In every debate over transgender identity, there is always discussion of “evidence,” and it tends to revolve around complex statistics, randomized controlled trials, or medical consensus.
Before considering any of this, however, we should ask ourselves: Does any of this make sense? On the most basic level, does the medical intervention proposed make sense for the pathology identified?
We doctors ask ourselves this simple question every single time we treat a patient. It becomes so thoroughly embedded in our decision-making that it becomes instinctual.
To illustrate, consider a woman who comes into my clinic with a breast lump that has been rapidly growing over the last few months. An ultrasound and mammogram show the mass has features suspicious for cancer. A biopsy is obtained, which confirms the suspicion. I inform this patient that she has breast cancer and that there is a high risk of metastasis to other organs.
I propose something that makes sense for the clinical situation—a physical intervention (i.e., mastectomy) for a physical pathology (i.e., breast cancer). I explain the rationale to the patient so she can provide her informed consent—if it makes sense to her, too, she will consent.
Consider another situation.
A patient comes into my clinic and tells me she has chronic migraines and believes a bilateral mastectomy could solve her problem. A physical exam doesn’t reveal any breast masses, and imaging doesn’t show any suspicious lesions.
Would it make sense for me to surgically remove this patient’s breasts? Of course not.
But what if I affirmed the patient’s belief and performed a mastectomy anyway? What if I told her that, based on my expert opinion, surgery to remove her breasts could successfully cure her migraines? Even if I went over all of the risks of the procedure, could this still be considered a valid informed consent?
You don’t need an advanced medical degree to answer this question. It’s intuitive. Informed consent is not valid if the doctor egregiously misinforms his patient about the nature of the pathology and the intervention being used for treatment.
These examples illustrate two core principles in medicine: applicability and proportionality. Does the intervention apply to the problem (applicability), and are the risks proportional to the net benefit (proportionality)?
In the first example, the answer is yes to both—a mastectomy is an applicable treatment for breast cancer, and removing the cancer is more beneficial to the patient because the risks of metastasis are greater than the risks of surgery.
Consider the applicability and proportionality in the second example. Is a mastectomy (a physical solution) applicable for chronic migraines (a neurological problem)? On both accounts, the answer is no. The proportional risk of surgery is greater than the benefit because, in fact, there is no benefit—the patient’s migraines would remain the same.
At this point, you should see how the question—does any of this make sense?—is quite simple. It’s the universal question in healthcare. Doctors ask themselves this question before offering a treatment, and patients ask themselves the same thing when deciding whether they will accept.
This is the question that underlies every advancement in modern medicine. It was this basic question that led surgeons to correctly perceive arterial blockages as an issue of plumbing and develop strategies to bypass blockages with other vessels. It was what allowed oncologists to identify the key characteristic underlying cancer—uncontrolled cellular reproduction—and develop treatment protocols that specifically targeted these cells.
This simple question is critically important to good medicine because it requires reliance on objective evidence of real biological phenomena. This question is what compels doctors to treat patients based on what they see and what they can prove. Doctors must ask themselves whether a certain treatment makes a patient healthier or sicker—and the only evidence they can rely on is in front of them.
Instead of relying on institutional dogma to inform decisions, the patients themselves become the highest priority. This question serves as the foundation for good medicine and the mechanism of accountability for bad medicine. It separates good doctors who heal from bad doctors who harm.
For generations, this was the true “evidence” in medicine.
Unfortunately, many medical specialties have abandoned this principle in favor of institutional dogma. Among these, doctors specializing in transgender medicine and “gender affirming care” stand out from the rest. They are a radical outlier among the medical profession’s long, sordid history of radical outliers.
All you have to do is ask yourself—does any of it make sense?
Consider their central claim—gender dysphoria is the psychological distress that results from the incongruence between an individual’s “gender identity” and their “sex assigned at birth.” These doctors propose that the only way to treat gender dysphoria is with powerful medical and surgical interventions.
To the rational mind, the problems are obvious. First, the phrase “sex assigned at birth” is biologically incoherent. Sex is not “assigned”; it is a biological reality objectively determined at conception. There is no decision or assignment made, merely an observation of fact.
Second, “gender identity”—which they define as an individual’s internal sense of belonging to a certain gender—is logically incoherent. This definition lacks any meaning. The word to be defined (gender) is the object of the definition. As a result, “gender identity” becomes everything and nothing at all, both permanent and transient. The patient, not the doctor, becomes the sole arbiter of what it means. The doctor’s role is not to observe, investigate, and treat, but rather the singular act of affirmation.
