When Courts Are Asked to Forget Reality

The Supreme Court: By Jesse Collins – CC 3.0

In a healthy constitutional republic, courts interpret laws; they do not redefine reality. Judges are charged with reading legal texts, not resolving questions of basic human biology that ordinary citizens have understood for centuries. Yet our cultural moment has produced an inversion: courts are increasingly asked to decide whether obvious truths about sex still count as truths at all.

That tension was on full display during yesterday’s Supreme Court arguments challenging state laws in West Virginia and Idaho that reserve girls’ and women’s sports for girls and women. These cases are not really about athletics. They are about whether the law must affirm a fiction—namely, that biological sex is either unknowable or irrelevant.

Why Female Sports Exist at All

Sex-segregated sports exist for a reason. Biological differences between males and females are real, measurable, and consequential—especially in competitive athletics, where strength, speed, and endurance matter not only for fairness but also for safety.

Female sports were created precisely because competing against males would disadvantage women and girls. To claim that excluding males from female sports is discriminatory misses the point entirely. The distinction is not arbitrary; it is grounded in biology.

That is why these cases almost always involve males seeking access to female sports rather than the reverse. Males who identify as female are not barred from sports altogether. They are barred from competing as females.

Sex Discrimination—or Biological Reality?

The challengers argue that laws preserving female-only sports constitute unlawful sex discrimination under the Equal Protection Clause and Title IX. But this argument collapses on contact with reality.

Sex-based distinctions are not inherently unjust. The law has long recognized that some forms of sex discrimination are legitimate when they reflect real biological differences rather than irrational prejudice. This is why sex-based classifications receive less stringent judicial scrutiny than race-based ones. Biology is not bigotry.

Female-only sports discriminate on the basis of sex by design—and rightly so.

The Question That Ends the Debate

During oral arguments, Justice Alito asked the question that cuts through all the legal gymnastics: What does “sex” mean for purposes of equal protection and federal civil rights law? How can courts determine whether discrimination has occurred if they cannot define the category at issue?

The response was astonishing. The challengers conceded that they had no definition. Sex, we were told, has no fixed legal meaning.

That should have ended the case.

When Congress prohibited discrimination “on the basis of sex,” it used a word with a clear, public meaning—one rooted in biology and universally understood when those laws were enacted. If that definition governs, laws protecting female sports are plainly lawful. If federal law is silent, then states are entitled to define sex reasonably for themselves. Either way, a biological definition cannot violate federal law.

The Absurd Alternative

The only alternative offered is worse: a system in which schools must police hormone levels, medical histories, and bodily alterations to determine who qualifies as female enough to compete. Such a regime would be invasive, unworkable, and deeply unjust—especially to girls.

The truth is neither complicated nor cruel. Boys are not girls. Men are not women. A legal system that cannot say so is not advancing equality; it is abandoning reality.


Companion Post

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Celebrate God’s Good Creation

Why Liberals Should Take the HHS Review Seriously

In a striking and carefully argued Newsweek editorial, bioethicist Moti Gorin and psychiatrist Kathleen McDeavitt urge liberals to reconsider their assumptions about pediatric “gender-affirming” medical care. Their appeal is unusual not because it is partisan, but because it is not: both authors identify as liberals and were contributors to the recent review issued by the U.S. Department of Health and Human Services titled Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices.

The authors begin by acknowledging widespread distrust of HHS—especially among progressives after years of controversy surrounding public health institutions. But they argue that skepticism should not excuse disengagement, particularly when the evidence concerns vulnerable children.

Their central claim is straightforward: many organizations and professionals trusted by the political left have embraced a medical model for pediatric gender distress that is not supported by strong scientific evidence.

A Fragile Foundation for a Sweeping Medical Practice

The editorial traces the origins of today’s “gender-affirming” approach to a small and methodologically weak Dutch study involving just 70 adolescents. Most of the participants were same-sex attracted, and all who proceeded to medical transition were rendered sterile. One patient died from surgical complications, others were excluded from analysis due to adverse outcomes, and some were lost to follow-up. Yet despite these limitations, the study became the foundation for a sweeping international medical practice involving puberty blockers, cross-sex hormones, and sometimes surgery.

Gorin and McDeavitt argue that serious ethical concerns have since been minimized or obscured. They note reports of unfavorable findings being buried, including completed suicides among minors placed on hormones. They also highlight the role of the World Professional Association for Transgender Health (WPATH), which removed age limits for medical interventions under political pressure while failing to warn patients about risks such as permanent sexual dysfunction.

The HHS review, the authors explain, reached conclusions that should alarm anyone committed to justice and evidence-based medicine. The risks documented in the review include infertility, impaired sexual function, decreased bone density, delayed cognitive development, and irreversible surgical consequences.


Progressive Countries Lead the Retreat

Importantly, the authors point out that this reassessment is not driven by conservative politics. Some of the first countries to restrict pediatric medical transition were progressive social democracies, including Finland and Sweden, followed by the United Kingdom. These nations conducted systematic reviews and concluded that the benefits of medical transition for minors were unproven and outweighed by the harms.

