Bruce Jenner, Paul McHugh, and Transgender Denialism

The media has been full of speculation recently about whether or not Bruce Jenner is transitioning to live life as a female (and it is all still speculation at this point, no matter how many anonymous sources TMZ speaks to). This has fueled a sometimes raucous and angry reaction online about what it means to be transgender and what the proper treatment is for gender dysphoria, the mental distress that comes from the conflict between a transgender person's gender role and gender identity. I'm not interested today in speculating on whether Bruce Jenner is or is not transgender. I'm more interested in the high amount of science denialism the Jenner story is bringing out on the Internet, regardless of how accurate the reports are.

And yes, the crass, transphobic responses many have expressedto the Jenner story can be classified as a form of science denialism. just as climate change deniers reject overwhelming consensus about the damage we have done to the environment; just as evolution deniers ignore overwhelming consensus about the origins of life; just as vaccine deniers ignore overwhelming consensus about vaccination; so too dothose who deny the validity of transgender identities and the proper treatment for the mental distress of gender dysphoria do so by ignoring overwhelming medical consensus on these topics.

A typical trans denialist response to the Jenner story came recently from conservative pundit and radio host Carl Jackson. His screed, "My Hope for the Man Bruce Jenner," (note the forced insertion of "the Man") has been widely shared on conservative blogs, religious sites, and social networks over the past week. Jackson starts by saying he will "pray [Jenner will] get the psychiatric help he needs to conquer his illness," and then dives into repeating a number of transphobic talking points.

Did you know that transgenderism [sic] is a mental disorder? Nothing more, nothing less. Dr. Paul McHugh, the former psychiatrist-in-chief for John Hopkins Hospital and its current Distinguished Service Professor of Psychiatry has stated that “transgenderism is a ‘mental disorder’ that merits treatment, that sex change is ‘biologically impossible,’ and that people who promote sexual reassignment surgery are collaborating with and promoting a mental disorder.”

I was not surprised to see a trans denialist cite Dr. Paul McHugh. In fact, Jackson's article is largely just a repetition of McHugh's on-the-record positions. McHugh is the kind of poster-expert science denialism often seeks out: an educated professional in the right field with a distinguished career who, nonetheless, supports their brand of willful ignorance. McHugh has taken a number of controversial stances in his career. He opposes the Diagnostic and Statistical Manual of Mental Disorders (DSM), the standard diagnostic tool in psychiatry; he disregards Post-Traumatic Stress Disorder (PTSD) as a valid medical condition; he believes that homosexuality is a choice individuals make; and in all things transgender, he rejects the accepted, science-supported view in favor of his own antiquated ones.

McHugh rejects, as do all trans denialists, the notion that one's biology ("sex") is separate from one's self-identity ("gender"), a position that is increasingly in the minority of both psychology and society. This position puts him at odds with the likes of the World Health Organization and even his own employer Johns Hopkins University.

McHugh instead embraces the idea of autogynephilia, otherwise known as "Blanchard's autogynephilia typography," or BAT. BAT argues that transgender women are actually just extremely gay men and that the rest are just heterosexual men with a fetish for their female identities. Autogynephilia was never widely accepted as science, has been highly criticized since its introduction, and only exists in any form today because the idea's originator, Ray Blanchard, sat on the board that compiled the DSM-V.Even then, it's relegated to a small sub-section of the "paraphilic disorders" category, nowhere near the diagnosis of gender dysphoria.

McHugh also voices a common trans denialist position that claims gender-reassignment surgery (GRS)is not an effective treatment for gender dysphoria. In fact, trans denialists like to tout McHugh's connection to Johns Hopkins Hospital, one of the first medical institutions to offer GRS, in support of this claim. The hospital has since stopped performing GRS because, they say, the institution "no longer saw a need to amputate 'normal organs'." What they fail to mention is that this happened in 1979 and was largely done because McHugh himself was the one in charge. Hopkins Hospital hasn't brought it back since, not because they still stand by McHugh's views, but because the administration feels that there's no need to start a new program, as there are other facilities that perform the surgery.

Furthermore, the study McHugh used to justify the cessation of the surgeries at Johns Hopkins was flawed. It is is often held up as "proof" that such surgeries are ineffective, but that study was done in the late 1970s, at a time when the procedures were still rare and experimental; and it was done by Johns Hopkins, under the purview of McHugh himself, and focusing only on a small sample size of patients at Johns Hopkins. This all suggests ample conflicts of interest for a man who admits to having been opposed to GRS from the start.

[Incidentally, the other study trans denialists like to point to, the so-called "Swedish Study," doesn't actually say what they claim it says. Like so many things in denialism circles, it's a case of the deniers cherry-pickikng the numbers that suit them and ignoring the rest.]

Another argumentMcHugh and other trans deniers often repeat is the idea that "surgery cannot change one's biological sex," insisting that because GRS does not change one's chromosomal makeup or grow new organs, the surgery is invalid and its results a sham. But this sort of biological determinism isn't what the surgery is about. I challenge McHugh or any detractors to find a single informed trans person, pre- or post-op, who honestly believes they are being changed on a DNA level by these surgeries. Quite the opposite; trans people probably understand the surgeries and the procedures behind those surgeries better than most people do when going in for other routine or extreme surgeries. GRS is about aligning the secondary sex characteristics to better fit the patient's gender identitiy; but then, to understand the theraputic value of GRS requires one to understand that sex and gender are not the same thing, something we already know trans denialistsreject.

Finally, McHugh and trans denialists also support the supposed value of reparative therapy. "Advocates for the transgendered," McHugh wrote in 2014, "have persuaded several states [...] to pass laws barring psychiatrists, even with parental permission, from striving to restore natural gender feelings to a transgender minor." The "natural gender feelings" line is just more biological determinism; the rest is advocating for a type of therapy that was part of the stew of intolerance and rejection that recently led to the heart-rendingsuicide of Leelah Alcorn. Reparative therapyhas been outlawed in several places because it doesn't work and because it causes harm to those it tries to "cure."

In taking these stances, trans denialists stand opposed to a growing body of science literature and the stated position of virtually every major domestic medical organization on the record. In the United States, organizations such as the American Medical Association, the American Psychiatric Association, the American Psychological Association, the American Academy of Family Physicians, and others all have spoken out against the diagnosis of transgender identity as a mental illness. They all support the treatment of gender dysphoria through necessary medical care including gender-confirming mental therapy, hormone replacement therapy, and gender-reassignment surgery. These organizations base their positions on over 50 years of study. Transgender identities are real, and science has built up an increasingly impressive corpus of evidence in support.

It's not surprising to see all of these discredited denialist arguments coming up as the Jenner story continues to make headlines. Jenner and the Kardashian clan are lightning rods for criticism and insults, and unfortunately news stories involving transgender individuals are also likely to draw ignorant vitriol and ire. Putting the two together is a proverbial tempest in the teapot of gossip sites and tabloid publications. Fortunately, the science is on the side of transgender identities, and that is why public opinion and public policy is increasingly on our side as well. So let the deniers continue to deny; they do so as vaccine deniers, evolution deniers, and climate deniers before them, from a position of increasing willful ignorance and disregard for the scientific consensus. Science is about progress, and that progress has generally bettered humanity. We can't let the deniers hold us back.