Harm, in gender's name

It is plainly wrong to pathologise the natural puberty and sexual development of adolescence

Photo by Olivia Hibbins on Unsplash

Paul Tyson

An obvious and unambiguous harm that arises from the capture of mental health therapeutic norms by gender theory, is the sterilisation, puberty blocker-induced sexual dysfunction, and the genital and mammary mutilation of minors. This harm is promoted by mandating that clinicians deploy “gender-affirming care”,¹ heavily pressuring parents to give their consent to gender-affirming treatments and even proceeding with puberty blockers without parental consent for minors in some cases.² All of these radical harms have been authorised by the American Psychiatric Association’s (APA) fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

In 2013 the DSM-5 dropped the DSM-4’s diagnostic category “gender identity disorder” and replaced it with “gender dysphoria”. This radical diagnostic recalibration was accompanied by gender theory’s deliberate confusing of biological sex with psycho-social gender. The DSM-5 had a significant and immediately realised impact in validating what are now called gender-affirming care treatment models around the world, thus facilitating a pandemic of girls and young women with autism spectrum disorder getting onto the gender-transition medicalised conveyor belt.³

The APA notes that the DSM-5 changes were made “to avoid stigma … for individuals who see and feel themselves to be a different gender to their assigned gender.” The APA goes on to explain:

“[I]t is important to note that gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition …

“Gender dysphoria is manifest in a variety of ways, including strong desires to be treated as the other gender or to be rid of one’s sex characteristics …

“Persons experiencing gender dysphoria need a diagnostic term that protects their access to care and won’t be used against them in social, occupational, or legal areas …

“[T]reatment options for this condition include counselling, cross-sex hormones, gender-reassignment surgery, and social and legal transition to the desired gender. To get insurance coverage for the medical treatments, individuals need a diagnosis … Ultimately, the changes regarding gender dysphoria in the DSM-5 respect the individuals identified by offering a diagnostic name that is more appropriate to the symptoms and behaviours they experience without jeopardising their access to effective treatment options.”⁴

Firstly, there is no clear terminological delineation between objective biological sex and subjective gender. Functionally, the APA seems to have accepted a co-constructed sex-gender irrealism.⁵ So much for psychiatry as an objective and evidence-based science. In the above APA explanation, biological sex is only directly referred to as “sex characteristics” and it is indirectly referred to as “assigned gender”. This is the ideological capture of the APA to non-scientific—indeed anti-science—gender theory.

Secondly, this is an activist justification for a profound diagnostic and treatment regimen change, rather than a clinical justification. Avoiding stigma and making sure that transgender people can get medical insurance for radical sex-presentation-altering treatments are stated reasons for launching the new diagnostic regimen.

A significant key to understanding the therapeutic impact of the shift from the diagnostic categories of the DSM-4 to those of the DSM-5 is the difference between a disorder and a condition within the DSM lexicon. If you have a psychiatric disorder, you have a mental illness. But you can suffer from a psychological condition without being mentally ill.

The DSM-4’s diagnostic category “gender identity disorder” (GID) meant that a physiological male child or youth who believed that he was really female was mentally disturbed. GID is a body morphology disturbance wherein the mentally ill mind rejects, or punishes, or hates, the sufferer’s body. Such a sufferer believes—incorrectly—that their natural body is wrongly formed. Back in the day of DSM-4, a psychotherapist did not “treat” the natural body according to the desire of the body-morphology-disturbed mind.

For GID was then seen as a mental illness, and it is the mind that is ill, not the natural and healthy body. To this day, we do not enable a sufferer from the body-dysmorphic disturbance of anorexia nervosa by helping them starve themselves to death.

Prior to 2013, the treatment for sufferers presenting with GID symptoms typically entailed long and non-judgmental listening and talking psychotherapies where the patient could safely explore their gender-identity’s misalignment with their physical body. In this process the therapist would carefully examine any psychological co-morbidities, life traumas, social pressures, and so forth, that might contribute to or even cause GID, in the hope that the patient will, with time, realign their gender identity with their naturally sexed body. Only if, after long attempts, such psychotherapy does not resolve dysphoric anguish for the patient, will reproductive disabling body-altering accommodations to the mental illness be pursued.