Just imagine what this “affirmation” approach would look like if I began employing it in my own practice.
Consider a young, healthy woman who came to my clinic and insisted she had breast cancer. Although there was no objective evidence to support the claim, the patient believes it to be true.
According to the logic underlying “gender affirming care,” the patient is the sole arbiter of biological reality—if she believes she has breast cancer, then she has breast cancer. My role as the doctor would be to simply affirm this belief and treat her as if she did have breast cancer. A bilateral mastectomy (radical excision of a patient’s breast tissue) would not only be justified but celebrated. This would, of course, be followed by chemotherapy and radiation.
To truly appreciate how far these transgender doctors have gone, consider that although this example is absurd, it is magnitudes more reasonable than what is proposed by “gender affirming care.” In the previous example, the patient’s misperception is limited to a single, somewhat elusive, facet of reality (i.e., a cancerous clump of cells in their breast) while the primary perceptions remain intact (i.e., name, sex, age, etc.).
In transgender medicine, the patients are compelled to deny the unchangeable characteristics that govern their existence, the key features that determine how they function in human society. The most salient traits that make a person who they are, are those which they have to claim are not real. Every single person in their life is pressured to comply with this same, radical denial, while any resistance, even from complete strangers, introduces the risk of personal existential dissolution.
And this pathological state, rooted in deception and narcissism, is endorsed by these doctors as standard medicine—nothing to see here. Of course, something so absurd requires relentless attacks and vitriol directed at anyone who refuses to participate in the charade.
In comparison, the young woman who believes she has breast cancer seems like the paragon of psychological stability.
How is it possible then that these doctors justify the highly predictable and irreversible risks of these powerful medical and surgical interventions? Unlike the example from the beginning, where I described a patient with breast cancer—which can be observed, palpated, imaged, and biopsied—”gender identity” is something that is unobservable and immeasurable. How can they even begin to have a conversation about applicability and proportionality when they can’t even define gender identity?
Does any of it make sense so far?
Of course not. And you don’t need to consult an expert in the field of gender medicine to know why.
The Rise of Anti-Medicine
There is an internal logic that governs human physiology, and doctors must recognize that these laws exist beyond our control. The doctor’s role is to understand these mechanisms and to use that knowledge to restore (treat) natural function (health) when there is dysfunction (disease). From this Aristotelian perspective, we can define health as the proper functioning of natural physiological mechanisms required for human survival and flourishing.
Medical treatment is, therefore, the means to a single end—the restoration of health. There is no other end than this—medicine is meant to restore natural physiology, not to transform it. This makes intuitive sense—taking something in its natural, properly functioning state and changing it in a material way to move it away from its natural state is the very definition of disease.
The practice known as “gender affirming care” is not merely a deviation from the restorative logic of health but rather its antithesis. Their goal is not to restore health but rather to transform it and therefore destroy it. This is not just bad medicine; it is anti-medicine.
These practitioners deny the existence of basic biology and appoint themselves the writers of a new set of laws. But these laws are different, as can be seen with gender identity—it becomes an intangible phantom. So ephemeral is the concept of gender identity that these doctors have given up the pretense of objective diagnostic evaluation and instead outsource the effort of thought to their vulnerable patients.
If a patient claims they are transgender, then they are. No matter the presence of red flags indicating social contagion or laundry lists of comorbid mental health conditions, the party line is the same—transgender transformation, no barriers, no restrictions. This is the new law of medicine—as simple as that.
And unlike breast cancer, or any other medical problems for that matter, which are treated to restore natural function, these doctors pursue the opposite with reckless abandonment. Their patients’ healthy physiology is what they claim to be pathological, their essential nature a mistake, their original name nothing more than a “dead name.” What they seek is not the restoration of natural physiology but transformation into a new transgender state.
It is worth taking a moment to consider how truly sinister all of this is. Not only are they taking healthy children and polluting their bodies, but they are also poisoning their minds into believing that self-hatred is self-love.
You have to wonder what could be the root cause behind something so vicious. Have these doctors become so blinded by ideology that they are no longer aware of the damage they are inflicting? Or is it money that drives them? Could it be something more banal—average people lacking in moral fortitude, causing them to passively follow the tide of expert opinion?
