I did some banking yesterday. As I sat and waited to see my banker (joined by an elderly woman who complained to me about the modern age), the video wall told customers about the bank’s close relationship with the LGBTQ+ community. I then noticed the table across the room with the Pride Progress flag and a cup with thematic pens.
My bank’s displays are always quite something. I had, on earlier occasions, remarked upon the four-panel display behind the tellers, which included a photo, taken from the perspective of a person sitting in the backseat, of a black couple returning from snowboarding, putting a plastic sled full of snow into the back of the SUV.
Why would people put a snow-filled sled in their car? That’d be like getting in the car after a day at the beach without washing the sand off your feet. It took another second to understand why: How would I know that the couple had been snowboarding if they had shaken out the snow first?
At any rate, the Pride Progress flag displayed at the bank was notable. The flag symbolizes the inclusive acronym. But the acronym is incoherent, since it attempts to pair gay, lesbian, and bisexual pride with a range of mental and physical disorders, along with a political project, namely Queer, an offshoot of anarchism.
Most customers wouldn’t know that the Pride Progress flag is not the Pride flag. And soon, the Pride Progress flag will be the only flag any of us will know. We will believe that it alone represents Pride. It will replace the Pride flag not only because Pride is scheduled for erasure, but because, if the Pride flag is displayed, the queer community will demand to know why trans people are left out.
“I support the gay, lesbian, and bisexual community.” “Yeah? Well, what about trans people?” I have actually had this conversation.
Well, what about them?
The point of the Pride Progress flag is to make people reflexively conflate two entirely different things: homosexuality and gender identity, the first having to do with romantic attraction, the second with kinks, mental illness, and the politics of transgression.
I avoided the recent Pride celebration in Green Bay because it was festooned with Pride Progress flags. I also worried about harassment had I attended, given my reputation as a notorious transphobe. I am not imagining this, since I have been the subject of harassment by trans activists.
But more troubling than harassment is that the conflation of these things allows queer activists to frame psychological and psychiatric treatment of mental illness as “conversion therapy,” as if it’s the same as treating homosexuality as a mental illness. This not only allows the industry to valorize gender affirming care, but it also hides the fact that puberty blockers, cross-sex hormones, and genital surgery to produce simulated sexual identities are the most obvious forms of conversion therapy in modern medicine. Gender affirming care is actually the medical practice of denying gender. It is a regression to alchemy.
While we wait for the Supreme Court to finish its term (I am especially anxious about the pending birthright citizenship decision), a ruling issued a few months ago is worth noting. The Supreme Court handed down its ruling in Chiles v. Salazar on March 31, 2026.
Following the decision, the Colorado General Assembly passed an updated, viewpoint-neutral law on May 7, 2026, to align its youth protection policies with the Court’s strict speech standards.

Before the Court’s ruling, Colorado and more than twenty other states restricted therapists from trying to change the gender identity of clients under eighteen. Colorado banned what the trans lobby terms “conversion therapy,” thereby attempting to deceive the public into believing that an intervention that treats gender dysphoria as a psychological disorder rather than affirming the concept of gender identity is similar to an intervention that attempts to change sexual orientation.
But gender affirming care is conversion sui generis. Conversion is defined as the process of changing or causing something to change from one form to another. In the case of gender affirming care, the process attempts to change a man into a woman, or vice versa. Conversion therapy in the case of sexual orientation is an attempt to change a gay man or a lesbian into a heterosexual. In this instance, the attempt is to modify a natural disposition with respect to sexual attraction. In the case of gender affirming care, the attempt is to modify a natural body.
Kaley Chiles, a licensed professional counselor in Colorado Springs, filed suit in 2022 over Colorado’s ban on conversion therapy for minors. The Supreme Court on Tuesday sided with Chiles, rejecting a Colorado law that prohibited mental health professionals from denying the construct of gender identity. The Supreme Court’s reasoning was that the law, as applied to talk therapy, represented an “egregious assault” on the First Amendment.
“Colorado may regard its policy as essential to public health and safety,” Justice Neil Gorsuch wrote for the eight justices in agreement. “But the First Amendment stands as a shield against any effort to enforce orthodoxy in thought or speech in this country.”
The lone dissenter was the justice who could not tell Senator Marsha Blackburn during her confirmation hearings what a woman was. “The Constitution does not pose a barrier to reasonable regulation of harmful medical treatments just because substandard care comes via speech instead of a scalpel,” Justice Ketanji Jackson Brown argued. The decision, according to her wisdom, “risks grave harm to Americans’ health and well-being.”
Is it not incongruous for a justice who does not (strategically, to be sure) know what a woman is to pontificate on what constitutes substandard care? What’s harmful in this case is gender affirming care, not a therapist helping a confused child, one with no medical condition, feel comfortable with his body.
