A Florida law banning gender-affirming health care for transgender minors and restricting access to care for certain adults is unconstitutional, a federal judge ruled today. The decision by US District Court Judge Robert Hinkle permanently blocks a law supported by Republican state lawmakers and Florida Governor Ron DeSantis, as well as rules adopted by the state’s medical boards in 2022 that prevent minors from accessing treatments such as puberty blockers and hormones. According to Brooke Migdon writing for the The Hill, “Gender-affirming health care for transgender adults and minors is considered medically necessary by every major medical organization, though not every trans person chooses to medically transition or has access to care.”
Hinkle, a Clinton appointee, who temporarily blocked enforcement of the law last June, added that the law was motivated by state lawmakers’ “anti-transgender animus” and a “deeply flawed, bias-driven” report from Florida’s Agency for Health Care Administration that determined gender-affirming care for minors is experimental and should be excluded from Medicaid coverage. Florida’s medical boards, for their part, “imposed requirements that have no medical justification and were plainly intended to prevent or impede patients from receiving gender-affirming care,” Hinkle wrote.
Clearly Hinkle is all in on the atrocities being perpetrated by the medical-industrial complex. “Transgender opponents are of course free to hold their beliefs,” he continued. “But they are not free to discriminate against transgender individuals just for being transgender,” Hinkle wrote in Tuesday’s ruling. “In time, discrimination against transgender individuals will diminish, just as racism and misogyny have diminished. To paraphrase a civil-rights advocate from an earlier time, the arc of the moral universe is long, but it bends toward justice.”
“In the meantime, the federal courts have a role to play in upholding the Constitution and laws,” Hinkle wrote. “The State of Florida can regulate as needed but cannot flatly deny transgender individuals safe and effective medical treatment—treatment with medications routinely provided to others with the state’s full approval so long as the purpose is not to support the patient’s transgender identity.”
I had planned another essay for today’s blog, but when this came across my screen, I pulled up another essay I had been working on a few days ago because it bears on the matter of how we should think about the abdication of child safeguarding by government officials in deference to the associations that have grown up around corporate medicine. It is bizarre for a judge to find in the Constitution a right for the medical corporation to drastically alter human bodies through drugs, hormones, and surgeries—alterations that have no medical necessity beyond the one that associations grown up around the industry defined into existence. Comparing the protectors of children to racists and misogynists—especially when trans ideology is itself an expression of misogyny—is not merely bizarre but contemptible. This is not a judge but an ideologue. A very dangerous ideologue. (see my recent essay The Persistence of Medical Atrocities: Lobotomy, Nazi Doctors, and Gender Affirming Care.)
Females have an expectation that there will be spaces where they don’t have to be around males. But not just females have this expectation. There is almost universal agreement that males should not be in female sports, changing rooms, locker rooms, bath rooms, rape crisis centers, domestic violence shelters, prisons, or any other facility or opportunity segregated by gender. There are reasons sex segregation exists (see my latest, Decoding Progressive Newspeak: Equity and the Doctrine of Inclusion), and recognition of these is why there is no movement to dismantle sex segregation across a range of activities, opportunities, and spaces. Yet, if a man says he is a woman, then he is treated as such and permitted to participate in those activities, take advantage of those opportunities, and enter those spaces as if he really were woman. “Transwomen are women” is the incantation uttered to manifest the doctrine of transubstantiation in the neo-religion of gender ideology, which tragically enjoys sway beyond the confines of the ideology.
In addition to the general problem of faith-based belief in a rational secular society, there is the special problem of determining whether a charm works or not. Of course charms don’t work. Nevertheless, given how widespread faith belief is among human populations, it’s a useful exercise to work through illusion to expose the absurdity of magical thinking or, more charitably put, the problem of the nonfalsifiable claim or proposition.
Suppose a man who says he is a woman and uses that identity to access women’s spaces because he finds being around naked women sexually arousing, or because doing the things women do is sexually arousing (a pathology Ray Blanchard identifies as “autogynephilia”), or because he knows women are vulnerable in those spaces and he’s a predator. It’s also possible that he is a misogynist, participating in women’s sports out of a strong desire to humiliate women. Now suppose another man who says he is a woman because he really believes he is, and, for the sake of argument, let’s suppose that matters. He wants access to women’s spaces because he feels vulnerable in male spaces. After all, the reason men aren’t allowed into women’s spaces is because women are vulnerable and, according to doctrine, he is one.