Does the answer even matter? Probably not. The question is worth asking, but I also believe the answer is irrelevant since there is no way for us to know with any meaningful reliability. More importantly, though, the consequences are the same regardless of whatever is motivating them. These doctors’ underlying belief system has caused them to become unmoored from the biological reality governing their profession.
This can be appreciated by the fact that there are no boundaries to constrain the term transgender. It is a wide umbrella—a single answer meant to cover an array of complex problems like mental illness, social contagion, etc., and normal behaviors like youthful tendencies for self-exploration. The former go unaddressed, and the latter become pathologized. Real problems are ignored while new problems are introduced.
Despite their natural manipulative abilities, there is an unavoidable problem that cannot be fixed with euphemisms or intimidation. Just like everyone else, these doctors are forever bound by the laws that govern biological reality, namely, the real effects these interventions will have on their patients. No matter what they do, their patients will suffer the consequences of these radical interventions.
They know that at some point, their patients will ask, Does any of this make sense? An answer to this question is critical since the predictable misery from life-long commitment to medication and surgery has to somehow be justified.
To tip the scales in their favor, they need to present a risk of non-intervention that can offset the severe risks of intervention. These are the risks from blockers, hormones, and surgery, which include irreversible physical changes, infertility, surgical complications, etc. Put another way, they must present an even worse alternative for patients who decide against pursuing the “gender affirming” pathway.
But how could a doctor make something so illogical seem logical? What could a doctor possibly say to a mother and father that would compel them to forsake their child’s birth name, accept the miracle of their conception as a mistake, and enthusiastically pursue their child’s destruction?
Do you want a living son or a dead daughter?
In a sick, twisted way, these doctors—whose practice is based on the denial of logic—came up with the most logical answer to this predicament. The only thing more terrifying than suffering the long-term consequences of blockers, hormones, and surgery is the possibility of descending so deeply into despair that you take your own life.
This pressure tactic works especially well for family members since the threat carries an unstated, yet unavoidable conclusion—they would be the ones who are most likely to bear witness to such a grave outcome. They not only lose the person they love but will also carry the mental images of the gruesome act. The doctor’s threat—living son or dead daughter—makes sure those haunting images would serve as permanent reminders of the family’s guilt and the doctor’s virtue—if only the family listened, their loved one would still be alive.
To appreciate the psychological effect of this blackmail, consider a recent quote from Prisha Mosley, a prominent detransitioner. “When a medical professional weaponizes fear, the patient is stripped of their ability to freely choose. Convincing a vulnerable person that they need to transition in order not to die negates consent.”
When a doctor threatens an already terrified patient with their own suicide, the risks of anything else pale in comparison. With the right amount of fear, a doctor can get a patient to agree to pretty much anything. What makes this blackmail even more treacherous is the fact that it’s complete fiction.
Silencing the Medical Field
At this point, it is reasonable to ask how something so blatantly unethical could be accepted by the medical profession.
Average people simply assumed there had to be some legitimacy to the practice since all of the major medical organizations unanimously supported it. And if this was as bad as the critics said, wouldn’t other doctors speak up against it?
To go back to the central question—does any of this make sense?
I believe it makes perfect sense when you consider the drastic changes to the culture of American medicine over the last few decades.
Just like every other institution in American society, the medical profession fell prey to the erosive effects of left-wing radicalism. Meritocracy was abandoned for race and sex-based preferences. A culture that valued open debate was replaced with groupthink supremacy. Ethics that centered on the inherent dignity of human life were replaced with dignity through identity.
The changes taking place in American medicine were the same ones happening in society at large.
These slow, linear trends turned exponential in March 2020 with the emergence of COVID. It was the first time we were able to see what happens when radical ideologies become the dominating force in the medical profession. And although the transgender ideology had been growing and integrating within American institutions for decades, I believe the changes in the post-COVID era provided the fertile soil for it to emerge with its full, hideous strength.
But to truly make sense of how this happened, you have to zoom in on the characters—just like you can’t understand COVID without knowing the role of Anthony Fauci, you can’t understand this issue without understanding the role of WPATH.
The World Professional Association of Transgender Health (WPATH) is an organization that has been around for decades and progressively grown along with the institutionalization of left-wing radicalism. It became the preeminent professional medical society responsible for anything “transgender,” in the same way the American Urological Association is responsible for anything that has to do with urology. WPATH’s guidelines were known as “Standards of Care” (SOC).
The Department of Health and Human Services released a 409-page report in May 2025 titled Treatment of Gender Dysphoria: Review of Evidence and Best Practices. The HHS Report, as I will refer to it, tells the story behind WPATH’s most recent clinical practice guidelines, Standards of Care-8 (SOC-8), released in June 2022.
