with someone born without arms either, so that argument is quite silly). They feel threatened by the idea that the Left, with their fad-driven and even dangerous "toxic masculinity" ideas, is actively trying to weaken masculinity and diminish femininity by confusing children in schools, in sports, and on social media. They believe that China and Russia are engaged in a social media campaign to create mental illness among America's children (they may not be wrong about that), and that gender dysphoria is part of that agenda. Because of these fears they are quick to reject any actual science on gender dysphoria because they believe that academia, and therefore scientific research, is biased in favor of the Left and part of the system attempting to undermine America. 

Modern research demonstrates those with gender dysphoria may have a physiologic explanation for their disorder. Using MRI, multiple researchers have found congruity in brain activity between those with gender dysphoria and those with neurotypical brains aligning with their identified gender. For instance, a person identified as female at birth but who identifies as a male now was found to have the same kind of brain activity as a neurotypical male, instead of that of neurotypical females. Other studies mapping neurometabolic features found that those who identified as transgender tend to have their own unique neurological physiology, different from either neurotypical males or females. Some studies have found evidence that these differences in brain structure and function among those with gender differences originate in the womb. The science is new and rapidly developing, but there is enough of it to convince me that transgender people are not simply “confused.”

The Right doesn’t view it through this lens, though. They seem disgusted at the direction their beloved institutions are going; they feel like they've blinked and ended up in an alternate universe, and they have no frame of reference for people with gender differences in their lives. The Left preys on their fears and sometimes states their intentions of dismantling the "old ways," denigrating conservatives as "bigoted." This leads the Right to be terrified as they watch their world melt away. Their fears are not entirely unfounded, as academic institutions are notoriously and almost unanimously biased toward the Left. And the Left has hijacked the issue of gender and made it about politics (more on that later). 

But because of the Right's fear-based approach, they are missing an opportunity to help children with gender differences who need, more than anything else, an unbiased and medical approach to treat their disorder. They could be the voice of reason here. For instance, the Right is terrified of puberty blockers, dissuaded by politicized doctors who have warned that their side effects are deleterious. In reality, those side effects are not any more egregious than other hormone therapies sometimes prescribed to children, and the severity of gender dysphoria necessitates treatment. All medicine is about compromises, and providing an intervention that will result in the least amount of harm. I think, with the right approach, the Right could come around on this issue. But first they would have to consciously abandon their fear of the unknown, and be willing to separate the obviously anti-conservative agenda from all people who just happened to have gender differences. Not everyone is out to get you, I promise!

Now for the Left. Although liberals are much more open to the medical treatments many people with gender differences need, they probably have the most problematic views and actions when it comes to this issue. The Left believes that gender is fluid and are eager to help any individual interested in "changing" their gender. I can't tell you how many on the Left (at my school, among my friends) congratulated me for making a “brave” decision. No one thought of me as a patient trying to obtain needed treatment. They thought of me as a person embarking on some journey of self-discovery, where my happiness and satisfaction were more important than my physical wellbeing.

I was a young junior in college when I started my gender transition. Professors who had previously disliked me for my conservative commentary suddenly embraced me and improved my grades. This bias in favor of any "protected class" is ultimately harmful for obvious reasons. When it is implemented in an institutional setting, like a doctor's office, it can be extremely dangerous. Two of my physicians did not even ask if I had seen a psychiatrist, but were eager to perform surgery and prescribe medication without the appropriate workup. This is highly unusual. As a physician myself, I have never seen this happen in any other setting than the politically-charged atmosphere surrounding gender dysphoria. 

The Left has put the cart before the horse and decided that everyone has the right to choose their gender. With righteous indignation they will “cancel” anyone who challenges this idea. That is actually why I am remaining anonymous for this letter. I am open with my family, friends, and my church about my medical history. My workplace knows. I don’t hide it out of fear, but I also don't go around advertising it (any more than you advertise your colonoscopy results). However, I do sometimes have to hide my conservative views. The danger of losing everything is very real.

The Left also has problematic approaches to treatment. They sometimes advocate for "real-life experience" trials in children who do not yet have gender constancy, a fixed idea about their own gender. This concept develops at around age 7-8, after gender identity is recognized at age 2-3. You can imagine that this would be a big problem, allowing a child to live "full time" as the other gender before they have the cognitive capability to understand that gender cannot change. The Left will sometimes advocate for life-altering surgeries and hormone replacement therapy in teens too young to fully comprehend the gravity of their decision. Research shows that children with gender dysphoria, most of the time, will identify as their "birth gender" after the age of puberty (with or without going through puberty itself). This is a very inconvenient truth for the Left. 

The Left will sometimes also ignore another inconvenient truth — the concomitant mental illnesses in many individuals with gender dysphoria. These disorders need to be treated first. An analogy would be an individual with decompensated liver cirrhosis and an umbilical hernia. We do not treat the hernia until we treat the cirrhosis because otherwise we put the patient at increased risk for significant complications, and endanger the hernia repair itself. First, we control the cirrhosis, and then we address the hernia. Doing this doesn't mean that we are saying the hernia is not a problem. And it doesn't mean that we are saying there is no hernia, either.

The Left's focus on fighting for the "rights" of transgender individuals might be seen as noble, but making them victims is ultimately counterproductive. Creating new "minorities" is a good strategy to gain voters but is very harmful to the "minority" on a social and medical level. 

There is a movement among the Left to push people away from saying that being "non-binary" is a disorder... but, technically speaking, it is. It is a deviation from normal physiology that creates a problem. The very definition of a disorder. The Left worries that we shouldn't try to fit people in boxes, and so they reject the litany of evidence that shows when people with gender differences live in either a male or female role they do better from a social, financial, and mental health perspective. And current data suggests that children too young to pursue definitive treatment can likely be safely treated with what we call a "temporizing" measure — puberty blockers.

To be clear, hormone replacement therapy is not the same as "puberty blockers" — hormone replacement therapy is giving the appropriate amounts of supplemental estrogen or testosterone to a person to induce puberty or maintain a masculine or feminine physique. "Puberty blockers" halt naturally occurring puberty for a time. Hormone replacement therapy results in permanent changes associated with puberty. Puberty blockers do not result in these changes. When appropriately prescribed, they have the potential to help a child get through a very difficult time in their life.

The science shows that people with gender differences probably do have a physiologic explanation and should therefore seek treatment tailored to their individual needs. This issue is not a political one about "rights," it is a highly nuanced medical issue. It doesn't need legislation, it needs research. What might be right for one patient will not be right for all. Gender dysphoria is a disorder, not a choice.

I love science and capitalism because they are both based in reality. Objectivism is the idea that truth is not relative, that things are what they are. I was born with a disorder — a deviation from normal physiology that created a problem. Medicine solved that problem, as it will for the vast majority with similar problems and without other confounding issues. The solution to the "transgender problem” is to depoliticize it, and treat patients with compassion, an open mind, and science. 

Anonymous MD is a physician, husband, and father. He is a self described free market capitalist and believes in small-government, evidence-based solutions. 

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