Collaborating With Madness

You may think my last post finished a bit overheated. “Stop the Madness!” Unfortunately, I don’t think so. And neither does Paul McHugh, former Chair of Psychiatry at Johns Hopkins Medical School and psychiatrist-in-chief at Johns Hopkins Hospital. (McHugh just turned 90 and is still kicking.)

The following quotes by McHugh come from his article “Surgical Sex,” in First Things, November 2004. The editor of the New Atlantis called McHugh “the most important American psychiatrist of the last half-century.”  Recent comments from McHugh reveal he still isn’t persuaded by today’s “Gender Science.”

When the practice of sex-change surgery first emerged back in the early 1970s, I would often remind its advocating psychiatrists that with other patients, alcoholics in particular, they would quote the Serenity Prayer, “God, give me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” Where did they get the idea that our sexual identity (“gender” was the term they preferred) as men or women was in the category of things that could be changed?

“Advocating psychiatrists” encouraged him to meet with male to female sex-change patients (almost exclusively male back then) but he remained unconvinced. “Their psychological leanings seemed more like those of men than of women,” he said. After becoming psychiatrist-in-chief at John’s Hopkins Hospital in 1975 he decided to test advocate claims by studying two areas.

  1. Did sex-change surgery resolve patient psychological problems?
  2. Were male infants with deformed and/or ambiguous genitalia who were surgically “transformed” into females and raised as “girls” settling into the sexual identity chosen for them?
These claims had generated the opinion in psychiatric circles that one’s “sex” and one’s “gender” were distinct matters, sex being genetically and hormonally determined from conception, while gender was culturally shaped by the actions of family and others during childhood.

The first question was relatively easy given that one research member at Hopkins, Jon Meyer, was developing a follow-up protocol for sex-change patients at Hopkins and was compiling data.

He found that most of the patients he tracked down some years after their surgery were contented with what they had done and that only a few regretted it. But in every other respect, they were little changed in their psychological condition. They had much the same problems with relationships, work, and emotions as before. The hope that they would emerge now from their emotional difficulties to flourish psychologically had not been fulfilled.
With these facts in hand I concluded that Hopkins was fundamentally cooperating with a mental illness. We psychiatrists, I thought, would do better to concentrate on trying to fix their minds and not their genitalia.


Dr. Meyer concluded they were dealing with two distinct groups of men.

  1. Conflicted and guilt-ridden homosexual men seeking sex-change to resolve conflict.
  2. Heterosexual (and some bisexual) males who were sexually aroused by cross-dressing as females. (A disorder Canadian researchers later categorized as “autogynephilia.”)

Dr. McHugh decided not to collaborate with a mental disorder and stopped prescribing sex-change operations for adults at Hopkins in 1976. (In 2016 the hospital announced that it would start performing sex reassignment procedures again.)


The second claim made by advocates, “that sexual identity was a matter of cultural conditioning rather than something fundamental to the human constitution” was also studied.

Those born with malformed, sexually ambiguous genitalia and severe phallic defects were surgically “transformed” at Hopkins and given “female-like genitalia.” When doctors said to parents this must be done promptly “because a child’s sexual identity settles in by age two or three,” most parents consented and after surgery began raising the children as “girls.” They were told sexual identity would “conform to environmental conditioning” “without much travail.”

Did it? Was the all important question.

McHugh asked the advocates of sex-change surgery to provide solid empirical evidence that the changes worked. A resident psychiatrist William Reiner was tasked with doing a systematic follow-up of these children.

According to McHugh, the results here were even more startling than in Meyer’s work.

But before we take a look at what Dr. McHugh discovered from the research evidence by Dr. Reiner, let’s first define a term.


You may wonder why I use the word ideology so much? Like when I write the phrase, Gender Ideology. Let me clarify what I mean by the word. Ideology is not in and of itself a bad word but a more palatable way of expressing the same concept is worldview.

