Reality, adjusted

On the Queer theory underpinnings of gender medicine

Photo by Isi Parente on Unsplash

Sandra Pertot

The thing that has played on my mind ever since I became embroiled in the gender wars is, how did we get here? How is it possible that large sections of Western society—including health professionals who should know better—have come to accept ideas such as sex isn’t binary, a person can change sex, it is right to tell children they might have been born in the wrong body, and it is good medicine to give these children powerful drugs to “pause” puberty.

It is worth starting with the differences between opinions, beliefs, theories, facts and ideology—

Opinion: a view or judgement about something, not necessarily based on fact or knowledge.

Belief: an acceptance that something exists or is true, especially in the absence of proof.

Theory: a supposition or a system of ideas intended to explain something, especially when based on general principles independent of the thing to be explained.

Fact: a thing that is known or proved to be true (to prove: to demonstrate the truth or existence of something by evidence or argument).

Ideology: a set of opinions or beliefs of a group or an individual.

The denial of biological reality rests on a set of beliefs which are disputed by replicable, observable evidence.

Two will do

It is important to distinguish form from function. Humans are merely one species of many on this planet. The biological imperative is to survive, so each species must have a strategy for reproduction. In humans, that involves two partners (hence the term “binary sex”), one to provide sperm and the other to provide an egg to be fertilised and a place for that fertilised egg to grow into a complete little human. The process of two people engaging in the activity associated with fertilisation is called “having sex”. The participant who provides the sperm is called a male, and the participant who provides the egg is called a female.

We could give them any name we want, but the important fact is that it is impossible for a human to move out of one category into the other. Sex is binary because there are two, and only two, participants in this process of reproduction.

Across the human species, there are dysfunctions in every biological system: some people are born blind, or deaf, or with deformed limbs, and none of these variations boots an individual out of the category “human”. In the same way, dysfunction of a person’s reproductive system occurs and that does not remove them from their sex category.

Sex as a biological process is about beginnings, how a new human comes into being, regardless of any disorders or dysfunctions the new person may have. Although the two participants in the act of sex have distinct forms in terms of their reproductive organs, the body which contains the sex-specific reproductive organs has a wide range of individual variations, and there is some overlap in sex-related characteristics such as hormone levels, height, weight, and so on. These individual differences are wrongly used to suggest that sex itself is a spectrum, which is nonsensical because there would need to be a logical progression from XX on one end of the spectrum to XY on the other, and that does not occur.

Gender, aka sex

Until recent times, “gender” was used interchangeably with “sex”, for the simple reason that each society tends to have a set of rules about how a female (girl/woman) and a male (boy/man) should behave. Not behaving according to those rules is described as being “gender non-conforming”, but that does not change the person’s status as a girl/woman or a boy/man.

The belief that a person can change sex—that a male, for example, can literally become a female—has no theory as to how this occurs and no evidence to support it. Despite this, some transgender people insist that they change to the other sex, that a male becomes a female, and this is reinforced by the legal option under self-identification (self-ID) laws to change the sex marker on their birth certificate, medical records, and other documents, from one sex to the other.

This fiction is compounded when medical organisations, such as the Royal Australian College of General Practitioners, state that a person can change sex—

“Sex: A person’s assigned sex at birth, determined by sex characteristics observed at birth or infancy. A person’s sex can change over the course of their lifetime and may differ from their assigned sex at birth.”

Trans activists are emboldened by such statements, which fail to acknowledge that uncertainty about biological sex is limited to some of the very rare medical conditions known as disorders of sexual difference.

More broadly, what does the phrase “transwomen are women” mean? Is it possible for a person of one sex to adopt the gender of the other by living in the current societal expectations of that other sex? The problem of deciphering transgender ideology becomes even more confusing when trans activists claim that merely identifying as the other gender, without any sex-reassignment medication or surgery, automatically changes any physical sex characteristics to their preferred sex—for example, a penis becomes a “ladydick”.

There is significant disagreement within the trans community about these issues. Those who acknowledge that identifying as the other gender, even with sex-reassignment surgery, does not change their biological sex are attacked by trans activists.

My concern is, what are young people being told? What influences them to believe they are transgender? What do they believe can be achieved by social, medical and surgical transition—that they change sex, literally? That transition will solve their mental health problems? How did we get here?

Women and biology

Historically across all cultures, being born male or female determined the individual’s position in society and the roles they could or could not play. In summary, these are based on the widespread cultural belief that males are in charge, and female wants and needs are secondary to those of males.

A key factor in females gaining independence from male control and being accepted as equals was the development of effective birth control: the ability to control when and how often a woman had a child gave her the freedom to take control of her life. No longer bound by the needs of a continually growing family, women were able to pursue their own goals in their personal lives, in education, employment, and so on: biological reality in action.

The cynic in me speculates that as female issues of inequality were addressed and largely resolved, at least in the Western world, the academics who service the departments of Gender studies in tertiary institutions were left with nothing controversial to trade on, so they had to come up with a new area related to gender and/or sexuality to justify their existence.

