One time I sent a trans woman friend out to get me some menstrual supplies, and she brought back the wrong thing. By the point I realized, we were out on a boat. I cracked a joke about the whole situation, and had to immediately apologize for hurting my friend’s feelings. This annoyed me, though I was not annoyed at my friend. Society had been so completely shitty to her that I couldn’t crack one well-timed, fairly witty joke about being different kinds of women without hurting the hell out of her, which is insanely stupid. Women constantly crack jokes about the differences between women, and there’s something around 3.5 billion different kinds of women alive today. But society has so wildly abused trans people that my friend can’t get in on this rich vein of girl humor. I’m sick of this, and I need people to get a grip on how vicious and ignorant their behavior is.

Nothing about transsexuality is magical or strange, sinful, or even complicated. At this point in medical practice and human history, transsexuality is best understood as a disorder of the endocrine system of the human body, and not even a particularly complicated or esoteric one.

Your endocrine system is the term for the complicated interplay of glands that control signaling and growth around your body, using hormones instead of nerves. It interfaces with the nervous system at points, and some body chemicals, like norepinephrine and dopamine, are considered both hormones and neurotransmitters depending on where and how the body is using them. Diseases of the endocrine system can cause all kinds of crazy body effects: they can make you short, thin, fat, tall, nervous. They can make men lactate and women grow beards. They can cause intersex disorders. Anything the endocrine system controls is subject to the diseases and disorders of the endocrine system.

The endocrine system directs the body to develop in a male or female-sexed way, responding in part to genetics, but mostly as an epigenetic phenomenon. In some people, the brain and mind just aren’t going along with what the endocrine system is doing. For people without a very strong mental gender, this probably doesn’t matter much. I suspect there’s a lot more of these people than anyone realizes. For people with a strong mental gender that matches what the endocrine system is doing, it definitely doesn’t matter. For people with a strong mental gender and and an endocrine system that mapped their body another way, well, that’s the definition of a disorder or disease. In this case, the medical community refers to this as “gender dysphoria.”

Like nearly all other conditions, probably the vast majority of instances of transsexuality don’t rise to the level of needing medical treatment or public intervention. You can get a bit hypomanic sometimes without having bipolar disorder or be a handwashing neat freak without having OCD — the disorder comes, by definition, when it’s starting to harm your life. The idea of a medical problem is defined by the need for medical intervention. Transsexual or gender dysphoric patients are not pathological people, any more than appendicitis, or cancer, or asthma defines you or makes you pathological. It just makes you in need of medical help to manage your body.

Unlike those other things, transsexuality can’t be detected in a CAT scan. But in fact, most disorders can’t be. Think of things like neuropathic pain, phantom limb syndrome, or epilepsy. There might be nothing wrong in a tissue-trauma sense, but no one with a shred of compassion would tell someone who lives in constant, searing pain that it’s all in their head and therefore it doesn’t matter. Pain is literally all in your head, all the time. It can’t be perceived anywhere else.

So, for transsexuality to be a disorder, there has to be some degree of discomfort between the mind’s sense of gender and how the endocrine system is playing out in the body. When seeking to treat such a phenomenon, you might assume treating the mind is easier than treating the body. Let’s say that’s fine, whatever, what we want here is the trans person to be out of pain. Except as it turns out, no one knows how to change mental gender, and it’s not for lack of trying. In general trying too hard to alter the mind of someone in the power of a medical or governmental system has proven to be not only ineffective, but horrible.

That’s the horrible mistake people have made with gender dysphoria as well, sometimes going so far as to torture children to death in an attempt to violently alter the gender of their minds.

Many transfolk would have wanted to change their minds, if it were so easy. If there was a drug or therapy that adjusted mental gender, many transfolk would opt for it in a heartbeat. Not all, but many would avoid the social censure, breaks from family, and constant prejudice they face for having this endocrine disorder. Even cis people would be flocking to such a drug, based on all the successful marketing on being more of a man or more of a woman. Often transfolk have long painful stories of believing, as so many people in the public do, that mental gender is easier to treat than the endocrine system. The truth is, we’ve known of this disorder for thousands of years, and we’ve gotten nowhere trying to force an adjustment on mental gender.

The next medically responsible place to turn, therefore, is that pesky endocrine system.

The endocrine system is by no means a spotless operator. Some of the most common and terrible diseases in the world are endocrine diseases, such as diabetes and Addison’s. The sexual endocrine system seems just as error prone as the rest of it. I’m not sure why a system that causes puberty problems, infertility in both sexes, chronic pain, sexual dysfunction in both sexes, and even reoccurring tumors, would suddenly be considered a flawless determiner of gender. So if someone is experiencing a level of transsexuality that requires medical support, society should give them that medical support. I have no idea why this concept is so difficult for people.

How do we know someone is experiencing this endocrine problem? Like the vast majority of diagnosed illnesses, we know because they tell us. Even when your doctor tells you what you have, it’s often based on what you told them. I support what I call the Really Really test for transsexuality, which goes something like this:

“Do you really want to transition?”

“Really.”

“Really really?”

“Really really.”

“Well, ok then. Here’s how it works…”

(An aside: I do support the idea of a psych evaluation pre-transition, but this is because I support the idea of a psych eval before plastic surgery, having children, going to college, or possibly going on a long vacation. I think the idea of everyone getting supportive psych evals at least as often as general checkups or pap smears would make for a better society in general. We’ve worked out colds and flus aren’t caused by sin and demons, it would be nice if we could work out the same about bouts of minor depression, hypomania, and other things that derail our lives for seemingly no reason.)

The nice part of this story is that treating an endocrine disorder is relatively easy compared to treating a mind or brain problem. When the endocrine system isn’t releasing the right hormones we can often just take them as medicine and get on with our lives. This is what we do with Synthroid when we have a crappy thyroid gland, or insulin if we have Type 1 Diabetes. So it follows in many cases of gender dysphoria, we can at least start to fix it by administering the correct hormones, and giving those people support in managing their bodies, like we would any people with a chronic mismatch of interbody systems.

At least, until people without this disorder start freaking out about trans people’s junk. This is honest-to-god all that’s going on here: a group of people with an endocrine disorder, who may or may not get plastic surgery for it, dealing with almost everyone else in society freaking out thinking about their genitals. (Some of the surgeries can help with the medicine dosing and outcomes, so they’re not all strictly plastic surgery, but those are patient-doctor details which I rightly don’t care about as they are none of my business.)

So here’s my suggestion, fellow cis people: stop obsessing over the genitals of people with a particular endocrine disorder. That’s all you’re doing! Picking out a disease and poking and prodding people who have it, sometimes until they kill themselves. It’s horrible, and it’s amazingly tacky. It’s up there with cancer shaming and making fun of kids with Down’s Syndrome. Seriously, stop it.

Sometimes the brain doesn't match the endocrine system. People can take hormones to correct this, and live a normal life. Stop imagining them naked.

If you’re really stuck on wanting to treat this disorder by making the mind match the endocrine system, please by all means, devote your life to that science. Study neurology, and its link to psychology. We have so much we need to learn before we can get to the detailed depth of human gender and sex. At that level of understanding, I’d wager we could cure diseases like Schizophrenia, Bipolar, Depression. We could intercede for people with low intelligence, lack of creativity, Sociopathy, and PTSD. Go for it, all humanity would thank you for advancing our species. But until we have that level of understanding, let these men and women live their lives in a little damn peace.