“Dr. McHugh is an accomplished medical professional completely devoted to the health of his patients. Liberal attacks on him are disgusting.” That’s how Ryan T. Anderson, Heritage Foundation Senior Fellow and Public Discourse Editor, defended Paul McHugh on Wednesday morning, after publishing another of the doctor’s scathing rejections of transgender identities. Conservatives champion McHugh as an expert on transgender identities, but his antiquated rhetoric and biased rejection of what transgender people experience set him drastically apart from the consensus of psychiatrists and the standards of care that best support transgender people’s health.
McHugh, the University Distinguished Service Professor of Psychiatry at Johns Hopkins Medical School, writes this week that the very idea of transgender identities — the acceptance that a person’s gender identity might not be congruent with the sex they were assigned at birth — is a “meme,” a myth that has spread across society. He frames it as the idea “that one’s biological sex is a choice” and that gender is “more of a disposition or feeling about yourself than a fact of nature.”
His column, which suggests that this meme is a “pathogen” destroying society, is rife with his biased rejection of what transgender people experience. He uses quotation marks to refer to people’s names, like “Christine” Jorgenson (one of the first trans women to undergo sex reassignment surgery), “Jan” Morris (a Welsh historian), and “Renee” Richards (the famous tennis player). He doesn’t even mention the word “Caitlyn” as he repeatedly refers to Jenner by male pronouns and his previous name. McHugh, acknowledging he’s never even met Jenner, proceeds to unprofessionally diagnose her with “autogynephilia,” the notion that transgender women are disordered — that the nature of their identities is that they are “sexually aroused by the image of themselves as women.” Autogynephilia depends on the assumption that crossdressing is a disorder and ignores the concept of gender identity entirely.
Even when speaking of gender dysphoria, the intentionally nondisordered term for diagnosing and treating transgender people, McHugh insists that trans people should still be treated as disordered, like people with anorexia nervosa. “Its treatment should not be directed at the body as with surgery and hormones,” he writes, “any more than one treats obesity-fearing anorexic patients with liposuction. The treatment should strive to correct the false, problematic nature of the assumption and to resolve the psychosocial conflicts provoking it.”
McHugh specifically states that “no evidence supports the claim that people such as Bruce Jenner [sic] have a biological source for their transgender assumptions. Plenty of evidence demonstrates that with him [sic] and most others, transgendering is a psychological rather than a biological matter.” To make this claim, McHugh must ignore at least fifteen studies that have found exactly that kind of evidence showing a biological origin for transgender identities.
The reason for this distortion may be McHugh’s clear intention to not only reject the mental health of transgender people, but to also counterract the meme of acceptance with one of stigma and rejection. “The idea that one’s sex is fluid and a matter open to choice,” he concludes, “is doing much damage to families, adolescents, and children and should be confronted as an opinion without biological foundation wherever it emerges.”
McHugh ends by setting up the very kind of defensive posture utilized by Anderson and other conservatives seeking to prop up his unscientific views. “But gird your loins if you would confront this matter,” he warns. “Hell hath no fury like a vested interest masquerading as a moral principle.”
But the masquerade is McHugh’s. His approach to transgender support — and his general antipathy to the entire LGBT community — has already been widely debunked. For example, he regularly claims that surgery does not support the mental health of transgender people, but he does so by citing a study comparing people who had surgery to people who weren’t even transgender. He also claims that transgender people are simply persuaded by culture that changing their body will solve their other psycho-social problems, which ignores the fact that many transgender people never undergo such surgeries.
For this to even make sense, McHugh must ignore the notion that people who are transgender have psycho-social problems not because they are transgender, but because of how they are tormented by society because they are transgender. A large 2011 study found that transgender people are subject to rampant discrimination, poverty, harassment, and violence because they are transgender. A new study from Canada similarly found high rates of suicide attempts among transgender people, but specifically found that those suicide attempt rates significantly declined when trans people were supported by their parents, when they were able to update their legal documents to match their gender, when they endured less trans-based hate, and when they were able to transition their bodies to match their identities. In other words, McHugh has it totally backwards; it is affirming transgender people’s gender identities and supporting their traditions that helps them do best in society.
And of course, that’s what mainstream medicine says too. That’s why the World Professional Association for Transgender Health (WPATH) in no way resembles or reflects any of McHugh’s assertions. The WPATH standards of care guide medical professionals across the globe as they help transgender people through their transitions.
For social conservatives, however, Paul McHugh represents a distinguished “medical professional.” “He’s a giant,” Anderson boasts. Even though he is one of the only doctors willing to endorse their rejection of transgender people, they still take his word over the consensus of doctors who have helped thousands of transgender people live happier, healthier lives.