Prior to 2013, the large majority of GID juveniles (most of whom were boys) received such talking therapies and grew up to become comfortable with their naturally sexed bodies, with gender dysphoria simply fading away. The large majority of GID boys matured into gay men without undergoing cross-sex hormones or the amputation of their penises and testicles.⁶

The above mental-disturbance-treating therapeutic regimen was largely thrown away by the DSM-5. In the DSM-5 anyone who presents claiming to believe that they are a person of the opposite sex to their natural reproductive physiology is no longer deemed to have a mental health disorder. People, including children, who believe they are transgender have now been entirely de-pathologised. This, the APA believes, is in aid of de-stigmatising transgender people and respecting the validity of who queer people believe they are.

The APA now firmly asserts that there is no mental illness integral with having a transgender gender identity. But the matter does not rest there, as some transgender people experience their natural and healthy transgender identity (which is, by definition, a non-alignment of their gender identity with their natural sexual physiology) as a cause of severe psychological distress. This is the psychological condition of gender dysphoria. Let us unpack a bit further the difference between a condition and a disorder, and why the DSM-5 decided being transgender is not a “disorder”, but gender dysphoria is a treatable “condition”.

If you de-pathologise being transgender, then it might seem to follow that gender-identities should not even be mentioned by the DSM. But that would be a problem for transgender lobbyists, because they do not just want to be accepted as normal when they have a different gender to their sex, they also want hormonal and medical treatments so that they can overcome the non-alignment of their transgenderism and make their body’s sex-presentation comply with their mental gender identity.

For US health insurance purposes, to fund the treatment of gender dysphoria it must be an officially diagnosable condition (or disorder). Thus, the condition of gender dysphoria can now be diagnosed, and non-mental treatments (for it is no longer a mental health disorder) that socially and cosmetically, but not reproductively, realign one’s wrongly sexed body with one’s truly gendered identity can now be prescribed.

By discarding the DSM-4 diagnosis of GID, the APA is now sure (on what basis?) that wanting to be a person of the opposite sex is not a mental health disorder. What then causes the distress of gender dysphoria? It must be their wrongly sexed bodies. When this outlook is applied to children and youths under the age of majority, puberty can be seen as pathological, and the very possibility of a transgender-identifying child or youth growing to their natural reproductive maturity can be irrevocably removed under the banner of gender-affirming care.

But what if these children are just confused? What if their socially situated and mental gender identity is in flux? On what basis can they reasonably be expected to make irrevocable medical decisions that will radically impact their mature adult lives in ways that they cannot properly appreciate as minors?

In the diagnostic categories of the DSM-5, in practice, it is the body of the gender dysphoric sufferer that needs treatment, not their mind. To put it bluntly, it is the naturally sexed body that is the pathogen causing the psychological distress of gender dysphoria. For a transgender-identifying child, puberty itself must here be thought of as pathogenic. This is clearly implied in the treatment recommendations in the DSM-5. Significantly, no other condition in the DSM-5 is caused by having a healthy natural body or undergoing healthy natural maturation.

Some of the treatment recommendations for gender dysphoria in the DSM-5 are uniquely strange; who would have thought that chemical and actual castration can cure a boy or young man of anything?

Clearly, the APA is seeking to delicately calibrate its terminology so that transgender people can get insured hormonal and medical “care” for gender dysphoria treatments even though being a transgender person is not a psychiatric disorder. This is a serious conceptual incoherence. For if it is natural and healthy to have a gender identity that is not aligned to the biological realities of one’s actual sex, then traumatic psychological distress about the defining feature of that natural and healthy psychological profile is inexplicable in these diagnostic categories.

