Former psychiatrist in chief at Johns Hopkins Hospital, Dr. Paul McHugh, recently penned a poignant opinion piece in the Wall Street Journal titled “Transgender Surgery Isn’t the Solution.” John Hopkins was the first medical center to perform sex-reassignment surgery in the 1960s, but based on evidence that such surgeries did not help transgendered people, they ceased performing the surgeries. In light of the recent push to normalize transgenderism, Dr. McHugh has sounded the medical alarm to warn us that in our efforts to help these people we may be having the opposite effect.
I will quote his piece at length:
[P]olicy makers and the media are doing no favors either to the public or the transgendered by treating their confusions as a right in need of defending rather than as a mental disorder that deserves understanding, treatment and prevention. This intensely felt sense of being transgendered constitutes a mental disorder in two respects. The first is that the idea of sex misalignment is simply mistaken—it does not correspond with physical reality. The second is that it can lead to grim psychological outcomes.
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For the transgendered, this argument holds that one’s feeling of “gender” is a conscious, subjective sense that, being in one’s mind, cannot be questioned by others. … Psychiatrists obviously must challenge the solipsistic concept that what is in the mind cannot be questioned.
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You won’t hear it from those championing transgender equality, but controlled and follow-up studies reveal fundamental problems with this movement. When children who reported transgender feelings were tracked without medical or surgical treatment at both Vanderbilt University and London’s Portman Clinic, 70%-80% of them spontaneously lost those feelings. Some 25% did have persisting feelings; what differentiates those individuals remains to be discerned.We at Johns Hopkins University—which in the 1960s was the first American medical center to venture into “sex-reassignment surgery”—launched a study in the 1970s comparing the outcomes of transgendered people who had the surgery with the outcomes of those who did not. Most of the surgically treated patients described themselves as “satisfied” by the results, but their subsequent psycho-social adjustments were no better than those who didn’t have the surgery. And so at Hopkins we stopped doing sex-reassignment surgery, since producing a “satisfied” but still troubled patient seemed an inadequate reason for surgically amputating normal organs.
It now appears that our long-ago decision was a wise one. A 2011 study at the Karolinska Institute in Sweden produced the most illuminating results yet regarding the transgendered, evidence that should give advocates pause. The long-term study—up to 30 years—followed 324 people who had sex-reassignment surgery. The study revealed that beginning about 10 years after having the surgery, the transgendered began to experience increasing mental difficulties. Most shockingly, their suicide mortality rose almost 20-fold above the comparable nontransgender population. This disturbing result has as yet no explanation but probably reflects the growing sense of isolation reported by the aging transgendered after surgery. The high suicide rate certainly challenges the surgery prescription.
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Then there is the subgroup of very young, often prepubescent children who notice distinct sex roles in the culture and, exploring how they fit in, begin imitating the opposite sex. Misguided doctors at medical centers including Boston’s Children’s Hospital have begun trying to treat this behavior by administering puberty-delaying hormones to render later sex-change surgeries less onerous—even though the drugs stunt the children’s growth and risk causing sterility. Given that close to 80% of such children would abandon their confusion and grow naturally into adult life if untreated, these medical interventions come close to child abuse. A better way to help these children: with devoted parenting.At the heart of the problem is confusion over the nature of the transgendered. “Sex change” is biologically impossible. People who undergo sex-reassignment surgery do not change from men to women or vice versa. Rather, they become feminized men or masculinized women. Claiming that this is civil-rights matter and encouraging surgical intervention is in reality to collaborate with and promote a mental disorder.
July 23, 2014 at 5:00 am
Almost no one is suggesting reassignment for young children, which is the only piece of real data he is presenting here. Yes, it needs to be discussed, but the situation with children is well understood and presented in the DSM.
The Karolinska Institute study is not applicable here. In the Swedish study they were not comparing a group transgendered persons randomly assigned to sex-reassignment to those who were not provided the surgery. Instead, this group was compared to a group from the general population. Since these people never had the issues related to gender dysphoria this tells us nothing about how gender reassignment impacts those who wanted it. The authors, in fact, conclude that gender dysphoria is relieved by surgery, but that additional psychological follow-up should be added.