The HHS Report shares an insider perspective since it relies on WPATH’s internal communications that were made public as a result of evidence being unsealed in Alabama’s case defending their ban on the practice.
If you’re able to make it through the whole report, you can’t help but be overwhelmed by the sheer scale of the evidence implicating WPATH.
You can read the emails from leading WPATH members that show them aggressively censoring dissenting opinions, concealing scientific data that challenged their conclusions, and intimidating partnering academic institutions, like Johns Hopkins, to help cover up the evidence of wrongdoing.
You can see the emails where Admiral Rachel Levine, the crossdressing Biden regime apparatchik, successfully exerts pressure on WPATH leadership to alter their pediatric guidelines solely on the basis of politics. In an email from July 2022, a WPATH member writes:
“…her (Admiral Levine) biggest concern is the section below in the Adolescent Chapter that lists specific minimum ages for treatment; she is confident, based on the rhetoric she is hearing in DC, and from what we have already seen, that these specific listings of ages, under 18, will result in devastating legislation for trans care.”
The gravity of this cannot be overstated—Levine used his influence to alter WPATH’s pediatric medical guidelines, not because he believed this would make children healthier. Rather, Levine advocated for the removal of age minimums in WPATH’s SOC-8 solely on the basis of politics. WPATH complied with Levine’s demand, and the age minimums were removed before the final publication of SOC-8.
This is the organization responsible for publishing the clinical guidelines for every single doctor providing “gender affirming care” in America.
You can also see the documents describing WPATH’s decision to suppress the systematic evidence reviews commissioned from Johns Hopkins. These reviews found “little to no evidence” supporting the efficacy of their medical interventions. Rather than publishing data that contradicted their preferred narrative, WPATH decided to bury it.
To be clear, it’s not that WPATH didn’t like what the evidence showed—it’s that there wasn’t any evidence at all. Johns Hopkins could not find support for WPATH’s claim that their interventions led to better mental health outcomes in children.
In fact, all of the signals pointed in the opposite direction—more harm, not less. WPATH knew this and decided to hide the evidence anyway.
The HHS Report also addresses the fundamental question I posed earlier—does the suicide narrative make sense?
It doesn’t. The report meticulously dissects the claim that blocking puberty or cross-sex hormones reduces suicide risk in minors, revealing it to be completely unfounded. The evidence shows no relationship between gender affirming interventions and suicide reduction. If anything, the data suggests the opposite.
One study frequently cited by transgender advocates is from Jack Turban, an activist researcher at the University of California, San Francisco. Turban claimed that puberty blockers reduced suicidal ideation in transgender youth. But when you actually look at the study, the effect disappears entirely once you control for family support. In other words, having a supportive family matters—experimental medical interventions do not.
Even worse, Turban’s study showed that cross-sex hormones were associated with increased rates of suicidal ideation compared to those who did not receive them, a finding he conveniently downplayed in his conclusions.
The HHS Report also examined the most comprehensive systematic reviews available, including the Cass Review commissioned by the UK’s National Health Service. These reviews consistently found no reliable evidence that “gender affirming care” reduces suicide risk in minors. In fact, some studies suggest these interventions may increase psychological distress.
This shouldn’t be surprising. We’re talking about interventions that:
– Render children permanently infertile
– Prevent normal sexual development and function
– Require lifelong medicalization
– Result in numerous complications requiring additional surgeries
– Create a permanent medical dependency
How could these possibly improve mental health outcomes?
The answer is they don’t. The suicide narrative is a lie used to coerce frightened parents into consenting to the destruction of their children’s bodies.
This brings us back to the central question: Does any of this make sense?
The transgender medical establishment has created an entire industry based on:
- An incoherent definition of the pathology (gender identity)
- Interventions that don’t apply to any real biological problem
- Risks that are catastrophically disproportionate to any supposed benefit
- A complete absence of evidence supporting their claims
- Systematic suppression of evidence contradicting their narrative
- Coercion of patients through false suicide threats
This isn’t just bad medicine. It’s fraud on an industrial scale.
The International Retreat
While American medical institutions continue to embrace transgender ideology, the rest of the developed world has begun a dramatic reversal.
Sweden, once a pioneer in pediatric gender medicine, now restricts these interventions to research settings only. Finland issued new guidelines in 2020 emphasizing psychotherapy over medical intervention. The United Kingdom, after the Cass Review, banned puberty blockers for minors outside of research trials. Norway has similarly restricted access to these treatments for children.