The malleability of gender roles provided the perfect solution. Transgender people have always existed, although it isn’t always clear why an individual in the past had chosen to live in the role of the other sex. Some accounts are based on opinion and beliefs only, but others take a more rigorous approach.

Careers in queering

The author of Transgender History, Susan Stryker, is a Professor Emerita of Gender and Women’s Studies at the University of Arizona, also founding co-editor of TSQ: Transgender Studies Quarterly, and author of Transgender History: The Roots of Today’s Revolution. Her career demonstrates the shift in academic direction to issues of gender rather than sex discrimination, and gives a clue to how modern gender theory became so influential.

Although the dominance of gender ideology in health and education services took many of us by surprise, the takeover had been a long time in the planning.

Since the 1990s, Queer theory has become increasingly influential in the development of school curricula and the implementation of health policies for young gender-questioning clients. Queer theory evolved out of the works of philosopher Michel Foucault, who argued that gender and sexual identities are not biologically determined but are the result of the social constructs that shape our understanding of society and culture.

Queer theory has been defined as—

“a critical theory that examines and critiques society’s definitions of gender and sexuality, with the goal of revealing the social and power structures at play in our everyday lives. In particular, queer theory can serve as a lens to examine subjects outside the boundaries of traditional gender and sexuality binaries that assume that heterosexuality and cisgender are ‘the norm’.”

Further, David M. Halperin, an American sociologist, has this to say:

“Unlike gay identity, which, though deliberately proclaimed in an act of affirmation, is nonetheless rooted in the positive fact of homosexual object-choice, queer identity need not be grounded in any positive truth or in any stable reality. As the very word implies, “queer” does not name some natural kind or refer to some determinate object; it acquires its meaning from its oppositional relation to the norm. Queer is by definition whatever is at odds with the normal, the legitimate, the dominant. There is nothing in particular to which it necessarily refers. It is an identity without an essence (Emphasis added).”

Video: James Lindsay, who took part in the 2018 grievance studies hoax, discusses the book The Queering of the American child with co-author Logan Lancing

Gender grift

Trans ideology isn’t spread only through books, academic articles and media platforms. Every major university has a Gender studies department that attracts students from various health and education courses, and this is a major source of influence across Western society. It is interesting to map the progression of Queer theory concepts into the management hierarchies of health and education services and thus its introduction into policies affecting the delivery of services.

Existing advocacy groups for gay and lesbian rights had begun uniting in the early 1980s into a global network under the name of InterPride, which included trans rights activists—

“InterPride is the international organization that brings together Pride organizers from across the world to network, share knowledge, and maximize impact. To this end, Pride organizers design InterPride’s structure, programs, and initiatives, to better support them at the local, regional, and global levels.”

From the early 2000s, organisations such Stonewall in the UK, ACON in Australia, Hudson Pride Center in the USA, Pride at Work in Canada, and others, began to offer workshops and lectures to health, education, government agencies and industry.

Take, for example, ACON’s Pride in Health + Wellbeing (PIHW) program—

“The program provides 1:1 mentorship, training and advice on embedding LGBTQ inclusion throughout all aspects of your organisation; from direct care provision, policy and processes design, workforce and recruitment inclusion, quality improvement planning, advocacy, as well as personalised staff development and training.

“The program is suitable for all organisations in the health, welfare or human services sector, from government, peak bodies, NGOs and direct care providers. PIHW will assist you in ensuring your organisation is inclusive of LGBTQ people, embedding it in all your public-facing work and making LGBTQ health and wellbeing a priority (Emphasis added).”

Gender grift

Some Pride groups have incentive programs to encourage the member organisation to maintain a commitment to remaining “inclusive”. For example, employer members of ACON’s Australian Workplace Equity Index program are required to conduct an annual assessment using the index, which is described as the “definitive benchmarking tool for employers to measure their progress on lesbian, gay, bi and trans inclusion in the workplace.” Introduced in 2010, this Australian index was based on Stonewall’s UK model commenced in 2005.

It would be difficult to find any government department or large private organisation across the Western world that hasn’t had some training by a Pride organisation. The Dentons report of 2019 gives a detailed account of a very organised approach to advancing the aims and goals of trans ideology.

Here are some document titles illustrating various strategies to spread this ideology—

“Drag pedagogy: The playful practice of queer imagination in early childhood”

“Interrupting Hetero- and Cisnormativity in Social Work Programs: LGBTQ+ Student Strategies for Increasing Inclusion”

“Challenging cisnormativity, gender binarism and sex binarism in management research: foregrounding the workplace experiences of trans* and intersex people” 

“Supporting trans people: 3 simple things teachers and researchers can do”

“Disrupting Cisnormativity: Decentering Gender in Families”

This last title frames the family as reinforcing unacceptable social norms, which helps explain why parents are targeted as being abusive if they don’t go along with their child’s sudden trans declaration.

