Supreme Dysphoria
Just give me that old-time religion
In a 1967 episode of Get Smart, a KAOS agent posing as the beauty contestant Miss Formosa shoots two agents from Transmania. When one of the Transmanians, Dimitri Sokolov, protests that they are all members of KAOS, she declares, "Your brand of KAOS is weak and confused; only in my country is there pure KAOS."
Just as this post goes to press, the Transmanian Supreme Court will hear United States v. Skrmetti. It might take until June 2025 before there is a ruling. At issue is whether Tennessee Senate Bill 1, which prohibits all medical treatments intended to allow “a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex” or to treat “purported discomfort or distress from a discordance between the minor’s sex and asserted identity,” violates the equal protection clause of the 14th Amendment.
The climate for such a case is not auspicious. In late November, South Carolina Republican Nancy Mace introduced a bill barring transgender women from "women's private spaces" across all Transmanian federal property two months before Sarah McBride, the first-ever openly transgender Congresswoman, is sworn in.
It seems likely that soon after January 20th the new Department of Justice will drop its representation of transgender adolescents and their parents in Tennessee faster than Nashville dropped the Dixie Chicks or Miss Formosa dropped her competition.
Before I go farther, let’s clarify the science. We last visited the medical story in our post, The Expectations Barrier in 2022.
Swaab and Garcia-Falgueras determined that the process of sexual differentiation of the brain happens in two distinct phases. You can call the first “biological sex” but the term is misleading. It begins with the mating of sperm and egg and the choice of a sex-determining gene on the Y chromosome (SRY). Eventually, the presence or absence of androgens determines whether or not a penis, prostate and scrotum are formed or a vagina, womb and ovaries. These develop in the sixth week of pregnancy.
The second phase occurs in the developing brain cells of the fetus, beginning nearly five months into the pregnancy. During this period, gender identity (the conviction of belonging to the male or female gender), sexual orientation, cognition, aggression, and other behaviors are programmed by a different set of hormones into the emerging brain cells. Ten to 15 percent of the time, these brain hormones do not match the androgens that programmed the formation of your genitalia.
Even the suggestion of a sex-determinative gene is misleading. None of us are, as my earlier post described, an either/or male or female. We are a hormonal mosaic. Any single individual lies somewhere along a spectrum of male/female-ness. In one of the 83 amicus curae briefs accepted by the Court (including a consolidated brief of 21 states’ attorney generals), Dr. Deanna Adkins MD explained:
The terms “sex designated at birth” or “sex assigned at birth” are more precise than the term “biological sex” because all of the physiological aspects of a person’s sex are not always aligned with each other. For example, some people with intersex characteristics may have chromosomes typically associated with males but genitalia typically associated with females.*
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In the American Psychiatric Association’s Diagnostic & Statistical Manual of Mental Disorders (“DSM V”), “gender dysphoria” is the diagnostic term for the condition where clinically significant distress results from the lack of congruence between a person’s gender identity and the sex they were designated at birth. In order to be diagnosed with gender dysphoria, the incongruence must have persisted for at least six months and be accompanied by clinically significant distress or impairment in social, occupational, or other important areas of functioning. There are two separate diagnoses for gender dysphoria, one for gender dysphoria in childhood and the other for gender dysphoria in adolescence and adulthood.
Being transgender is not itself a mental disorder or a medical condition to be cured. But gender dysphoria is a serious medical condition that, if left untreated, can result in severe anxiety and depression, self-harm, and suicidality.
Before receiving treatment, many individuals with gender dysphoria have high rates of anxiety, depression and suicidal ideation. I have seen in my patients that without appropriate treatment, this distress impacts every aspect of life. When appropriately treated, gender dysphoria can be effectively managed. I currently treat hundreds of transgender patients. All of my patients who have received medical treatment for gender dysphoria have benefitted from clinically appropriate treatment.
[*See Hembree WC, et al. Endocrine treatment of gender-dysphoria/gender incongruent persons: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2017:102: 3869-3903, 3875, (hereafter “Endocrine Guideline”) (“Biological sex, biological male or female: These terms refer to physical aspects of maleness and femaleness. As these may not be in line with each other (e.g., a person with XY chromosomes may have female-appearing genitalia), the terms biological sex and biological male or female are imprecise and should be avoided.”).]
Last month Representative Mace went around to Congressional restroom doors, placing paper signs that say “Biological” above the signs that say “Women.” It could be funny were it not her profession to craft the precise language of laws.
Dr. Adkins, by the time of her amicus, had treated 745 transgender and intersex young people who had been assigned a different set of hormones to their genitalia at birth. While Tennessee has categorically banned medical treatment for transgender adolescents, it is not alone, as many of the amicus briefs described. The Supreme Court hearing arrives after 24 states banned some form or treatment for gender dysphoria, some on penalty of imprisonment, and more bills are pending—550 anti-trans bills were introduced in 2024—with bans on bathroom access, sports, and summer camp. Dr. Atkins is at personal risk of going to prison for what she does.
The American Bar Association told the Court, “Even ignoring the problematic lack of understanding of the relevant science reflected in that purported justification, [the Tennessee law] evidences profound antipathy for autonomy in making personal decisions about procreation.”
