Trans Issues According To A Trans Physician: Part Two!

OPINION | This article contains political commentary which reflects the author's opinion.

There was a great response to the piece by our resident physician and transwoman, Anna Collins. Because Anna isn’t planning to sign into our comment section, but DOES want to answer your questions, there is now a Part 2 to the story!

Anna writes:

I want to address some of the comments and questions my initial post produced.  I am grateful to each and every one of you for the positive comments and the kindness shown.  Even the person or two who seemed to disagree with me did it in a honorable and respectful manner.  So let’s get going shall we?

Rational, Critical, or Logical thinking:  I come from a time (and place) where we were taught rational/critical thinking skills and problem solving. I still teach classes in a medical school and over the past 20 years I have become more and more concerned about the ability of medical students to think and problem solve in a rational/critical manner.  Many, perhaps most, are great at making good grades and taking tests and scoring high enough on the MCAT to get into and remain in medical school; but honestly, more and more seem to not be able to apply the things they learn in a logical way. When a student starts a question or comment with, “I feel that we should …..(fill in the blank)” my brain shifts into neutral or stops altogether.  Who cares what you feel? What are the facts and how do we deal with the facts? I learned early on in my career that feelings can fool you and making decisions based solely or largely on feelings will get you into trouble. Feelings change and in fact change often while facts are pretty stubborn in that respect.

Recently I saw a video clip of a lady on a town council stand and announce that the employees of the town and those addressing town employees had to use gender acceptable pronouns or gender neutral words like “xi” or “xir” or more made-up words in order to be “respectful of the transgender individuals.”  It is my guess that the community there has about the same percentage of trans-people as any other and that’s less than 1%. So what about the 99% who may not agree with going along with a delusion or minimally what they perceive as a delusion? What about respecting them and their opinions? How exactly does that work?

So perhaps we should address some of the comments and concerns that have been expressed as rationally and thoughtfully as we can. I like to teach using stories with which people can identify. With respect to transgender issues, are we talking about real things or some sort of delusion?  I learned a real lesson during my medical residency. The lesson was that you cannot talk a person out of their delusion. I was called one morning by the chief of psychiatry to come with him to see a patient that had been referred to him. The woman (we can call her Jane) was a 33 year old, pleasant, attractive Afro-American woman.  Jane felt that her entire body was infested with worms. She insisted that this had been the case for a few years and that she had seen several doctors for this and no one had done anything to help her. In the interest of brevity I will say that Jane had every workup available to test for the presence of worms in her body and there were no worms….but she would not accept that.  Fortunately she was amenable to working with the psychiatrist and when I happened to see her some months later, she was free of worms. Her psychiatrist confided in me that she had been abused as a teenager and had come to believe that her body was somehow defiled and unclean and thus infested by worms. Some good old fashioned psychotherapy gave Jane insight into her delusion and it went away.  Delusions are best treated by behavioral specialists, not medically. There is no drug or procedure I can conceive of that would have made her better. But I did learn that delusions (a) are real to the person experiencing them, and (b) can produce awful effects in the person experiencing them, and (c) are often treatable and can be thus be “cured”.

It is of interest that a case pending before the US Supreme Court and involving transgender issues has had an Amicus Brief (friend of the court) submitted by a rather large group of “former” transgender individuals who have realized that they were suffering from a false belief (by definition a delusion) and were “detransitioning” or in other words reverting to their natal gender often after years living as the opposite gender.  You can look up this Amicus Brief on the Internet.

I have an acquaintance who is a neurologist and a transperson and she has a friend who is a prominent psychiatrist who also happens to be trans.  I once asked her friend (the psychiatrist) concerning trans folks thinking they were female when they were natal males (or visa versa) and was that indeed a delusion?  This very thoughtful psychiatrist opined that if enough people believed a delusion then it wasn’t really a delusion any longer. Hmm, really! How many is enough? In psychiatry if two people believe or share a delusion there is a name for it.  It is called Folie à deux. If three people do the same it is termed Folie à trois. So how many people believing a delusion makes it a reality?

The Heaven’s Gate community were a group (cult) of some 39 individuals that committed mass suicide falsely believing that in so doing they would reach an alien space craft which was following in the shadow of the Hale-Bop Comet.  Thirty-nine people believing this delusion did not make it so, and they all died in service to their delusion.

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James Jones was a preacher who became a cult leader and had many followers and a commune in the jungles of Guyana.  Again in an attempt at brevity, he and his followers (some 918 people) committed mass suicide (with poisoned Kool-aid…thus comes the expression about drinking the Kool-aid being associated with imbibing craziness).  Some of those poor people were coerced but many voluntarily drank the poison and even gave it to their children. Were they all delusional about what Jones had promised them? Evidently 918 people isn’t enough to make their delusion a reality.