The person who feels they’re not what they are, that their self-image is distorted, or their identity is trapped in a body, suffers from a range of disorders, e.g., borderline disorder. One feature of this particular disorder is self-mutilation, such as cutting oneself. The sufferer does this to regulate emotional pain (which is why the underlying cause is often identified as emotional dysregulation), relieve feelings of emptiness or numbness, express distress that feels hard to put into words, or regain a sense of control or reality.
I raise the matter of borderline personality disorder because Borderline Personality Disorder (BPD) and gender dysphoria (GD) often appear together, with studies finding a higher prevalence of BPD traits among transgender and gender-diverse (TGD) populations, often linked to elevated gender minority stress, trauma, or identity confusion. BPD is one of the most common personality disorders found in so-called gender-diverse populations. Studies find that the prevalence of personality disorders in patients with gender dysphoria is as high as 80 percent. Indeed, some research suggests BPD-related identity disturbance overlaps with GD, that is, that GD is not a distinct condition.
When psychiatry constructs a diagnosis, as in the case of gender identity, it calls into existence a reality. When it normalizes the reality it conjures, some will feel they have finally found a stable identity and demand that others affirm it. “I never knew what was wrong,” the thought process goes. “Now I know: I was trapped in the wrong body. I have always been trans.” The individual revises her biography in light of the revelation, blames others for not recognizing her true self all along, and then claims that this is the source of the trauma she experiences. Not only does she now know what she “really” is, but she has somebody to blame for it. And it’s the wrong person.
Typically, a teenage girl (three-quarters of borderline cases are female) who, with the help of her therapist or an online community, “discovers” that she is actually trans, blames her parents and those around them who should have known what was going on, or worse, for denying their real identity because they didn’t want a trans child. This imagined experience leads to family dissolution, the act of going “no contact,” or similar ruptures. Everything in their life is interpreted through the new frame of trans identity. She believes she has found her authentic self. But for how long?
What underpins borderline disorder and other disorders of a similar nature is an unstable identity, the feeling that one’s identity is not aligned with what she sees in the mirror or how other people respond to her. The disorder often comes with body dysmorphia, that is, a perceived distortion of the body.
One sees this in anorexia nervosa and other similar conditions. Unlike anorexia, however, which no doctor would treat using weight-loss drugs or bariatric surgery, properly reserved for those who suffer actual obesity, doctors treat a distorted gender identity using puberty blockers, cross-sex hormones, and surgeries such as phalloplasty.
One can expect pushback when putting the matter like this. Many sociologists will paradoxically argue that treating gender identity as a disorder “medicalizes” the problem. Psychiatry agrees, which is why it dropped GID from the DSM and identified the phenomenon of GD to put in its stead, defining the problem not as misperception of one’s gender, but as the distressed experiences at the perceived incongruence between the subjective sense of gender and the actual gender of the patient.
Extending the logic of this rationalization, referencing the DSM about borderline or other Cluster B personality disorders, delusional thinking, and so forth, would constitute medicalizing, specifically psychiatrizing, the “authentic self.” This is the influence of postmodernist thinking, specifically queer theory, in which psychiatric categories concerning gender are expressions of gender oppression—as if nature itself were an oppressor.
Those who know me—and certainly students who sit through my sociology classes—know that I am a fierce critic of medicalization. One would not be wrong to identify me as anti-psychiatry. I’m a fan of Erving Goffman (Asylums), Thomas Szasz (The Myth of Mental Illness, The Manufacture of Madness), Ivan Illich (Medical Nemesis), and Michel Foucault (Madness and Civilization). I find their arguments compelling. At the same time, I do recognize mental illness. I’ve seen too much of it to believe it’s merely a definition of a situation. This is why I oppose the administration of puberty blockers and hormones and genital surgery—we ought not be subjecting those with mental disorders to the ordeal of overly medicalized bodies.
Even the most ardent critic of psychiatry wouldn’t deny that there are conditions that have a medical basis. These conditions are not constructed by the diagnosis; rather, the diagnosis is determined by a process of abduction from the observation of symptoms. Nobody would deny that schizophrenia is an organic brain disorder, or that bipolar disorder likely has some biological basis.
Any number of other disorders could fit with this understanding. Body dysmorphia itself may result from the brain wrongly mapping the body, at first in an obscure way, then in a specific way once the experience is given a name. If these phenomena are determined to have a physiological basis, then they are properly medicalized. The question then is: what is the appropriate line of care?
The idea that a doctor would surgically alter bodies or give puberty blockers and cross-sex hormones to address the process via the wrong sort of medicalization. It treats an emotional, mental, or personality disorder not only as if it has an organic basis like those other conditions, but as a medical problem that may be treated hormonally or surgically.
Such an intervention would not be ruled out in the case of a teenage boy with gynecomastia, which is the abnormal enlargement of glandular breast tissue in males caused by a hormone imbalance. Intervention in this case is actually gender affirming care, since males normally do not grow breasts. But in the case of gender identity, such interventions constitute gender denying care. They are not treating aberrations but distorting normal bodies. An endocrinologist prescribing leuprolide acetate (Lupron) to a young girl with precocious puberty is not the same as prescribing this drug to a young girl who does not want to experience a phase in the normal development process.