Some strategies are designed to appeal directly to children—

“Queer theory is distilled down for easy, colorful, and fun consumption, taking shape through cute-looking cartoons in the ‘genderbread person’ and the ‘gender unicorn.’ Through children’s books, posters, Comprehensive Sexuality Education (CSE—a project formulated at and promoted by UNESCO, the United Nations Educational, Scientific, and Cultural Organization, to all its member states), and Social and Emotional Learning exercises, kids learn that their ‘gender identity’ is ‘how you think about yourself.’ They also learn that their ‘gender expression’ is ‘how you demonstrate your gender through the ways you act, dress, behave, and interact’.”

People who have any concerns about trans ideology are told to “get educated’:

If you want to delve further into who benefits from advocating for gender-affirming care, this bibliography explores the influence of billionaires.

Diagnosis depathologised

Queer theory’s wider aim is to normalise challenges to society’s gender norms. One obstacle was the presence of “gender identity disorder” in the Diagnostic and Statistical Manual IV (DSM-4) of psychiatry. In 2013, the word “disorder” was banished from the new DSM-5, and the condition was renamed as “gender dysphoria”.

In a pre-publication report to the American Psychiatric Association (APA), members of the DSM-5 workgroup for sexuality and gender issues indicated their concern to destigmatise trans people while preserving a diagnosis that medical insurance companies would accept when claims were made for medical transition. This inspired the practice of describing hormonal and surgical interventions as “medically necessary” and “lifesaving.” These terms appear multiple times in the current standards of care from the World Professional Association for Transgender Health (WPATH). As slogans, they have been weaponised by trans activists.

In a commentary on the diagnostic history, the APA said—

“With the publication of DSM–5 in 2013, ‘gender identity disorder’ was eliminated and replaced with ‘gender dysphoria.’ This change further focused the diagnosis on the gender identity-related distress that some transgender people experience (and for which they may seek psychiatric, medical, and surgical treatments) rather than on transgender individuals or identities themselves. The DSM–5 articulates explicitly that ‘gender non-conformity is not in itself a mental disorder’.”

Mission accomplished?

By any objective standard, the trans campaign has been an outstanding success. Health and education services are captured by trans ideology to the extent that any dissenters—health professionals, bureaucrats, teachers, other students, parents—are punished, sometimes by being required to “get educated”, or losing their employment, or in the case of families, having the child removed.

But the grip of gender ideology is starting to loosen as the time of “no debate” has passed, and more people who have been harmed by transgender policies—young people, parents, women affected by the loss of sex-based rights—are speaking out. An increasing number of health professionals who had been silenced by the threat of sanctions are now joining forces and revealing the serious flaws in the gender-affirming model of health care, culminating in the recent Cass report.

The basic ideas proposed by Queer theory are not new: society does influence our understanding and beliefs about sexualities (straight, gay or bi) and gender roles. The feminist movement of the 1970s-80s was all about challenging the restrictions imposed on females simply because of their biology. Also in that period, gay rights groups peacefully sought to have their sexuality acknowledged and recognised as a normal variation in human sexuality.

But Queer theory takes this to a new level which becomes nonsensical when the aim is to challenge norms just because they are norms. Paradoxically, queering the definitions of sex and gender creates new norms which then, according to trans activists, aren’t allowed to be challenged. For example, lesbians must accept “transbians”, who typically retain male genitals, in their groups. And rules such as using preferred pronouns must be obeyed. Queer theory in practice is the ultimate hypocrisy.

In line with this approach of adjusting reality to suit the purposes of applied Queer theory, gender-affirming care since the publication of DSM-5 in 2013 has morphed from a process with strict criteria before any medical and surgical treatment could be accessed to the current situation where a person’s stated claim they are trans should be enough to gain the treatment they want without any “gatekeeping” by health professionals.

This model of gender-affirming care is built on shaky grounds, as found by the Cass review. Despite growing disquiet, Queer theorists keep pushing the boundaries to further embed their beliefs into the broader society. For example, WPATH’s current standards of care advocate for the gender of “eunuch” to be recognised and eligible for the “medically necessary” surgical reassignment to remove the genitals.

A recent development that reflects the ongoing march of Queer theory is the successful campaign to have “self-ID” legalised in many jurisdictions around the world, so that anyone can change their sex markers on legal documents with no medical or surgical treatment and minimal requirements for social transition. More worrying still is the move to recast paedophiles as “minor-attracted persons”.

In the wake of the Cass report, it is time for gender-affirming health professionals to consider the real possibility that they have been conned by a sophisticated, well-organised network of trans activists who want to reshape society into their version of normal. It is time for health professionals to reflect on how they came to put their faith in the gender-affirming model as the best form of care for gender-questioning clients.

They could ask themselves, what training influenced my ideas? Was I exposed to alternative opinions? How do I reconcile gender-affirming care with the more robust process of a differential diagnosis to determine the safest treatment for an individual? What independent investigation have I done to be aware of the full range of issues in the assessment and management of gender-questioning clients?

Dr Sandra Pertot retired not long ago after 50 years of practice as a clinical psychologist specialising in human sexuality, including sexual dysfunction, sexual orientation and gender diversity