Lower courts across the country have looked at the evidence and repeatedly found that the claims about the harms of Atkins-style care do not hold up. Still, appellate courts, stacked with Republican judges over the past 25 years, have ignored advancements in science. The Republican Party used anti-trans ads—“Kamala supports taxpayer-funded sex changes for prisoners. Kamala even supports letting biological men compete against our girls in their sports. Kamala is for they/them. President Trump is for you.”—in the most recent presidential campaign. It worked. Their success has fed the fire that now lights anti-trans torches across the world.
Valuing popular myths over science is not a new phenomenon. Anti-science bias came home with deadly vengeance during the Covid pandemic. In his weekly clinical update on November 29, 2024, Dr. Daniel Griffin recalled:
Griffin: Immunity has really changed the outcomes with Covid-19, and, for most people at this point, this is a combination of vaccination and prior infection—so hybrid immunity for most folks. But unfortunately, here in the US, we now have over 1.2 million individuals with their death attributable to Covid-19 on their death certificate. We're still seeing thousands of people ending up in the hospital each week due to Covid-19. Thousands of deaths and—I don't want to leave this out—we also now have over a million individuals suffering from long Covid here in United States. So with that said, and the fact that getting vaccinated and getting boosted reduces an individual's risk of infection, the need for medical attention, a trip to the ER, hospitalization, death and the post-acute sequellae of long Covid, how are we doing with people getting those boosters here in the US? Right? I mean it must be lines, like you know, people wondering if a new Star Wars Episode came out, right? Everyone wanting to get updated vaccines? Yeah, apparently not.
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I am sort of trying to figure out the disconnect here. And you and I are old enough to remember the 1980s—remember when seat belt laws were being introduced? … what percent of Americans at that time opposed enforcement of seat belt laws? 65%! The majority of Americans [felt] a minority of Americans are forcing this on us… it's uncomfortable, it's cumbersome, it's going to wrinkle my shirt… it’s going to make it difficult to escape a damaged car. … And then the anecdotes, right? “I knew this guy and he was belted in and and he was in a crash and the car was completely mangled and he had bruising across his sternum.”
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Prof. Vincent Racaniello: So it's interesting. This law would never pass today. It definitely wouldn't pass in the next couple of years. And I wouldn't be surprised if it were repealed.
The United States has recently repealed the right to abortion after 50 years. The Supreme Court is set to hear a significant case regarding the level of deference that courts should give to federal agencies' interpretations of the laws they enforce, a principle known as the Chevron Doctrine. If the Court rules as expected, it would prioritize the opinions of law clerks who prepare case summaries for lower court judges over the expertise of career scientists at federal regulatory agencies. Such a decision would have immediate implications for sectors like healthcare, finance, and environmental regulation. Additionally, a concurring opinion by Justice Thomas in Dobbs v. Jackson (2022) suggested that the ruling in Lawrence v. Texas (2003), which invalidated sodomy laws nationwide and affirmed the right to privacy in consensual intimate conduct, should be re-examined. Justice Thomas invited appellants to bring forth such a case.
“People who disagree with Tennessee’s law can advocate for a different law through the democratic process,” opined Tennessee Attorney General Jonathan Skrmetti, who is defending the transgender ban today. “While the federal government is free to favor its transition-first, ask-questions-later approach, the Constitution does not bind Tennessee to that same choice.”
In the opinion of many, this is a case about States’ Rights. Transgender children find themselves thrust into a civil war well beyond their small, mosaic persons. But theirs’ is a problem we are all facing—fact versus fiction. We don’t have to wonder about some future Metaverse. We are already in it.
Meanwhile, let’s end these wars. We support peace in the West Bank and Gaza and the efforts to bring an immediate cessation to the war. Global Village Institute’s Peace Thru Permaculture initiative has sponsored the Green Kibbutz network in Israel and the Marda Permaculture Farm in the West Bank for over 30 years and will continue to do so, with your assistance. We aid Ukrainian families seeking refuge in ecovillages and permaculture farms along the Green Road and work to heal collective trauma everywhere through the Pocket Project. You can read all about it on the Global Village Institute website (GVIx.org). Thank you for your support.
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#RestorationGeneration.
當人類被關在籠内，地球持續美好，所以，給我們的教訓是:
人類毫不重要，空氣，土壤，天空和流水没有你們依然美好。
所以當你們走出籠子的時候，請記得你們是地球的客人，不是主人。
When humans are locked in a cage, the earth continues to be beautiful. Therefore, the lesson for us is: Human beings are not important. The air, soil, sky and water are still beautiful without you. So, when you step out of the cage, please remember that you are guests of the Earth, not its hosts.
We have a complete solution. We can restore whales to the ocean and bison to the plains. We can recover all the great old-growth forests. We possess the knowledge and tools to rebuild savannah and wetland ecosystems. It is not too late. All of these great works are recoverable. We can have a human population sized to harmonize, not destabilize. We can have an atmosphere that heats and cools just the right amount, is easy on our lungs and sweet to our nostrils with the scent of ten thousand flowers. All of that beckons. All of that is within reach.