There is a fascinating book recently written by Dugard and O’Reilly entitled, “Killing the Rising Sun” in which the authors note the belief of the Japanese (a mere 80 years ago!) that their emperor, Hirohito, was a living god.  Millions believed it and it came as a real shock at the end of WWII when the Japanese populace found out that he was just a common man. Did millions believing this delusion make it so? I think not and the Japanese met a hard reality. Delusions often crash head-on into reality and reality always comes out on top.

So, is actually believing that you are a female when you were born male (or vice versa)  reality or a delusion? How much does one have to bend and twist the obvious to reach that conclusion? I will leave the reader to decide.

Let me tell you about my trans-friend Amanda.  I have known her for a long time and Amanda is one of those who truly believes that she is a woman trapped in a man’s body.  She is sweet as can be but this is her belief. Some years ago she had breast implants which resulted in some very attractive breasts (I think I was a tad jealous to be honest).  She went back and forth as to whether she would have the “bottom surgery” and one day last year said to me after I had asked her what she had determined to do about it, “At my age, I have decided I don’t really need the bottom surgery.  It’s all in your head anyway”! Bingo, that’s precisely what I had been telling her for years and she unconsciously admitted it without thinking what she had just said.

Trans Children:  Is it possible to be born trans or is it a learned thing?  That is a real debate. Some believe that if a child, say a young boy, comes to believe that he is or wants to be a girl, that he was born that way.  After all, how could a child of 3, 4 or 5 years old just come up with that de novo? Another story or two to consider. When I was young, about 5 years old, maybe 6, I determined that I wanted to fly.  I watched the hawks and owls around by home and thought how great it would be to be able to fly. So, being a inventive kid, I made myself some wings of cardboard and worked for a couple days to figure out just how to tie them on to my arms and I jumped out of the barn loft and sure enough, I did fly……for about a second….and then I met reality really hard. I broke my wing……..arm (reality ya know).  And that reality kept reminding me for at least the next 10-12 weeks every time I had to deal with the cast on my left arm. I simply cannot imagine at 5 or 6 going to my parents and telling them I wanted to be a girl. But I suppose it does happen and some kids do tell their parents that at a young age. The question is…Why?

Now another story.  Recently at a social gathering a young family I had known for some years came in for the dinner a bit late and the woman was apologizing for being late telling everyone that she was having a difficult time getting her little 3 year old daughter to agree to wear the dress that she had picked out for her.  The little girl had her own idea of what she wanted to wear. The family had four children, three boys and the little girl. The boys were 8,7 and 5 and the little girl, as noted, about 3 and a half. The boys were all very handsome little guys. All had on their little khaki pants and nice little shirts with their hair nicely combed and they all looked adorable.  The little girl was wearing a fuchsia dress that she had picked out and her hair was blonde with curls and a matching ribbon.

I noticed that everyone was fussing over the little girl, telling her how pretty and cute she was, etc. No one was telling the little boys how handsome they were.  Then the 5 year old brother standing nearby said, “Yeah girls get all the attention!” Wow, out of the mouth of babes sometimes. What if that little boy decided that he wanted the attention and to get that attention he said that he wanted to be a girl? And what if the mother said, “Why baby if that will make you happy you can be a girl.”  Fortunately that did not happen in this case and the parents are well grounded parents, but the point is, who knows where a child gets the ideas they get? Where did I get the idea I could fly? I ask, can you imagine allowing a child to make those determinations?

It was said by one commenter, Mary York, that “gender dysphoria ……is absolutely a socially contagious phenomenon.”  Ms York is likely correct and there are more and more articles in the medical and psychological literature that demonstrate that once one child or adolescent sees the attention a trans-person is receiving that they psychologically seek that same attention. A cursory review of the literature via Google should bring up several of those articles.

There are physicians who will give puberty blocking drugs to pre-adolescent children to block the onset of adolescence to supposedly give the child time to determine “which way they want to go”.  In my opinion that is medically risky. I realize the intention is good but the potential adverse reactions to puberty blocking drugs should not be underestimated. I have reviewed the literature extensively and it is rife with articles both promoting and panning puberty blockers.  I’m afraid I do not possess the knowledge nor expertise to weigh in on this matter except to say in medicine, conservative treatments are almost always the best treatments and especially with medications, “less is best.”