The special problem is that the trans woman is indistinguishable from the predatory man or the misogynist. Deceptive mimicry deceives self or others either way, of course, but there is no check to see if the spell worked (this is the same problem with prayer). We have an individual’s claim of an identity, and people who say they believe him, and moreover say that this is enough for them to prevent others from refusing him access to activities, opportunities, and spaces exclusive to women. However, it’s absurd to suppose that a person’s identity is whatever he thinks of himself, since people identify as many things, and the only identity we usually and should accept is what the person really is.
It is just as absurd to suppose that others can affirm his identity based solely on what he thinks of himself. A white woman who claims to be black cannot expect others to affirm her blackness—absent some ancestry contrary to her phenotypic traits, which she would have to in any case explain. Indeed, the appeal to ancestry in claims-making would have to be verifiable in some way (there are many ways to do this). Thus all this is made all the more absurd in light of the fact that all the objective indicators of a man’s gender falsify the claim that he is the other gender. As it turns out, the spell doesn’t work because there is no such thing as magic. Gender incongruence is an illusion.
Sexologists in the second half of the twentieth century believed they could solve the problem of subjectivity by inventing a psychological concept they termed “gender identity.” In other words, by doubling down. Many psychological conditions are disorders are subjective like this. Gender identity is conceptualized as a person’s deeply held or innate sense of their gender. This admits that there is no objective test that can confirm the motive for men identifying as women, while at the same time represents an attempt to cloak that fact in an appeal to the popular acceptance of subjectivity or imagined entities (like the soul).
One might object (and many do) that a psychiatrist, an expert in his field (a medical doctor with psychiatric residency), relying on diagnostic criteria developed by other psychiatrists, has made an expert determination; but, since gender identity is entirely subjective, a feeling, which no behaviors to infer a latent variable (say the way one would with instinct), the diagnosis is only an interpretation based on what the man tells the doctor. The doctor has only determined that the man says he is a woman, a determination that requires no expertise. It is of the same quality as the man who claims he was abducted by aliens (which is, at least, a possibility).
Nonfalsifiability not withstanding, deploying professional and movement jargon, psychiatrists conjure a thing called “gender identity,” which is said to potentially differ from the “gender/sex assigned at birth.” Incongruence lies at the heart of the dysphoria, the theory holds. To relieve this distress, the medical industry has developed gender-affirming therapy (GAC), which includes medical interventions like hormone therapy and surgeries.
Traditionally, access to these interventions has required a psychiatric consultation. Although referral to a gender clinic is almost certainly guaranteed, there is a growing movement to sidestep the psychiatrist and go straight to the endocrinologist and surgeon. Since movement ideology holds that gender identity is not a psychiatric disorder, but a normal way of being, trans activists argue that there should be no gatekeepers to GAC. It doesn’t matter what a psychiatrist says; gender identity, an article of faith, need not be validated in any scientific or medical way (because it can’t). A person who says he is a woman is a woman. That’s good enough. Yet movement doctrine bears a remarkable similarity to the psychiatric theory and those who seek metamorphosis will need doctors to become butterflies.
It will help to understand this by summarizing the traditional approach to accessing what the industry calls gender-affirming care and contrast it with what the trans activist demand. The model necessitating psychiatric evaluation or referral from a mental health professional rests on three pillars: (1) clinical assessment to ensure the individual is experiencing gender dysphoria, thus validating the need for medical intervention (putting aside for the moment the history of this crackpot theory); (2) mental health support to help individuals navigate the complexities of their gender identity and the transition process (which, for the most part, is a rationalization for referral to a gender clinic); (3) informed consent to ensure that individuals are fully aware of the implications and risks associated with medical interventions. This last point remains a part of the emerging model that rejects the previous requirements; with the historic devolution of medical ethics (the lessons of Nuremberg fading), informed consent is a mere formality and so there no bottleneck.