Further, if sex itself is no longer defined by your biological physiology, but is simply assigned, why not simply assign yourself a sex identity that does align with your gender identity, without any medical procedures at all? This entire diagnostic category is astonishingly incoherent in its own terms. Indeed, it seems that highly educated and evidence-based clinical psychiatrists are perfectly happy to accept the idea that mentally healthy transgender people must really have a fixed magical gender spirit that has been born into the wrongly sexed body. Astonishing! What parent in their right mind would trust the APA to wisely treat their gender-confused child when we know that the normal passage of adolescence, youth, and young adulthood can be very rocky and changeable as regards a developing juvenile’s sexuality and identity?

Clearly the concerted effort of queer advocates to de-pathologise anyone with a visceral loathing of their naturally sexed body has worked in ideologically capturing the therapeutic profession. And yet, the above astonishing attempt to associate clinically significant mental trauma with gender dysphoria, without making gender incongruence itself a mental health disorder is not only glaringly incoherent, it also harmfully obfuscates some very basic facts:

1. Distress about one’s sexed body is a reasonably commonplace adolescent experience, and—until very recently—almost everyone who went through it came out the other side into relatively comfortable sexual maturation without sex-mutilating surgeries.

2. Amputating primary and secondary sex organs, particularly for minors, is a drastic and irreversible “treatment” with permanent life-course consequences that minors cannot be expected to fully appreciate.

3. Until recently, those who eventually had sex-presentation reassignment surgeries and cross-sex hormones only proceeded down that pathway after years of psychological therapies seeking to help the individual come to accept their naturally sexed body.

4. The idea that if your mind rejects your healthy and naturally sexed body, then your mind is fine and it is your body that should be changed has never been considered a reasonable and essentially automatic therapy model, until very recently.

5. De-pathologising transgender ideation and replacing “disorder” with “condition” has produced an avalanche of young people who will be permanently sexually disabled for the rest of their lives, most of whom were far too young to really understand what choice they were making.

6. Natural reproductive integrity is a significant natural good. Whether any given child of normal (that is, potentially fertile) reproductive potential will mature into an adult who successfully mates and pairs with their mate to raise their children is not, of course, known when they are a minor. But to exclude that possibility from them is to rob them of the possibility of one of the most essentially human and satisfying life opportunities people get to have. It is a serious harm to rob children of that possibility when they are in a confused and distraught state about their natural nascent sexuality.

7. The integrity of the natural body is a natural good. Of course, aids for defects (like glasses) are helpful. Of course, cosmetic surgeries that make people feel better about their appearance are often benign, to a point, and satisfying when they work as intended. And technology is increasingly integral with our bodily experiences. But all of this does not discount the intrinsic good of the natural integrity of the human body. We are not post-human yet.

8. Upholding a sacred commitment to the goodness and natural integrity of the human body is integral with the Western medical tradition, as expressed in the Hippocratic Oath. One does no harm to the natural body because the integrity of the natural body is an obvious marker of good health, and good health is a natural good desired by us all.

9. Up until the capture of key therapeutic authorities (like the DSM) by gender theory, anyone who did not want good health for their natural body was considered by therapists to have a mental health problem, even if their patients were convinced that their natural-body-rejecting ideations were perfectly healthy and normal. But now, it seems, the lunatics are running the asylum. Now natural-body integrity for something as integral to human sociality as our natural sex is considered a non-issue, and radically mutilating and dysfunctioning natural human sexual organs is deemed entirely acceptable, and indeed, mandatory for minors claiming to have a transgender identity.

The supposed hormonal and medical treatment of gender dysphoria for minors is the perpetration of harm on vulnerable minors, against their best interests, against therapists who are concerned for their best interests, and against parents who must fight the state, the therapeutic authorities, and the relentless online propaganda targeting their child to essentially join a genitally mutilating and sterilisation ideology that functions like a cult. All this is of serious harm to children. This harm is ideologically perpetrated by gender theory as aided and abetted by large quantities of state and private funding, to facilitate the strategic capture of law and government.