Instead of pursuing psychotherapy to teach an individual how to negotiate the incongruence experienced, as any ethical doctor or therapist would for a distorted body image or dissociative disorder, the doctor working from gender identity is opting for radical medical intervention.
Is trans identification always the result of a psychiatric disorder defined in this way? No. It can be other things. Much of the transgender phenomenon is explained by the problem of social contagion. It’s a fad or a fashion. For others, it’s a fetish or a kink, falling under a different psychiatric classification, namely, a paraphilia, an atypical sexual behavior, or sexual deviation. For those who are genuinely suffering from distress over their bodies, it is a delusion or distorted perception. But in all these cases, the individual is not really the other gender. What they think they are, or what they would like to be, or how they would like others to regard them, does not align with reality.
What has confused the person suffering from GD is this: a definition has been constructed by authorities and, by authority, what is defined is made to seem real. The identity is defined into existence by the words used to describe it—a thing that doesn’t exist. That is a definition of a situation. Sure, an underlying disorder may exist, but the idea of a “brain” or a “soul” trapped in the wrong body is an impossibility.
This is what is known in science as reification, that is, treating a concept or an inventory of attributes or characteristics as if it were a real thing, a thing independent of the mind. But it is ever only conceptual, at best intersubjective, and what it claims to describe does not exist apart from the mind that believes it.
A common justification for gender affirming care is that it will ameliorate symptoms and, therefore, it is an act of compassion. Whatever the individual is suffering from, he is suffering; the intervention helps him manage the suffering. If it works, then the intervention is justified.
This is the source of the language surrounding the phenomenon, that of affirmation and kindness. But affirmation here means validating something a person believes without reason, a perception without evidence. This is not kindness. It’s analogous to telling a person who has cancer that they don’t because knowing one has cancer causes distress. In every other case, that’s not an appropriate thing for a doctor to do. So why this one?
There are other reasons. The person wants to legitimize an identity they believe they are. In this case, it is difficult, if not impossible, to distinguish between the person who truly suffers from gender dysphoria and the person who wants to become the thing they desire. Either way, they want to be this thing, so they need everybody to affirm that they are this thing, and if affirmation is not forthcoming, they experience distress. They believe all their problems will be solved by transitioning, and their certainty of this precludes reason. They need affirmation because they have doubts that they really are the thing. They’re asking everybody to participate in a deception. This expectation is unkind to everyone around them—and society at large.
Another reason is that it generates billions of dollars in revenue for big corporations. The motive of doctors—we should say the medical industry, because it forces doctors to accept this. It’s not an act of compassionate care, but rather a practice that advances the financial interests of powerful medical corporations. These corporations work with psychiatrists, endocrinologists, and others to change definitions to suit their avarice. The disorder is redefined, and the new definition is upheld to advance material interests at the expense of the suffering person. That makes this an instance of institutional malpractice, and we should call it out.
When people ask me why I care about this issue so much, it’s for the same reason I care about corporate crime and medical malpractice, especially when it’s institutionalized. As a criminologist, I research and lecture on these topics all the time. It would be ideological for me to resist making this argument simply because it is politically unpopular. I’ve spent so much time on it because this is a particularly egregious example. This is the greatest medical scandal in my lifetime.
The fact that natural history has produced conscious and social animals doesn’t mean there is an ethereal realm where gender identities wander about untethered from biology. On the contrary, it should dispel such a notion. A mammal is either one or the other gender. A mammal cannot change gender, nor can it be both genders at once (unless it is a true chimera).
Here’s how those who subscribe to gender identity doctrine can know they’re wrong—or at least know that they subscribe to a neoreligion:
When a claim is made about gender, it can either be an empirical claim or an appeal to faith. If it is empirical, then testing the claim involves reference to chromosomes, gametes, and reproductive anatomy. If an article of faith, then by definition, there is no objective way to know or determine its validity. One may hold such a belief, but it’s not a scientific or true fact.
The demand for “affirmation” proves that gender identity doctrine is a neoreligion. If the claim that a man can be a woman were true, it could be demonstrated empirically. But since it cannot, those making the claim demand affirmation of the claim’s truth. “Transwomen are women. Say it! Use the pronouns!” (O’Brien to Winston, “How many fingers am I holding up?”)
The reality is that “gender affirming care” is gender denying harm, since it alters the body to represent a faith-based claim about the self that is contrary to the facts of one’s gender. Gender denying care is a type of conversion therapy. It is deceitful because it claims to make the impossible possible.
The trans body is a simulated gender identity. It can never be the thing it claims to be. True identity is what a thing really is, the thing-itself, and its truth is not determined subjectively or by affirmation or rituals, but by reference to empirical reality. Everything else is an appeal to faith. And faith here is not a stand-in for what we cannot know. A man remains an adult male human, regardless of what he believes about or does to his body.