Emphasizing bodily autonomy, activists argue that transgender individuals have the right to make decisions about their bodies without unnecessary barriers. Gatekeeping creates significant barriers to care, such as long wait times, limited availability of knowledgeable providers, and additional costs, which can exacerbate dysphoria and negatively impact mental health. What is being asserted here is that individuals should have access to medicine without having to demonstrate condition or disease. According to movement ideology, citing the World Health Organization’s ICD-11, which has reclassified “gender incongruence” from a mental disorder to a condition related to sexual health, psychiatric evaluation before accessing a radical medical progress is unnecessary. A variation on the claim is that the requirement for psychiatric evaluation contributes to the stigmatization of transgender individuals, implying that their identities are inherently pathological.
In response to movement politics, various professional organizations, including the World Professional Association for Transgender Health (WPATH), have updated their guidelines to reflect what practitioners consider a more flexible approach (it’s difficult to disentangle how much WPATH bends to the movement or represents the movement). WPATH’s Standards of Care emphasize informed consent and the importance of individualized care, while recognizing that not all transgender individuals require or benefit from extensive psychiatric evaluations before accessing gender-affirming treatments.
The appeal to WPATH Standards of Care is odd. If psychiatric definitions don’t matter when asserting something, then they shouldn’t matter when denying something. (The appeal to WPATH is odd for other reasons. For more on this, see Fear and Loathing in the Village of Chamounix: Monstrosity and the Deceits of Trans Joy; The Gender Hoax and the Betrayal of Children by the Adults in Their Lives; Since it is Not Possible to Change the Soul, the Body Must be Changed—Manifestations of Clerical Fascism; Anti-Minotaur: Reclaiming The Truth of Gender From the Labyrinth of Lies.)
The argument concerning bodily autonomy is fallacious. Bodily autonomy involves the right to make decisions about one’s own body without external coercion. This includes choosing to accept or refuse medical treatments, like drugs, surgeries, or vaccines, and deciding who can touch or interact with one’s body and under what circumstances. Bodily autonomy does not give a person the right to demand others provide him with drugs and perform surgeries on him. Forcing someone to take a medication against their will is a violation of bodily autonomy and is generally considered unethical and often illegal. This is a very different matter than asking somebody to perform unwarranted medical treatments almost certain to result in harm to the individual making the ask.
When it comes to the desire to be harmed, even with consent, those who carry out the harm may be liable for the harm caused. We might consider that this would be true for medical procedures without medical necessity, something that I am coming to. But if associations are erected to define standards of care justifying medical procedures by defining into existence a medical necessity. I want to begin, however, with an example different enough but of the same genre to make obvious the general principle, the example of persons seeking pain for pleasure. I hope the reason for this become clear when I come more specifically to the question of medical ethics.
There are scenarios where individuals seek out pain consensually, such as in certain BDSM practices, where both parties agree to the interaction with full knowledge of the potential harm. At the same time, there are cases where a desire for harm might indicate underlying psychological issues. The same problem emerges here as we saw with gender identity: it is impossible to differentiate between the two. One might consider that anybody who wishes to be beaten, cut, or tortured is mentally disordered and therefore anybody who beats, cuts, or tortures them is guilty of harming a vulnerable person. But even if the person is not disordered, there is still an ethical question as to whether a person should be permitted to harm them. To be sure, there are potential harms people undertake in tradeoffs concerning benefits, such as in a surgery to remove a brain tumor. But is deriving sexual pleasure from being beaten a reasonable benefit allowing harm?
The person one asks to harm him has his own moral and ethical responsibilities. Many ethical frameworks emphasize the duty to avoid causing harm to others, a principle often reflected in professional codes, such as those for medical practitioners who adhere to the principle of “do no harm.” Ensuring informed consent is crucial in scenarios governed by the principle of voluntary participation, meaning that the person requesting harm must fully understand the implications and consequences. Even with consent, some acts of harm might be illegal or unethical, posing legal and moral risks to the person performing the act. While a person might desire harm for various reasons, the person he asks to harm him must consider the ethical implications, including the potential for lasting damage, legal consequences, and transgression of personal ethical standards. Bodily autonomy allows an individual to make decisions about his body; it doesn’t necessarily impose a moral obligation on others to comply with requests that might harm him. The balance between consent and ethical responsibility is crucial in these discussions.
It is true that there are domains of medical treatment that do not require the presence of disorder or disease. Gender affirming care is necessarily one of them since, as I argued earlier, there is no evidence of a disorder or a disease, beyond the person possibly actually believing they are not the gender they are (again, which can not actually be determined).