The PC Culture:  When I was in medical school way back in the 60s, one’s sex and gender were the same thing.  Now transpeople are fond of saying, “Your sex is what’s between your legs and your gender is what’s between your ears.”  Really! Who made up that rule? As I noted in my first post, I am (in today’s vernacular) a trans-woman and I know when I first realized this long ago, I was in some anguish and wondered over and over why I was this way.  I know many, many other trans-people who similarly wonder why. They wonder if it’s genetics, if there is a trans-gene. They wonder if it is hormonal or psychological…every possible reason has been put forth. If one is uncomfortable with what they perceive themselves to be it is some comfort to come up with a putative reason…..Hey, gender is separate from one’s sex.  That’s the reason, I know my sex is male but my gender is female. Is that really rational? If you are whatever you think you are then I want to think I am 25 years old again and I want to be treated that way. Some things are just immutable. I cannot change my age, my sex (or gender), my race, etc.

Some comments/questions involved the current PC culture.  For example in Canada the Canadian Human Rights Act has been amended to introduce gender identity and expression.  In short, it is now against the law in Canada to discriminate against a person who says they are transgender. Fine.  But the law goes on to make it illegal to “misgender” (another made-up word) an individual and there are consequences and punishments for doing so. It is considered a hate crime with all the penalties associated with having committed a hate crime. Is that rational or mass delusion?

Young children in schools are being taught that there are several (or many) genders.  Imagine sitting in a grammar school classroom perhaps in the third grade and looking around at your classmates and seeing a mixture of boys and girls and then being told by a teacher that there are “boys and girls and many other genders.” I don’t know about how you readers view this but I would wonder if my teacher were nuts. I am concerned about whether our children (and in my case grandchildren) are being manipulated and taught to deny their logical/rational thought process for a politically correct thought process.

There are places in our country where children’s reading or story telling programs at public libraries are being conducted by drag queens.  Whose brilliant idea was this? What positive outcome can result from exposing children to drag queens? Oh I can just hear “acceptance of alternative lifestyles.”  Really! So what’s next, having them read to by convicted pedophiles so they can accept that lifestyle as well? I have to wonder about the parents of children who would take them to such programs.  You have to wonder how a child taught this will ultimately develop as an adult.

If in today’s society I want to be a unicorn, it’s really nobody’s business.  If I can find a surgeon to graft a horn on my head (and trust me, there are some who would do that) and live my life as a unicorn, who cares?  The problem arises when I come to believe that I really am a unicorn and I expect everyone else to believe that as well. In fact, I may come to believe that unicorns are a protected class and if you do not address me as I desire, then I will have you punished.  In addition, as a protected class, I demand that your tax money be used to have my horn attached to my head. Logical/rational people will resist and rightly so. This is where trans-people allow their train to run off the tracks. Demanding acceptance will promote resistance…it’s human nature.  In my opinion if trans-people would just pleasantly and quietly integrate, over time there would be acceptance. Of course there will always be some people who will not accept it but there are people who are just obstinate perhaps just to be obstinate. Who knows.

I will close by addressing a comment made by one person – it’s okay to say “I don’t know.”  When I was younger I thought I was pretty smart but now in my waning years, I realize that there is a huge amount I don’t know about a lot of things.  I don’t know why I’m “trans” (which as I’ve noted doesn’t really exist), I just take it that I am and that I can deny it or deal with it. I have elected to deal with it in the best way I can.

When I was younger, I was often told that I was attractive when presenting as a woman.  In fact, I even won a couple of “beauty contests” such as they were. I was blessed with a good physique, a fair complexion, and never really had an Adam’s apple to give me away. But if anyone cared to take a close look they could readily see that my shoulders were a bit too wide and my hips a bit too narrow and my hands a little too big.  As I’ve aged, I am still told that I am attractive from time to time although I’ve noticed that the people telling me that usually are wearing thick glasses! As a younger person, when out and about I would be addressed as “Miss,”or “Ma’am,” or referred to as “she” or “her.” Now that I am older and my voice is no longer capable of being as feminine and my physique is no longer as nice as before, now when out and about about a third of the time I get a “Sir” and referred to as “he” or “him.” Initially that upset me until one day I realized it was me who was being unrealistic. The people addressing me were the ones operating in the reality of the situation. So from that day forward, it does not bother me at all which way I am addressed. However what was it Aretha Franklin said, “R-E-S-P-E-C-T”……I always try to respect other trans-people and address them according to their public presentation. I do believe if others would attempt to do this a good bit of the animus trans-people feel would become a non-issue.

That’s all of my ramblings for now.  Thank you all again for your thoughtful comments.


You may reach out to Anna for questions or comments at: [email protected]