All of us operate at the level of worldview. This means we bring to every decision, conscious or unconscious, a collection of ideas, perceptions, and values held by a particular group of people in a particular time and place. We don’t decide afresh each time a question arises and a decision or evaluation needs to be made, that would be time-prohibitive & exhausting, rather we fall back on a pre-conceived understanding of the world, and ourselves in that world. These understandings are gleaned from personal analysis, true, but mostly they come from the cultural environment we grew up in. They come as a gift from others. They are the accumulated wisdom our family, church, school, town and country taught us about the good life and how best to live it. Think of them as “glasses behind the eyes” through which we perceive the world and how we ought to behave in that world. These basic viewpoint assumptions for the most part remain unquestioned until we are forced, often uncomfortably, to reconsider them.

The important question is one of Truth and Falsity. Is your worldview basically true or false? And if false is it collaborating with madness?

Today’s Gender Ideology is doing just that. The male female binary is basic. It’s fundamental. Confusion on this point is not progressive, it’s delusional.


How did this happen? Well, we’ve experienced a revolution in how the self is understood, that’s how.

The best way to describe the modern view of the self would be to say that by the late nineteenth-century there was a dramatic “inward turn” facilitated by a movement known as Romanticism. Poets, like Wordsworth, Shelly, & Blake, philosophers like Rousseau placed the inner psychological life of the individual at the heart of what it means to be a self.

Then the ideas of Marx, Nietzsche, Darwin, and Freud became part of the intuitions of Western culture. All are important because they call in question the idea of human nature. No longer are we created in the image of God as male and female and therefore have an intrinsic transcendent worth.


Here’s one non-Christian assumption we hear a lot today. Humans are infinitely malleable. For example, with today’s Gender Ideology one’s biological constitution is as much a malleable artifact as one’s dress. Dr. McHugh addresses that ideological bias below as it relates to sex.

Which brings me to another popular assumption today, thanks mostly to Sigmund Freud. We now tend to think of sex as identity. After Freud the idea of sex as an act was changed to the idea of sex as intrinsically determinative of personal identity. Those feelings that uniquely define us are really at bottom sexual. Prior to Freud few people thought of identity in those terms and even though hardly any psychiatrist turns to Freud’s rather comprehensive worldview today, his basic idea of sex as identity remains the standard belief of so many in the Western world.

You are your sexual desires.

In the past our identity was largely based on our family history, our clan, our ethnic group, our religious community, or our particular vocation. No one would have thought about sex as identity or sexual orientation as our most important characteristic . But today our identity, recognition, and belonging are now deeply connected to the sexual desires we have and the manner in which we express them.

This is a profoundly new cultural development.

Gender Ideology rejects the idea that we are God-created embodied beings with a given nature. Isn’t this the oldest temptation? In the Biblical origins story, Eve was tempted by the serpent to taste the forbidden fruit so she could be like God, knowing good and evil. You might say, what does the temptation to grasp for knowledge or the desire to be like God have to do with the rejection of embodiment? Ideas, knowledge are invisible. God is Spirit. You can’t see an idea. And Spirit or spirits are not embodied. But humans have bodies that are visible. Perhaps wanting to change, or transcend our fundamental nature, grasping for something not given to us, is the most basic temptation. The fatal conceit inspired by the Serpent. At root it is a rejection of how we were created, and a dissatisfaction with God’s wise design. Gender Ideology fundamentally rejects that design.

We were given bodies by God, mediated through our parents, because we were meant to have them. We will never transcend that design. No matter how hard we try. And why would we want to?

Classic Christianity, echoed in our Creeds, teaches us that today, sitting at the right hand of the Father, is the second Person of the Trinity with a human body.

Now meditate on that for a moment. If true, what does that say about God’s view of humanity, and our embodied life?

Instead of “grasping for God-likeness” as the human protagonists in the original story did, God extended himself to become likes us, an embodied being. And suffered bodily death on our behalf.

Philippians 2:5–11 (ESV): Have this mind among yourselves, which is yours in Christ Jesus, who, though he was in the form of God, did not count equality with God a thing to be grasped, but emptied himself, by taking the form of a servant, being born in the likeness of men. And being found in human form, he humbled himself by becoming obedient to the point of death, even death on a cross. Therefore God has highly exalted him and bestowed on him the name that is above every name, so that at the name of Jesus every knee should bow, in heaven and on earth and under the earth, and every tongue confess that Jesus Christ is Lord, to the glory of God the Father.