Cosmetic or plastic surgery is another area where individuals seek surgical procedures without having a medical condition. While obesity is conceivably a medical condition, old and ugly aren’t, except in the case of ugly if there is a deformity society stigmatizes, what Erving Goffman calls “abominations of the body” in his book 1966 Stigma: Notes on the Management of Spoiled Identity. Procedures such as breast augmentation, liposuction, facelifts, and rhinoplasty are typically performed to enhance appearance rather than to treat a medical issue. Patients usually undergo these surgeries based on personal desires and informed consent rather than a medical diagnosis. However, cosmetic surgery is not a benign practice. While such surgery may provide psychological benefits, such as increased confidence and self-esteem, there are problems with the practice.
One major concern in cosmetic surgery is the physical risks and complications associated with any surgical intervention, including infection, scarring, anesthesia complications, and unsatisfactory results that may necessitate further surgeries. Beyond the physical risks, the psychological impacts of cosmetic surgery can be mixed. While some individuals report enhanced satisfaction and self-esteem post-surgery, others face disappointment, depression, or exacerbation of body dysmorphic disorder if the results do not align with their expectations. The pursuit of physical perfection can lead to a cycle of dissatisfaction and repeated surgeries, impacting mental health and financial stability. An addiction may result in which the person routinely seeks out procedures, or the seeking of such procedures indicates an addiction.
If the reader is wondering about my position on cosmetic surgery, I am not not sure it should be allowed except in the case of deformity and disfigurement, such as in the cases of disorders of sexual development or reconstructive surgery following a mastectomy or a car accident. Societal pressures and unrealistic beauty standards drive individuals to seek such procedures electively. Some seek cosmetic surgery from insecurity. Others from vanity. Whatever the motivation, these surgeries perpetuate harmful norms and body image issues—norms pushed by the culture industry. Ethically and morally, we have to question the appropriateness of medical professionals exploiting insecurities.
What of authenticity? Altering one’s appearance through surgery undermines the acceptance of natural, diverse forms of beauty. There are ethical concerns regarding the commercialization of beauty and the manipulation of vulnerable people to conform to certain aesthetic standards by seeking surgeons who are allowed by the system to exploit their insecurities for profit. We know that commercialization perpetuates unrealistic and narrow beauty ideals, contributing to widespread body image issues. Additionally, the trend towards cosmetic surgery can contribute to the medicalization of normal aging and natural bodily variations, promoting the idea that these should be corrected rather than accepted.
Stepping back, is cosmetic surgery really distinct from gender affirming care? Cosmetic surgery and GAC share numerous procedural similarities. Both involve surgical interventions aimed at altering physical appearance, often utilizing techniques such as breast augmentation, facial contouring, and liposuction. Surgeons employ skills, technologies, and recovery protocols common to both domains. The major difference, the activist and practitioner will tell us, concerns the underlying motivation and patient experience. Cosmetic surgery aims to enhance or modify aesthetic features for personal or social reasons, driven by a desire to meet certain beauty standards or achieve a specific look. Gender-affirming care, on the other hand, is fundamentally about aligning an individual’s physical characteristics with their gender identity (assumed to be a real thing), thus addressing psychological and emotional well-being alongside physical transformation. This type of care is touted as critical to the individual’s mental health and overall quality of life, reflecting a deeply rooted need for congruence between one’s body and gender identity.
All this strikes me as a distinction without a difference (which is expected in light of the fallacious distinction made between gender and sex in this domain). Even the matter of motivation seems the same in both cases. Phalloplasty, vaginoplasty, mastectomy, when performed for non-medical reasons, all represent forms of radical cosmetic surgery in which the person seeks to correct what they wrongly believe is a mistake of nature or to present themselves to others as something they are not. Cosmetic surgery apart from some medical need aids in the practice of deceptive mimicry, where the person seeks a simulation to either deceive themselves or deceive others.
Circumcision, which I am certainly opposed to absent some medical condition, is another relevant example. This involves the surgical removal of the foreskin of the penis, and is performed for various cultural, religious, and medical reasons. One primary critique of circumcision, particularly when performed on infants or young children, is the lack of consent. This raises significant ethical concerns about bodily autonomy and the rights of individuals to make decisions about their own bodies. Cultural and religious pressures often drive the practice of circumcision, leading individuals to feel pressured to conform to these practices without considering their personal preferences or beliefs. (For more on bodily autonomy and medical freedom see Thomas Szasz, Medical Freedom, and the Tyranny of Gender Ideology.)
