They Will Always Disappoint You

 "They will always disappoint you."

--Norm--Carcetti's campaign manager in "The Wire," on what happens after your candidate gets elected

McHugh

For many blog posts, I have used Paul McHugh as a classic example of a man who has been vilified, shouted down by people you might describe as "liberal" as they defend transgender medical practices which he has opposed. McHugh looked like the man who insisted on the truth, no matter what the personal costs.

August Macke

And, it is true that he was excoriated and ostracized at Johns Hopkins when he suggested that gender dysphoria--the primary disorder of someone who says he or she feels like they are in the wrong body, feeling like a woman in a man's body--may be a problem of  suffering from "a single wrong idea," like people with anorexia nervosa, who feel they are too fat when, in fact, they are emaciated.  Saying this was apostasy, heresy, and it violated the whole premise for transgender clinics, where the assumption has been that patient is always correct. But what if the patient with transgender dysphroria is as deluded as the patient with anorexia nervosa?

He might have had a real insight there, might even have been right, but it turns out, like so many things, when you have more information, there is often another side to the story.

McHugh has also said that homosexuality is a disorder of "erroneous desire" and he opposed same sex marriage.

When critics said he allowed his Catholicism to blind him to science, they may have referred to his testimony for the defense of Catholic priests accused of sexual abuse, or his recommendation against using stem cells because this could be the killing of an unborn child, according to Wikipedia. If he harbors these ideas, how objective can he be about viewing other people, patients, who violate the norms of sexual behavior and preference?

Obadiah Youngblood

It is, of course, possible, to be correct about some things, but very wrong about other things.

McHugh tried to follow up on patients who had sex change operations, and found that while few patients expressed regrets about the change in their sex operations, as a rule, they were unable to find happiness or satisfying sexual lives.  How exactly he did this is not clear. Did he simply review journal articles or did he personally interview the patients? 

But his assertion comports well with the study by the British pediatrician, Hilary Cass, who, reviewing literature and data from British transgender clinics, concluded that there was something rotten in Denmark, or actually in the UK, and possibly, the Netherlands, where transgender medicine had been most clearly defined and which looked like the model to be pursued.

It is notable that in the Netherlands, you cannot get your gender changed on your driver's license until and unless you have transgender surgery, castration (and mastectomy in some cases)--apparently because they recognize that patients who have not gone to the ultimate step may be indicating they are not sure of their own choice.

The big question raised by Cass had to do with the observation that some number (in dispute what that number is) of patients who decided to go from female to male (FTM) later gravitated back to their gender assignment at birth, raising the question whether sex affirming surgery, (mastectomies, among other procedures) is a good idea. The Dutch have not found the levels of reversion (detransitioning) to be as  high as what the Brits had seen.

Cass was asked to do her review of the experience with transgender clinics in the UK because the number of patients presenting to clinics exploded from a few thousand to over 500,000,  raising the suspicion this may be another one of those "fad" diseases, which run through medicine now and then. There have been epidemics of hypoglycemia and chronic fatigue syndrome over the years and it's not entirely clear of many of the patients said to have these disorders actually have true organic disease.

The other big idea Cass proposed is that the approach of clinic doctors who unquestioningly embrace the patient's assertion they are in the wrong body, may not be the best approach. If transgender dysphoria is, in fact, more like anorexia nervosa, then embracing the patient's delusion might be harmful.  McHugh, in his wolfish way suggested embracing the patients' formulation uncritically is like offering liposuction to a patient with anorexia nervosa.

But McHugh's critics may have a point about the source of his opposition to transgender medicine, and about how dispassionately he has viewed the studies he cites in his review of the literature.

Paul McHugh, MD

The trouble is, it is hard finding the "truth." 

The "truth" coming out of the Trump/MAGA crowd is there are only two genders and none of these transgenders really has anything wrong with them other than they are weird; the truth coming out of LGBTQ crowd is that transgenders have a medical condition, an innate driven quality, like homosexuals, to simply have to be something other than what the world wants them to be.

One truth, at least one tentative truth, appears to be that whatever problem transgenders have, whatever is driving them to present to transgender clinics, is not the problem homosexuals have. Homosexuals simply want to be left alone; they do not seek out clinics for help.  They are lumped in that LGBT group because of social/political similarities, i.e. they are faced with a hostile world which tries to humiliate, discriminate and deny them basic rights and respect. 

But that's simply an affinity of being grouped together as undesirables. Like the victims in German concentration camps--Jews, gypsies (Roma), homosexuals and communists--they shared the stigma and disapproval of the ruling Reich, but they shared little else.

So, we wander in the darkness of the unknown, which is where science offers the only hope of light.