These countries didn’t make these changes because of political pressure from conservatives. They made them because the evidence—or rather, the complete lack of evidence—forced them to confront reality.
The Cass Review, in particular, is devastating to the transgender medical establishment. Dr. Hilary Cass, a pediatrician with decades of experience in the UK’s National Health Service, spent four years conducting the most comprehensive review of evidence ever undertaken on pediatric gender medicine.
Her conclusions were unequivocal: the evidence base is “remarkably weak.” The studies cited to justify these interventions are of “poor quality” and suffer from numerous methodological flaws. There is no good evidence that medical transition improves long-term mental health outcomes in children.
Dr. Cass found that many children referred to gender clinics had complex mental health needs that were being ignored in favor of rushing them toward medical transition. The clinics were operating under an “unquestioning affirmation” model that failed to properly assess whether gender dysphoria was the primary issue or a symptom of other underlying problems.
Most damning, Dr. Cass found that follow-up data on patients was virtually non-existent. Clinics were putting children on irreversible medical pathways without any systematic way of knowing what happened to them years later. This is medical malpractice on a massive scale.
The American Exception
So why does America stand alone in continuing to embrace these discredited practices?
The answer lies in the unique nature of American medical institutions and their susceptibility to ideological capture.
In most countries, healthcare is more centralized, with government agencies playing a direct role in regulating medical practice. When the evidence base collapsed, these centralized systems could respond relatively quickly.
In America, medical practice is more diffuse, governed by a complex web of professional associations, hospital systems, insurance companies, and state medical boards. This diffusion creates multiple points of ideological capture and makes coordinated change more difficult.
More importantly, American medicine has become thoroughly politicized. Major medical associations like the American Academy of Pediatrics, the Endocrine Society, and the American Psychological Association have issued policy statements strongly endorsing “gender affirming care.” These statements are treated as authoritative by hospitals, insurance companies, and state medical boards.
Retracting these statements would require admitting they were wrong—not just scientifically incorrect, but catastrophically, harmfully wrong. The reputational and legal liability would be enormous. So instead, these organizations double down, circling the wagons to protect themselves rather than protecting patients.
The financial incentives also play a role. As documented elsewhere in this volume, transgender medicine has become a multi-billion-dollar industry. Hospitals have opened specialized gender clinics, pharmaceutical companies profit from lifelong hormone prescriptions, and surgeons charge tens of thousands of dollars for procedures that must be repeated multiple times as complications arise.
This creates a powerful constituency resistant to change, even as the evidence base crumbles.
What Comes Next
The current situation is unsustainable. As more children are harmed, as more detransitioners come forward, as the international consensus shifts away from these practices, American medicine will eventually be forced to reckon with what it has done.
The question is how much damage will be done in the meantime.
Every day that passes, more children are placed on puberty blockers. More teenagers receive cross-sex hormones. More young adults undergo irreversible surgeries. The scale of the harm grows larger.
Those of us who have tried to sound the alarm have faced professional retaliation, social ostracism, and in some cases, criminal prosecution. I have faced federal charges for the “crime” of exposing that Texas Children’s Hospital continued to perform these procedures on minors after publicly claiming they had stopped.
The message is clear: do not question the orthodoxy. Do not expose the truth. Do not prioritize children’s welfare over ideological commitments.
But the truth cannot be suppressed forever. Eventually, the edifice will collapse under the weight of its own contradictions.
When that happens, there will be a reckoning. The doctors who performed these procedures, the hospital administrators who enabled them, the professional associations that endorsed them, the journalists who promoted them, and the politicians who mandated them will all face questions they cannot answer.
Why did you do this? Didn’t you know the evidence didn’t support these interventions? Didn’t you see the children being harmed? How could you participate in something so obviously destructive?
The answer, I fear, will be the same answer given after every medical atrocity: we were just following the guidelines. We were just doing what everyone else was doing. We thought we were helping.
But that answer won’t be good enough. Not for the thousands of children who were sterilized. Not for the detransitioners living with permanent damage to their bodies. Not for the parents who were coerced into consenting to their children’s destruction.
The time for accountability is coming. The only question is whether we can minimize the harm in the meantime by telling the truth, loudly and repeatedly, until enough people are willing to listen.
Does any of this make sense?
No. It never did.
And deep down, everyone involved knows it.