The transgender industry is incoherent

This is a diatribe against the establishment, not trans people

Many of my fans are trans.

This is not about them.

Trans people exist, and have every right to the care they need. Gender binaries are not entirely social constructs, even if they emerge from underlying biology. If someone has a mismatch between their brain and their body, it’s up to them how they reconcile that difference.

With all that being said, the medical establishment surrounding transgenderism is totally incoherent.

Let me use cancer as an example, to provide contrast. If you feel sick, what do you do? You go to the doctor, and they run blood tests, checking for white blood cells and immune factors. They perform medical imaging with X-rays, CT scans, MRIs, and ultrasounds.

They get empirical data to see what is actually wrong with you.

Do you know what they are required to do for transgender care? None of that. No endocrine analysis to see if maybe your hormones are out of whack. No inflammation tests to see if you’re actually sick. No lab tests, no blood work. You just feel gender dysphoria and a psychologist signs off “yep, you’re trans, let’s start putting you on hormones.”

I know this is an oversimplification, but the point stands. There are plenty of known metabolic and endocrinological disorders that should be addressed first. Consider this: take any ordinary woman on the street and give her high doses of testosterone. Guess what? Her personality and identity would change. Even her sexual orientation would change. Now, I don’t advocate forcibly masculinizing people, but the point remains: sex hormones are powerful.

Doesn’t it stand to reason that maybe, just maybe, hormone imbalances explain some transgenderism? The fact that such tests are not even required is alarming to me. It strikes me as medically irresponsible that any quack in a lab coat can start prescribing gender-affirming care without any mandate of due diligence.

Returning to the cancer idea: let’s say you have a doctor who is gung-ho “yep, you’ve got cancer, time to start aggressive chemotherapy!” Wouldn’t you want some evidence first? Chemo is intense and can cause irreversible changes to your body.

In the medical industry, this is called “differential diagnosis” or a “diff” for short. Many pathologies can have multiple causes, so you need to do a diff to figure out if you’ve got the right diagnosis, which then speaks to the correct plan of care.

For gender-affirming care, there is no standard or requirement for differential diagnosis.

We’re completely inundated with hormone-altering chemicals, so-called EDCs (endocrine disrupting chemicals) as well as high-inflammation diets and lifestyles. Guess what these do? They disrupt your sex hormones in a big way. Many of us have been saturated with these things since before we were born, which impacts the sexualization of the brain and body. Is it not possible that BPAs and microplastics and xenoestrogens might have had a pervasive impact? Could it be that gender dysphoria is a downstream side effect of our high-chemical, high-stress environment?

Furthermore, if someone has lived with this their entire life, they might not see the forest or the trees. They’ve just always felt off. Always felt wrong in their body. I’m not saying that inflammation is the only explanation for transgenderism, but the fact that this possibility doesn’t even enter the conversation is problematic. May as well ask the fish if water is wet, though.

Hypogonadism (chronically low testosterone) is proven to impact men’s identity, personality, mood, and self-perception. Furthermore, it kinda sucks to be a man. You are expected to “man up” and “emotions are weak.” I even had some jack-hole on the internet say that “burnout is for pussies.” Insinuating that “real men” don’t experience burnout, and that we should just keep pushing through. Toxic masculinity is real, but you know what else is real? Emotional abandonment of men and boys. We’ve spent the last couple of decades telling every man and boy that their sexuality is intrinsically pathological, that their emotions are pathological. Modern therapy was designed for and by women, and clinical providers are more than twice as likely to view health, normal male emotions with suspicion, fear, and hostility. So just keep a lid on it, fellas! In this social milieu, is it any surprise that some men might prefer to switch sides so that they can be emotionally validated and have the intimate relationships that all humans need?

Just a thought.