The editorial closes by proposing an alternative: non-medical therapeutic support that helps young people manage distress without rushing them into irreversible interventions. Most adolescents, the authors note, will see gender-related discomfort resolve over time. While the issue remains politically polarized, polling shows that a majority of Democratic voters already oppose pediatric medical transition.

Gorin and McDeavitt’s plea is simple but bracing: liberals should read the HHS review for themselves (link above). Doing so, they argue, is not a betrayal of progressive values—but an affirmation of them.

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When Science Silences Itself: Censorship in Gender Medicine Research


In recent years, debates around gender medicine have become some of the most polarized in the scientific and cultural landscape. What was once the realm of cautious inquiry has, in many institutions, hardened into dogma. Researchers who raise empirical or ethical concerns about puberty blockers, cross-sex hormones, or surgical interventions for minors increasingly find their work censored or discredited—not through evidence, but through social pressure and editorial gatekeeping.

A new paper by J. Cohn in the Journal of Controversial Ideas shines a bright and uncomfortable light on this phenomenon.

In “Censorship of Essential Debate in Gender Medicine Research,” (see below) Cohn exposes a disturbing trend in modern medicine: the systematic censorship of scientific debate in the field of gender medicine. The piece reveals how leading medical journals and professional societies have created an echo chamber that suppresses scrutiny, silences dissent, and promotes ideology under the guise of science.

The Core Problem: Debate Is Being Shut Down

Cohn argues that medical research on gender dysphoria—especially regarding hormonal and surgical interventions for minors—has been overtaken by advocacy rather than evidence. The core claim is simple but explosive: major journals like JAMA and The New England Journal of Medicine routinely reject well-documented critiques of published research, allowing false or exaggerated claims to circulate uncorrected. Letters highlighting factual or methodological errors are blocked, and even platforms like PubPeer have removed accepted criticisms without explanation.

This, Cohn warns, is not merely academic malpractice—it is a corruption of science itself. When editors silence valid scientific debate, public policy and medical practice are shaped by untested assumptions and political pressure rather than by evidence.

What the Evidence Actually Shows

The article points to a striking fact: despite the confident tone of many advocacy-driven statements, there is no scientific consensus on the effectiveness of medical transition, especially for youth. Systematic reviews—the gold standard of evidence—consistently find the evidence base to be weak or of very low certainty. The long-term outcomes of puberty blockers, cross-sex hormones, and surgeries remain largely unknown.

Even basic questions about etiology, persistence, and predictors of benefit in gender dysphoria are unresolved. Yet, U.S. medical bodies have promoted these interventions as both safe and necessary—often claiming they are “lifesaving” while dismissing alternatives like psychotherapy or watchful waiting.

False Claims and the Refusal to Correct Them

Cohn provides concrete examples of misinformation that have been published and then protected from correction. Some articles claim that regret rates after transition are “low” or “rare,” despite the fact that true rates are unknown because of poor follow-up and incomplete data. Others assert that randomized controlled trials would be unethical—a claim that is scientifically indefensible, since experimental rigor is what distinguishes genuine medicine from ideology.

Cohn recounts instances where he attempted to submit brief corrections or letters to editors, only to see them rejected without explanation. One such letter challenging NEJM was dismissed; another, initially accepted by JAMA, was later withdrawn before publication. In both cases, his critiques were grounded in empirical evidence.

How Journals and Societies Reinforce Error

The article describes what Cohn calls a “closed loop” between medical journals and professional associations. Guidelines by groups like the American Academy of Pediatrics cite the very same uncorrected journal articles that overstate the evidence for gender transition. The result is a self-reinforcing cycle: advocacy-based claims become the official line, while attempts at correction are buried.

The International Picture: Caution Abroad, Ideology at Home

Outside the United States, several nations have already reevaluated their approach. Sweden, Finland, and the United Kingdom have all pivoted away from automatic medicalization toward a more cautious model emphasizing psychotherapy and holistic care. The 2024 Cass Review in the U.K. and a 2025 U.S. Department of Health and Human Services review both acknowledge the same reality: the evidence for pediatric gender medicine is extraordinarily weak.

Why This Matters

The censorship of debate in gender medicine is not just a matter of professional ethics—it directly affects vulnerable patients and the integrity of public trust in science. When unsupported claims about safety and efficacy are treated as settled facts, doctors cannot give truly informed consent, and policymakers are misled into endorsing experimental treatments for children.

Cohn concludes with a reminder drawn from JAMA’s own editorial policy: “The integrity of the scientific process hinges on the free exchange of scientific ideas grounded in rigorously conducted inquiry.” That principle, he argues, is being betrayed by the very institutions charged with upholding it.

The Way Forward

True science welcomes scrutiny. It is strengthened by disagreement and refined by debate. Cohn calls for the restoration of open, evidence-based discourse in gender medicine—a return to the first principles of inquiry: transparency, humility, and courage. Until that happens, medical journals risk losing what makes them credible in the first place.

The article ends with a simple warning that resonates far beyond gender medicine: when science silences itself, ideology rushes to fill the void.

You can download a PDF version of this article for easy sharing and reference.

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Grace and Truth