In her forensic exposé of the gender-theory ideological capture of the Gender Identity Development Service (GIDS) for children in the UK, Hannah Barnes’ book Time to Think opens by noting this deeply worried concern by a therapist working at GIDS: “Are we hurting the children?”⁷ Read Barnes’ book, read the Cass Review,⁸ read brave outspoken therapeutic voices advocating for a “wait and see”⁹ psychotherapeutic approach to gender dysphoria instead of rapid and clinically unproven hormonal and surgical “therapies”.

The evidence is in: We are hurting the children because we have been duped by gender theory into making ourselves ideologically blind to obvious harms. But getting uncoupled from deep ideological capture is now no easy task, as too many people of power and prestige are invested in the correctness of the gender-affirming care model to back down just because we really are hurting the children. But gender theory is harming our children. Gender theory is wrong.

This is an extract from Paul Tyson’s new book “Gender Theory Is Wrong: A Genealogy of Sex-Irrealism, Why It Fails, and How We Can Restore a Meaningful Understanding of Natural Facts” (2026, published by Cascade Books of Eugene, Oregon). Dr Tyson is a philosophical theologian and sociologist.

1. See LGB Alliance Australia, “Dr Jillian Spencer.” Dr Spencer, who has been suspended by Queensland Health for refusing to comply with a mandated gender-affirming care policy, notes that the Queensland Children’s Hospital has “a culture in which clinicians are unable to employ medical discretion or a neutral therapeutic stance and are bound by their employment to affirm children’s gender transition”.

A significant factor in this culture is that government policies are heavily formed by transgender activist organisations such as the Australian Professional Association for Trans Health (AusPATH, which is a gender medicine lobby). See Spencer and Clarke, “AusPATH Activism Influenced Health Policy.”

Note the abstract to this journal article: “As a consequence of a membership policy which admits members with lived experience as health experts, AusPATH functions as an activist organisation whilst claiming to be a professional association. There is no accreditation or endorsement underpinning AusPATH’s influence on health policy in Australia. Its role as an activist organisation is demonstrated by a lack of caution in its position statements, which are misleading in circumstances where accurate information has been long available.”

“The considerable influence of AusPATH on health policy in Australia needs to be reconsidered, as well as RANZCP Position Statement 62, which provides insufficient guidance upon balancing research and clinical knowledge, as well as medical ethics, with voices of lived experience.”

2. For example, Tim Nicholls, Minister for Health in the Queensland government, issued a media statement on January 28, 2025 regarding the state-funded Cairns Sexual Health Service (CSHS), noting that the CSHS “delivered an apparently unauthorised paediatric gender service without an agreed model of care. The service was delivered to 42 paediatric [that is, children] gender service clients … A recent internal review undertaken of the CSHS identified deficiencies relating to credentialling and scope of practice and medico-legal concerns relating to patient and parental consent.”

3. See Shrier, Abigail. Irreversible Damage: Teenage Girls and the Transgender Craze.

4. American Psychiatric Association, Gender Dysphoria Fact Sheet 2013.

5. An irrealist thinks the question of whether something is real or not does not apply. Simply put, sex-irrealists think “sex” is a term that is far too complex in its shades of use and meaning to be pinned down to any crude factual definition. In contrast, sex-realists think we can have a true knowledge of what the sex of any given person is, which is not difficult to objectively determine.

6. Dr Az Hakeem ran the Gender Dysphoria Psychotherapy Service at the Portman Clinic in London from 2000 to 2012 and has been working in this field since in a private capacity. He is a clinical specialist in gender-identity conditions as a psychiatrist and medical psychotherapist. He notes that, “Studies have repeatedly shown that gender non-conforming children with gender dysphoria, if left alone, will in most cases grow up to be gay adults without gender dysphoria …” Hakeem, Az. DeTrans: When Transition is not the Solution, 55.

7. Barnes, Hannah. Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children, 1.

8. Cass, Hilary. The Cass Review.

9. Lane, Bernard. New Therapist Group on the Watch.