Now, imagine you’re at the doctor and he’s all gung-ho about starting chemo and radiation. But what if there’s a simpler explanation? What if he didn’t do a thorough differential analysis? Wouldn’t you consider that medical malpractice if he completely treated the wrong thing? What if you didn’t need radiation and chemo at all? What if you actually had a benign tumor that was surgically operable?

We see “wins” like Elliot Page (formerly Ellen Page) transitioning very publicly. Good for them. Given their wealth and celebrity status, I’m sure they had top notch care and were quite physically healthy. But I am concerned about the message this sends.

Conversely, let’s imagine you went to the psychiatrist because you were not comfortable in your body. And, rather than examining your childhood trauma, your burnout, your high ACE (Adverse Childhood Experiences) scores, your systemic inflammation, and endocrine dysfunction, they said “Yep, you’re obviously transgender, time to put you on hormones.”

Up to 13% of people detransition for various reasons. Among those reasons? Realizing that gender dysphoria had other causes. However, we don’t actually have the full picture due to low follow-up and poor adherence. We just don’t know. We don’t have good data.

If this isn’t ringing alarm bells in your head, I don’t know what would.

Requiring gender-affirming care to go through both psychological and physiological differential diagnosis would probably alleviate much of the hate that trans narratives get. Particularly where children are concerned.

As I mentioned at the beginning, I’m all for people’s right to live their life on their terms. Their body, their choice. I’m completely anarchic in that respect. The government has no right regulating bodies. The government does, however, have a mandate to regulate the healthcare industry.

So let’s talk about the clinical side. Requiring differentials alone would address many concerns, but how do things actually work today?

So, you might have gone to a psychiatrist who “conclusively” proved that you’re transgender with no bloodwork or deeper evaluation. Problematic, but okay. The reason you went to that provider was because every other provider wanted to do medical tests and see what else was wrong. But your friends said “no, they are gatekeepers, they are transphobic. Don’t go to that provider!”

Because there’s no standard of care, no oversight, and no accountability, you can find extremely “pro-trans” providers who will quickly put you on a pipeline to HRT and surgery. Is it problematic that there are so many providers who are skeptical and will gaslight you? Yes, this is also problematic. But two wrongs don’t make a right.

Now, even worse, are the perverse incentives that providers have. Those psychiatrists and doctors who are even vaguely skeptical? The ones that want to look for differential diagnosis? They don’t get patients. Meaning they don’t get money. They get labeled as “unsupportive” and their business dries up. The system creates a loophole—insurance coverage, lack of burden of evidence, no requirement for differentials—all of this adds up to a broken system where some providers are incentivized to just rubber stamp anyone who claims to be trans.

With cancer, there is procedure, indications, tests, differential diagnosis.

With gender-affirming care? All those best practices seem to go out the window.

The current backlash against transgenderism is unfortunate because there are many innocent bystanders caught in the crossfire. I do believe that, perhaps in those 13% of cases, what people really needed was endocrine support, inflammation support, and help with complex PTSD.

Now, before we wrap up, you might be thinking “Dave, you’re missing your own incoherence.” Let me acknowledge that:

1. If people are the ultimate authority of what happens to their body…

2. And someone definitively wants gender affirming care…

3. Then where’s the problem?

Yeah, I would say I’m a “bodily autonomy absolutist” to the point that I would support people having voluntary amputations in the case of alien limb syndrome, sex changes for any reason, and even life-ending care. If you don’t own your body, then you don’t live in a civil society.

But, this runs contrary to what I’m saying about responsible gender-affirming care. It looks like I’m advocating for gatekeeping the establishment wagging its finger at people saying “you didn’t jump through enough hoops.”

Fair. That’s not what I mean, but I can see how it could be perceived that way. All I’m saying is “what if there’s an easier (and cheaper) way to feel better that doesn’t require irreversible decisions? Isn’t that worth a shot?”

And yeah, I know there are plenty of trans folks who have tried everything they can think of. At the end of the day, this one principle stands: their body, their choice.

Long story short: Caveat Emptor.