Critics argue that the circumcision is not medically necessary for most individuals and that the risks may outweigh the benefits. Circumcision can be painful and traumatic, especially for infants who cannot understand or cope with the pain. Even with anesthesia, there are concerns about the immediate and long-term psychological impact of the procedure. As with any surgical intervention, circumcision carries risks, including infection, excessive bleeding, and potential damage to the penis, which can have lasting effects on health and well-being. Circumcision can reduce sexual pleasure and sensitivity due to the removal of the foreskin, which contains a significant number of nerve endings.
Gender affirming care is highly similar to circumcision in all these regards. When done for religious reasons, circumcision not only alters the genitalia, but also marks the child as a member of a faith he did not choose for himself. Chemicals and surgeries in the context of GAC mark the subject as a member of a tribe, the “transgender community” (The Body as Primary Commodity: The Techno-Religious Cult of Transgenderism). Surgeries carry risks, including infection, excessive bleeding, and damage the body, which carries lasting effects on health and well-being. Circumcision can reduce sexual pleasure and sensitivity due to the removal of the foreskin, which contains a significant number of nerve endings. The practice of circumcision, particularly when performed on minors, raises ethical questions about human rights and the protection of children’s bodily integrity. I discussed this matter in my previous essay, The Persistence of Medical Atrocities: Lobotomy, Nazi Doctors, and Gender Affirming Care.
The normalization of circumcision is profitable for the medical industry. Therefore, the industry has found ways of promoting a medically unnecessary and potentially harmful practice. If a circumcised penis is portrayed as standard and normal, it encourages more parents to opt for it, thus generating revenue for healthcare providers and related industries (for example, the cosmetic industry). The construct “uncircumcised penis” thus implies that being intact is an aberrant state that deviates from the norm. This is paired with claims about hygiene and social acceptance. The foreskin is an organ with evolutionary functions, including protective and sensory roles. Since the foreskin has these functions, it should not be viewed as an anomaly, a deficiency, or an optional part of the body. Instead, it should be considered the natural and normal state. Given this we should use terms that reflect the natural and intact state of the foreskin.
A shift in terminology would help reshape perceptions, recognizing the foreskin’s natural and functional role in human anatomy. The construct “cisgender” functions the same way. Just as “uncircumcised” implies that being intact is an abnormal state, reinforcing the idea that circumcision is the norm, thus normalizing circumcision and perpetuating its practice, “cisgender” reinforces the notion that gender is not necessary the default or normative state. The term suggests that being transgender is equally standard, thus normalizing gender-affirming care and making the typical alignment of gender identity with assigned sex seem less typical, not normative. It thus disrupts the ordinary in ways that make alterations of the natural state desirable. The normalizes transgender identities by framing them as one of the many possible states of being, rather than a disorder. This language helps to make gender-affirming care more accepted as a valid and necessary medical practice.
Both cosmetic surgery and circumcision involve altering the body, often without a direct medical necessity. The critiques of both practices highlight concerns about consent, potential risks, cultural pressures, and ethical considerations. While cosmetic surgery is typically sought by adults for aesthetic reasons, circumcision is typically performed on infants or children, raising additional issues about autonomy and rights. But even in the case of cosmetic surgery in adulthood, the surgeon still has a moral obligation to not perform procedures where there is no compelling medical reason to do so. It is not only that a person who feels the desire to alter themselves to fit stereotypes is suffering from a delusion or the victim of cultural and peer pressure, but that the physician is ethically obligated to do not harm and not take advantage of individuals.
All of this applies to gender affirming care. The judge put ideology above principle and reason. Gender affirming care for minors should be banned except in the case of disorders of sexual development. Moreover, the practice of GAC on adults has to be openly examined, unconstrained by a language of bigotry calculated to prevent honest discussion of radical medical intervention for an alleged condition that does not enjoy the evidence necessary to justify the practice. For those who read this and wish to provide the list of medical associations that the judge alluded to, know that I have no faith in corporate medicine or any other corporate bureaucracy. That there are associations that shill for and attempt to legitimize corporate bureaucracies has never helped me find that faith and never will.
freedom and reason 