Some claim that sexual orientation is a preference, not genetic, and therefore can be changed. However, nothing is more clearly genetic than our biological sex. It is determined by our two “sex” chromosomes, one from each parent. Two X chromosomes determine a biological female, while one X and one Y chromosome determine a biological male. The Y chromosome can only come from the child’s father.
But in the 21st century, “gender” has moved beyond biology, morphing into a new construct that is part socio-cultural, part ideological, and part political: that gender is based on one’s self-perception of being male or female, and is changeable.
Hence we have controversial legislation allowing self-selection of public bathrooms by transgender individuals – or anyone who claims to be transgender.
“Social equality” activists believe that one’s feeling of gender cannot be questioned by the rest of society, and policies should be made according to the individual’s assumption of gender rather than biological sex. Such self-perceptions are rarely considered the criteria used for decision-making in other areas of medicine, psychiatry, or social policy. To do so across the board would result in chaos.
In medicine and psychiatry/psychology, we recognize that self-perception may be distorted and not consistent with observable phenomena. False self-perceptions or assumptions can have serious, and possibly lethal, consequences. Consider these common examples in medicine:
• An alcoholic has self-perception that he/she is sober, then decides to drive while legally intoxicated, crashes into another car, and kills a whole family.
• A diabetic has a self-perception that blood sugars are normal, doesn’t check or treat them, and then falls into a coma from either hypo or hyperglycemia.
• A patient with high blood pressure has self-perception that blood pressure is “normal,” doesn’t check or treat it, then has a stroke due to severe hypertension.
• A young woman with anorexia nervosa has self-perception that she is grossly fat, yet has lost so much weight that she dies from malnutrition.
• A young man with body dysmorphic disorder has a fixed self-perception that he is “grossly ugly” and commits suicide, in spite of appearing being a normal, good looking young man.
I think most people would agree that the individuals described above should be helped with treatment, not allowed to continue in their detrimental self-perception. As medical professionals, our job becomes helping that person’s self-perception match the medical reality so that proper therapeutic interventions may be offered, and lives spared.
Transgender patients, who make up 0.3% of the U.S. population, have a similar disorder of assumption. One of the largest and longest studies, published in 2011 from the Karolinska Institute in Sweden, followed 324 individuals for up to 30 years after sex-reassignment surgery.
Researchers found an alarming 20-fold increase in death by suicide among the trans-
gender individuals compared to
a non-transgender population. Further, about 10 years after the sex-reassignment surgery transgender individuals began developing higher rates of mental disorders such as depression.
Johns Hopkins, the first American medical center to perform gender-reassignment surgery and to have a comprehensive team evaluation and treatment program, developed an outcomes study starting in the 1970s to evaluate post-surgical psycho-social adjustment. The Hopkins study found no better psychological outcomes for the group who had surgery vs. those who did not. The Hopkins team decided to stop performing high risk sex-reassignment surgeries that had no long term benefit.
My personal experience as a physician agrees with the studies. I have scrubbed in on gender-reassignment surgery. It is lengthy, complex, risky—and expensive. Many procedures are needed, and patients have long, painful recoveries. I have treated a number of patients who had it done.
Even with surgery and lifelong hormone therapy to maintain a feminized body, transgender men are still biologically male even though they have assumed the social role and appearance of a woman. They still have the XY chromosome makeup, and need prostate monitoring for later cancer.
The reality is quite different from simply granting a patient’s preferences. Reality cannot be changed. Perception of reality can be. Our goal should be to “do no harm” in our treatment. Since long-term studies show that transgender patients who have sex-reassignment surgery may actually suffer more emotional distress over time, treatment should be focused on the underlying mental disorder, that commonly is not “fixed” by surgery.
Giving in to activists’ demands, Medicare ruled in 2014 that it would pay for surgical costs for those over 65 who perceived they were males “trapped” in female bodies or females in male bodies. Private Bradley (now Chelsea) Manning, found guilty of crimes of leaking classified documents and imprisoned, had sex-reassignment surgery at taxpayer expense.
Meanwhile, Medicare denies payment for hormone replacement treatment for menopause or andropause; has reduced payments for hospice care, home health care, physical therapy, and hospital readmissions for seriously ill patients; and is approving fewer hip, knee, shoulder, and back surgeries.
Instead of seeking a sound therapeutic approach to help patients with their misperceptions, activists are ignoring the studies and demanding that society pay for wish-fulfilling but potentially harmful and risky surgeries.
The left’s politically correct social engineering is refusing to protect women and girls from sexual predators pretending to be transgender. This ideological agenda continues a war on women jeopardizing lives to satisfy a miniscule minority.
Bureaucrats endanger lives by rationing standard treatments for Medicare beneficiaries and shifting funds to costly surgeries harmful to the troubled people it claims to help. Politicians are a danger to public safety and personal privacy when they replace reality and common sense with radical ideology.
Elizabeth Lee Vliet, M.D. is Past Director of the Association Of American Physicians and Surgeons. She is a preventive and climacteric medicine specialist with medical practices in Tucson AZ and Dallas TX that take an integrated approach to evaluation and treatment of women and men with complex medical and hormonal problems. Dr. Vliet is also President of International Health Strategies, Ltd., whose mission is twofold: liberty and privacy in treatment options and preservation of the Oath of Hippocrates focus on the individual patient.