Dr. McHugh seems to have a simplistic, almost religious view of gender and sex which are much more complicated than he presents. Not only is it not true that everyone is genetically male or female, but it is very possible to be genetically one sex and have physical characteristics of another, due often to conditions that occur during gestation but after conception. Most commonly what you see is a brain that has developed in one way while the most of the rest of the body develops another (although some key characteristics may be identifiable). If the brains mapping for one’s body is different from the body one is born with then a problem will arise, and if these persists after puberty the best solution we now have is to adjust the body to match the brain. There is not currently an alternative.
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July 24, 2014 at 5:17 am
eyeontheuniverse “There is not currently an alternative”. I beg to differ. The alternative is to view the condition as a mental illness and treat it accordingly.
There is obviously something wrong with people who think they are in the wrong gendered body. Since it is impossible to perform a “sex-change”, and thereby correct the body, it would be more prudent to offer psychological help. After all, the article claims that many people are in a phase anyway.
If the body is perfectly fine, then I would contest that it is the mind that is in error. A lot of people will not like this concept though as it paves a logical slippery slope to the fact that homosexual attitudes could also be deemed a mental illness (as it was in the 50s).
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July 24, 2014 at 6:07 am
Yes, there is something wrong with people whose brains don’t map to their bodies. But the question is which to change. Is the brain more “real” or the body? More importantly, which one *can* we change effectively?
Certainly, many people may only be having a temporary experience that resolves as they age. Time in a particular body can help make some post-birth structural modifications. Some relearning of regions is possible. But this is almost always seen only in children, and has not been successful in adults. So yes, you can certainly see if you can match a child’s brain to his or her body for a while, but this does not always work.
When a person reaches their mid to late teens, and certainly once they are in adulthood, the ship has pretty much sailed. Even with time and effort not everyone can get the brain to match the body (this applies to issues with arms and legs as well…sometimes the brain can be trained, sometimes not). In those cases you make the body match the brain, and the results, as the study you yourself cite recognize, have been quite successful in improving quality of life.
Homosexuality is a different matter when you talk mental illness, and this rests simply on the meaning of mental disorder (the dsm does not use the word “illness”…just a technicality). A disorder must be something that causes distress or disability (or endanger certain other states…see the DSM). It cannot be simply an abnormality, or such things as high IQs or any new evolutionary mutation would be a disorder. If a person is unhappy with his or her sexuality it becomes a disorder and then would be treated (again there are two choices here, and I have no desire to enter that controversy at this time).
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July 25, 2014 at 7:57 pm
Trouble is parents will come in contact with mental health professionals that will re-enforce the child’s belief they are in the wrong body and sex-reassignment surgery is the solution to the problem. These professionals will recommend hormone therapy should begin before puberty in boys before masculine features develop for best possible physical outcome. This will set the child on track for surgery whether or not it is the best course of treatment. Some may adjust others may not and then not the therapy but society will be blamed. Then of course it’s we have to be more tolerant and understanding as the surgeries increase. This could turn out to be a real catastrophe and we should proceed with extreme caution.
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August 5, 2014 at 8:13 am
Jason:
You claim that: “John Hopkins was the first medical center to perform sex-reassignment surgery in the 1960s, but ……………..based on evidence that such surgeries did not help transgendered people, they ceased performing the surgeries……………..”
It seems to me that your broad brush that John Hopkins: “…….ceased performing sex-reassignment surgery” is rather misleading because it was in fact the decision, not of John Hopkins Hospital, but “In 1979, in his capacity as chair of the Department of Psychiatry, McHugh ended gender assignment surgery at Johns Hopkins Hospital.” SOURCE: ( Richard P. Fitzgibbons, M.D., Philip M. Sutton, and Dale O’Leary, The Psychopathology of “Sex Reassignment” Surgery, Assessing Its Medical, Psychological, and Ethical Appropriateness, The National Catholic Bioethics Quarterly, Spring 2009, p. 100.)