Could there be any greater love than this?

We embodied creatures are exceptionally special to our Creator. Christians know this, or at least they should, more than any other religious pilgrim on planet Earth. The embodiment (incarnation) of the Second Person of the Triune God and the resurrection and ascension of His body and the Truth those doctrines teach is Christianity’s unique contribution to World Religion.

But in contrast Gender Ideology believes that our bodies don’t matter. Only our internal disposition, our invisible desires count as real and reveal our most authentic self. This is a rejection of Christianity’s most fundamental tenets. As Christians we are called to fight as Jesus would fight for God’s body affirming worldview! Body & Soul are designed to be an integrated whole. Also….

In the beginning God made us male and female. To those who have ears to hear. Hear.


Now back to McHugh’s assessment of Dr. Reiner’s research into the nature or nurture question and the startling results of that study. How were little boys born with ambiguous or deformed genitalia who were surgically given “vaginas” and raised as “girls” actually doing? When parents were told sexual identity would “conform to environmental conditioning” “without much travail” did that in fact happen?

Reiner concluded from this work that the sexual identity followed the genetic constitution. Male-type tendencies (vigorous play, sexual arousal by females, and physical aggressiveness) followed the testosterone-rich intrauterine fetal development of the people he studied, regardless of efforts to socialize them as females after birth. Having looked at the Reiner and Meyer studies, we in the Johns Hopkins Psychiatry Department eventually concluded that human sexual identity is mostly built into our constitution by the genes we inherit and the embryogenesis we undergo. Male hormones sexualize the brain and the mind. Sexual dysphoria—a sense of disquiet in one’s sexual role—naturally occurs amongst those rare males who are raised as females in an effort to correct an infantile genital structural problem.

Gender Ideologues constantly refer to the findings of science to back up their claims when in fact those claims are more about worldview than empirical science. Also, it must be acknowledged, medical professionals can be committed to an ideology just like anyone else.

Dr. McHugh recognizes ideology at work in the medical profession today:

I think the issue of sex-change for males is no longer one in which much can be said for the other side. But I have learned from the experience that the toughest challenge is trying to gain agreement to seek empirical evidence for opinions about sex and sexual behavior, even when the opinions seem on their face unreasonable. One might expect that those who claim that sexual identity has no biological or physical basis would bring forth more evidence to persuade others. But as I’ve learned, there is a deep prejudice in favor of the idea that nature is totally malleable.

Without any fixed position on what is given in human nature, any manipulation of it can be defended as legitimate. A practice that appears to give people what they want—and what some of them are prepared to clamor for—turns out to be difficult to combat with ordinary professional experience and wisdom. Even controlled trials or careful follow-up studies to ensure that the practice itself is not damaging are often resisted and the results rejected.

I have witnessed a great deal of damage from sex-reassignment. The children transformed from their male constitution into female roles suffered prolonged distress and misery as they sensed their natural attitudes. Their parents usually lived with guilt over their decisions—second-guessing themselves and somewhat ashamed of the fabrication, both surgical and social, they had imposed on their sons. As for the adults who came to us claiming to have discovered their “true” sexual identity and to have heard about sex-change operations, we psychiatrists have been distracted from studying the causes and natures of their mental misdirections by preparing them for surgery and for a life in the other sex. We have wasted scientific and technical resources and damaged our professional credibility by collaborating with madness rather than trying to study, cure, and ultimately prevent it.


If you’ve just found my blog and are intrigued about this issue, and want to learn more, I highly recommend a book by Abigail Shrier.

Shrier is a graduate of Columbia College who went on to earn a bachelor of philosophy degree from the University of Oxford and a JD from Yale Law School.  Her book Irreversible Damage: The Transgender Craze Seducing Our Daughters was named a “best book” by The Economist and The Times of London. [2020, 2021]

SEGM Bulletpoints The Madness

The Society for Evidence-Based Gender Medicine (SEGM)1 An international group of over 100 clinicians and researchers concerned about the lack of quality evidence for the use of hormonal and surgical interventions as first-line treatment for young people with gender dysphoria. They represent expertise from a range of clinical disciplines. was mentioned in my last two posts. They have done a great job accumulating the relevant studies from which today’s Gender Science is based. If you enjoy reading technical scientific abstracts and journal articles, and who doesn’t <grin>, you will find your fill at their website.

