Gender dysphoria (transgenderism)formerly known as gender identity disorderwas once considered a mental illness. Today, the conditionand how individuals and society react to itis a prominent civil rights issue, the “T” in LGBT.



The current standard of care for people with gender dysphoria begins with nonjudgmentally accepting the reality of the patient believingknowingthat he was “assigned” (in the parlance) the wrong body at birth. Then, the patient is treated for any underlying anxiety or depression. He or she may also receive gender reassignment treatments, such as hormone therapy and/or sex change surgery. Dysphoric children may be prescribed puberty blockers to prevent their bodies from developing secondary sex characteristics, which can facilitate more-successful future gender reassignment.

In recent years, advocates for transgender rights have arguedsuccessfully, in some casesthat public and private health insurance systems should pay the costs of these interventions. San Francisco’s employee and public health systems pay for gender dysphoria treatments, for example. So does Medicaid in some states, most recently added as a benefit in Oregon. Medicare also pays for senior citizens to receive reassignment surgery. The convicted felon in the NSA/Edward Snowden scandalformerly known as Bradley Manning, but now called Chelseahas sued the Department of Defense seeking a court order that her gender dysphoria be treated as she serves time at Leavenworth. I have no doubt that Obamacare regulations will one day require that all private insurance carriers cover treatments for gender dysphoria.

Meanwhile, California has passed a law requiring that dysphoric school children be allowed to use the bathrooms and locker roomsas well as join the sports teamsof the gender they believe themselves to be. Similar laws and ordinances are being proposed and passed around the country.

To be frank, at age sixty-five, I don’t fully understand the cultural dynamics driving these startling social transitions. People want to be fulfilled and lead happy lives as “themselves.” Very well. But I also worry that once we accept the premise that we have a fundamental right to be physically remade to comport with how we feel about ourselvesand to have society act in accordancewe will have crossed a cultural Rubicon, leading to extreme outcomes.

Take the anguishing conditionoften compared to gender dysphoriaknown as body integrity identity disorder (BIID). People who suffer from BIID are convincedthey knowthat they inhabit wrongly intact bodies, that their real and true identities are as amputees or even as paraplegics or quadriplegics.

Over the last ten years, arguments have increased in medical and bioethical journals for permitting the amputation of healthy limbs as a treatment for BIIDand for many of the same reasons that treatment of gender dysphoria can now include surgical alteration. A 2009 article published in the journal Neuroethics argued:

When faced with a patient requesting the amputation of a healthy limb, clinicians should make a careful diagnostic assessment. If the patient is found to have body integrity identity disorder, amputation of the healthy limb may be appropriate after a trial of selective serotonin reuptake inhibitors and after careful consideration of the risks, benefits, and unknowns of all possible treatment alternatives. . . . Sufferers of BIID might be relieved to know that members of the medical profession will take their concerns seriously, and that, after careful deliberation, elective amputation of their troubling limb is a real possibility.

Amputations are not yet part of the clinical armamentarium for treating BIID, and such surgeries are not being performed except by the occasional rogue doctor. Maybe that is why almost all of these suffering people struggle successfully through life without chopping off their offending body parts. But if we one day legitimize BIID amputations, it will become increasingly difficult for sufferers to resist the gravitational pull of having themselves surgically disabled.

And why would that be the end of it? What if a person knows that his true self is part animal, a meme sometimes seen in transhumanism advocacy? (Transhumanism is a futuristic social movement that demands a right to use technology to recreate ourselves into a “post-human” species.) Could we someday see medical procedures developed to accommodate these and similar desires?

The current controversies surrounding gender dysphoria seem to be leading toward the establishment of a fundamental right to (let’s call it) personal recreationism. I understand why many see this as the most humane and liberating course. But nothing happens in a vacuum. Once that principle is accepted, there will be no limits.

Wesley J. Smith is a senior fellow at the Discovery Institute’s Center on Human Exceptionalism and a consultant for the Patients Rights Council.

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