Furthermore McHugh generally opposes sexual reassignment surgery for both children and adults. But this is no different than the position of many religious people.
In addition, Paul McHugh is a practicing Catholic. ….. “who describes himself as religiously orthodox, politically liberal and culturally conservative — a “believer” in marriage and the Marines, a supporter of institutions and family values.” AND “believes” that adult males who wish to surgically alter themselves to appear anatomically female fall into two main groups: (1) “conflicted and guilt-ridden homosexual men” and (2) “heterosexual (and some bisexual) males who found intense sexual arousal in cross-dressing as females”.
I would remind everybody that conflicted and guilt-ridden homosexual men are generally conflicted and guilt-ridden-reinforced by religious societies which have forced homosexual men into closets, on pain of death, since the year dot and that are still current conditions faced by the Gay Community in many countries around the world.
McHugh’s reasons against sex-reassignment surgery follow along a myopic religiously skewed mind and are summed up thusly: First, “they [the transgendered individuals] were little changed in their psychological condition. They had much the same problems with relationships, work, and emotions as before. The hope that they would emerge now from their emotional difficulties to flourish psychologically had not been fulfilled”. Second, they expressed little interest in and seemed indifferent to babies or children (typically female interests). Third, they came off as caricatures of the opposite sex.
Can anyone imagine that a traumatized child since birth, through puberty and into adulthood would be expected to change overnight with the healing of a few sutures? immediately change? After surgery I submit, the intense feelings of societal shame continued to exist in the psyche as the severe trauma since childhood….I also submit that homosexual men would not have been encouraged to play with babies; i.e. dolls and girly things so it is not too far fetched to imagine that forms part of their continued trauma and thirdly when you stifle the spirit of the child they would necessarily need to play act in a caricature way not having had the normal opportunity to grow into their orientation as the rest of us have had.
McHugh’s theoretical orientation has led him to take controversial stands on a number of current psychiatric/medical issues including post traumatic stress disorder but PTSD is an accepted phenomena. From this McHugh concludes that the concept of PTSD has moved the mental health field away from, rather than towards a better understanding of the natural psychological responses to trauma. Instead McHugh “believes” this condition can be treated as before; that is, that this development should be diagnosed as officially presumed to exist in acute, chronic, delayed, complex, subdromal, and even “masked” forms and not PTSD as we understand it today.!
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August 13, 2014 at 7:41 pm
Jason,
Thanks for posting this! I had not seen it. Very interesting. I appreciate Dr. McHugh’s willingness to speak out on the issue.
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August 14, 2014 at 9:17 am
CHad:
“Dr McHugh’s “willingness” to speak out on the issue”…….is hardly anything new. He has been speaking out against homosexuality as a behavorial issue solvable by anything but surgery. McHugh does not believe that homosexuality is a gestational issue or a genetic issue. McHugh’s religious bent is what guides his observations and he believes that homosexuality is merely a life-style-choice. McHugh’s willingness to speak against homosexuality thusly from the darkness of religion, is a disservice to humanity whose only supporters are themselves so religiously inclined.
McHugh is so old-school; his religious position is so obviously warped; he has been speaking from the darkness of a religious belief system since 1975, almost 40 years and as the commentary in Post # 5 notes he, using his position of authority as Chair of the Psychiatry Department at John Hopkins, ended gender assignment surgery at the Hospital.
Belief will lead you in darkness until you gain the truth of knowledge for it is only truth that can set you free from the tyranny of belief system darkness. You will never find light in darkness because darkness is the absence of the light and it is only the truth of knowledge that Jesus challenges us: “Ask, and it (knowledge) will be given to you; seek, and you will find (knowledge); knock, and it (knowledge) will be opened to you. 8 For everyone who asks receives (knowledge), and he who seeks finds (knowledge), and to him who knocks it (knowledge) will be opened. Knowledge, not Belief! There is no truth in belief; your belief must lead you to knowledge, then you will be set free but belief cannot do that for never and never. And I respectfully submit these are the words from the teachings of Jesus.
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June 4, 2015 at 5:44 pm
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