But for now let’s just focus on their home page Bullet Points which outline the single Dutch study upon which today’s Gender Affirming Care Model of hormones and radical surgery is based.

A single Dutch study!

  • 55 subjects (only 40 with complete data)
  • 100% had childhood-onset gender dysphoria (no adolescent-onset gender dysphoria cases which are the vast majority of cases today)
  • Only 1.5 year post-surgery follow-up at an average age of under 21
  • No control group
  • No physical health effects evaluation
  • One adolescent died as a result of post-operative complications. Several others could not pursue treatment due to new health issues arising following hormonal administration.
  • Unchanged or worsening gender dysphoria and body image difficulties while on puberty blockers, especially among natal adolescent females.

Multiple subsequent studies have found the following associations with the “standard care” treatments:

  • Bone/skeletal impairments
  • Cardiovascular complications
  • Premature death
  • High rates of post-surgery suicide

Despite the uncertainties and poor evidence, hormonal and surgical interventions are being scaled up. They go beyond the experimental “Dutch protocol” by:

  • Encouraging early social transition, explicitly discouraged by the Dutch protocol
  • Being applied to young people with adolescent-onset gender dysphoria, a population not included in the Dutch study.


This past May the Karolinska Hospital in Sweden, home of the Nobel Prize in Medicine, rejected the so-called Dutch protocol. [See story here]

And yet in North America trans-advocates are shouting “full-steam ahead” on prescribing radical experimental treatments for children and teens with gender-dysphoria. All on the basis of seriously incomplete scientific research. If you say slow down, you are suspected of being a bigot interested only in so-called “conversion therapy.

This is madness.

And some in Europe, like the Swedes above, may be finally coming to their senses.

One of the lead researcher-clinicians at the Center of Expertise on Gender Dysphoria in Amsterdam, Thomas Steensma, is asking some critical questions today. On Feb 27 Algemeen Dagblad, the second-most widely read newspaper in the Netherlands published an astonishing article. Here are some excerpts:

Because what is behind the large increase of children who have suddenly registered for transgender care since 2013?  And what is the quality of life for this group long after the sex change?  There is no answer to those questions.  And that must happen, thinks Steensma and colleagues from Nijmegen.

Thomas Steensma

"We don't know whether studies we have done in the past can still be applied to this time.  Many more children are registering, and also a different type," says Steensma.  "Suddenly there are many more girls applying who feel like a boy.  While the ratio was the same in 2013, now three times as many children who were born as girls register, compared to children who were born as boys."

[About the effect of early medical intervention on future fertility Steensma has this to say]

It is still unclear whether these administered hormones affect the fertility of boys and girls.  "We just don't know," says Steensma.  "Little research has been done so far on treatment with puberty blockers and hormones in young people.  That is why it is also seen as experimental.  We are one of the few countries in the world that conducts ongoing research about this.  In the United Kingdom, for example, only now, for the first time in all these years, a study of a small group of transgender people has been published.  This makes it so difficult, almost all research comes from ourselves."  

[Lamenting the lack of research, and decrying the fact that other practitioners are applying Dutch research without adequate assessment of their patients he says]

"We conduct structural research in The Netherlands.  But the rest of the world is blindly adopting our research.  While every doctor or psychologist who engages in transgender health care should feel the obligation to do a proper assessment before and after intervention."

You can read the full article here:

How can we justify a full-steam ahead mentality when the Dutch clinicians who do “almost all research” on these questions say stop “blindly adopting our research.”

Stop the Madness!


If you’ve just found my blog and are intrigued about this issue, and want to learn more, I highly recommend the book by Abigail Shrier.

Shrier is a graduate of Columbia College who went on to earn a bachelor of philosophy degree from the University of Oxford and a JD from Yale Law School.  Her book Irreversible Damage: The Transgender Craze Seducing Our Daughters was named a “best book” by The Economist and The Times of London. [2020, 2021]